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Enhanced peripartum hemostatic management does not decrease postpartum hemorrhage incidence in hemophilia carriers:

A de Vaan1, Mjha Kruip2, J Eikenboom3

  • 1Division of Internal Medicine and Dermatology, Center for Benign Haematology, Thrombosis and Haemostasis, van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.

Journal of Thrombosis and Haemostasis : JTH
|March 9, 2026
PubMed
Summary
This summary is machine-generated.

Revised Dutch guidelines for pregnant hemophilia carriers did not reduce severe postpartum hemorrhage (PPH) rates. Increasing factor thresholds to <80 IU/dL and ≥150 IU/dL did not prevent PPH, indicating a need for further research.

Keywords:
blood coagulation disordershemophilia Ahemophilia Binheritedpostpartum hemorrhage

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Area of Science:

  • Obstetrics and Gynecology
  • Hematology
  • Reproductive Medicine

Background:

  • Pregnant hemophilia carriers at risk for severe postpartum hemorrhage (PPH) receive prophylactic factor concentrates.
  • Dutch guidelines were revised in 2018 to increase third-trimester factor thresholds and target peak levels during childbirth due to high PPH rates.

Purpose of the Study:

  • To assess the incidence of severe PPH in pregnant hemophilia carriers following the implementation of revised Dutch guidelines in 2018.
  • To compare severe PPH rates with historical data from before the guideline revision.

Main Methods:

  • Prospective enrollment of pregnant hemophilia carriers (2018-2024) in Dutch hemophilia treatment centers.
  • Recording of factor activity, hematologic, and obstetric outcomes.
  • Comparison with a historical cohort (2012-2017) using logistic regression for confounder correction.

Main Results:

  • Severe PPH occurred in 12.4% of 170 deliveries; no thrombosis was observed.
  • Prophylaxis in carriers with third-trimester levels <80 IU/dL showed similar PPH rates to those with spontaneous rises >80 IU/dL.
  • The severe PPH incidence did not decrease compared to the historical cohort (third-trimester cut-off <50 IU/dL).

Conclusions:

  • Increasing the third-trimester factor threshold to <80 IU/dL and aiming for ≥150 IU/dL at delivery did not reduce severe PPH risk in hemophilia carriers.
  • Further research is necessary to determine optimal clotting factor levels for preventing severe PPH during delivery.