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

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.