Obstetric and Gynaecologic Considerations in Inherited Bleeding Disorders

Area of Science:

• Reproductive Medicine
• Hematology
• Genetics

Background:

• Women and girls with inherited bleeding disorders (IBD) experience significant gynecologic and obstetric complications due to heightened bleeding risks.
• Heavy menstrual bleeding (HMB) is prevalent, requiring combined hormonal and antifibrinolytic treatments.
• Reproductive milestones like pregnancy, labor, delivery, and postpartum are particularly high-risk periods.

Purpose of the Study:

• To outline the distinct gynecologic and obstetric challenges faced by women and girls with IBD.
• To emphasize the importance of multidisciplinary management and advanced diagnostic tools.
• To advocate for improved recognition and care for symptomatic female carriers.

Main Methods:

• Review of current literature on IBD in women.
• Discussion of management strategies for HMB, pregnancy, and postpartum complications.
• Highlighting the role of genetic counseling, prenatal diagnosis, and coagulation assessment.

Main Results:

• IBDs increase risks for HMB, miscarriage, antenatal hemorrhage, and postpartum hemorrhage (PPH).
• Severe factor deficiencies are linked to higher miscarriage and bleeding rates.
• Advances in genetic testing (NIPT, PGD) aid reproductive decision-making and delivery planning.
• Neuraxial anesthesia and delivery mode require careful coagulation assessment and shared decision-making.
• Multidisciplinary teams and individualized support are essential for managing PPH.

Conclusions:

• Optimal management of IBD in women requires a proactive, multidisciplinary approach.
• Systematic screening and education are crucial to address under-recognition of symptomatic female carriers.
• Improved care pathways can reduce maternal morbidity and mortality associated with IBD.