Management and Outcomes of Pregnancies Complicated by Inherited Bleeding Disorders

Aim of the work was to study the obstetrical outcome and management of pregnant women with hereditary coagulation factor deficiencies. A retrospective study was carried out on 13118 pregnant women between July 2003- June 2011 at SJMCH. Women with coagulation disorders in pregnancy were identified and those with inherited coagulation factor deficiencies were selected. Their antenatal, intra and postpartum management and neonatal outcomes were analyzed. The incidence of coagulation factor deficiency in pregnant women is 0.068%. Of the 9 pregnant women with coagulation factor deficiencies, 4 had vWD, 3 had factor XIII deficiency, 1 had factor XII deficiency and 1 had factor VII deficiency. Only 1 woman was detected to have a factor deficiency at birth; 5 were detected during pregnancy; 2 at puberty and 1 in childhood. Women with factor XII and factor XIII deficiency were transfused cryoprecipitates antenatally and one prenatally. Caesarean section was performed in only 2 women. All were transfused cryoprecipitates in active phase of labor prophylactically. 2 women with vWD had primary PPH; 2 had secondary PPH, which was controlled with cryoprecipitate transfusion; one received DDAVP, progesterone and danazol. Prophylactic transfusion of factor concentrates, cryoprecipitates and adjunctive treatment can prevent pregnancy loss and PPH.