Recent study results suggest that for some women, the experience of severe postpartum hemorrhage (PPH) may be a sign of an inherited bleeding disorder. The results were presented in Haemophilia.
In this retrospective study, 85 women who demonstrated severe PPH received referrals for hemostatic examination at a hematology clinic. Severe PPH was considered a loss of blood of 2000 mL or more in the first 24 hours following delivery. Only women without a previously diagnosed bleeding disorder were included in this analysis.
Median level of blood loss with PPH was 3000 mL among women in this study.
Of the women who were referred for hematologic examination, 69 were evaluable for diagnosis. A mild bleeding disorder was diagnosed in 16 (23%) women and half of those cases (8 patients) included a diagnosis of low von Willebrand factor. Other diagnoses included platelet function disorders in 5 patients, bleeding of unknown cause in 2 patients, and type 1 von Willebrand disease in 1 patient.
Obstetric risk factors for PPH were reportedly not associated with the existence of a bleeding disorder among patients in this study, as determined through logistic regression analysis. The study investigators also noted that a patient’s PPH may have multifactorial origins.
According to the investigators, the high rate of diagnosis of bleeding disorders among women evaluated for severe PPH suggests that severe PPH itself may be an initial sign of an inherited bleeding disorder. “This finding is important for optimizing clinical management, in order to prevent bleeding complications during subsequent deliveries and interventions later in life,” wrote the researchers.
The investigators recommended hemostatic evaluation following events of severe PPH. They also suggested further research should be undertaken to validate the study’s results and to improve management of PPH.
- Veen CSB, van der Reijken IS, Jansen AJG, et al. Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder [published online October 3, 2019]. Haemophilia. doi:10.1111/hae.13846