29 April 2019

Haemophilia in pregnancy – what to expect

Haematology O&G

Women with inherited bleeding disorders are sometimes not aware of how their disorder might affect their pregnancy, says Dr Scott Dunkley, a haematologist at Royal Prince Alfred Hospital.

Bleeding disorders that are severe in men, such as haemophilia A and haemophilia B, can be fairly mild in female carriers, so women are “usually less educated about how that might impact on them and are also perhaps less aware of the genetics and the transmission to their children”, Dr Dunkley said.

GPs can help by giving patients with a family or personal history of bleeding disorders the option of involving a genetic counsellor or an IVF doctor before conception, he said.

Dr Dunkley is the lead author of a new consensus statement on pregnancy and bleeding disorders, released by the Australian Haemophilia Centre Directors’ Organisation.

The consensus statement, published in the MJA, is an update on the 2009 version. It contains comprehensive, easy-to-read tables on the different types of bleeding disorders and how they affect women during pregnancy.

“Despite inclusion of pregnancy and delivery management in a number of published evidence-based guidelines on the management of inherited bleeding disorders, many guidelines are lengthy and not user-friendly,” the consensus statement said.

While severe or rare bleeding disorders can complicate a pregnancy, many women with common bleeding disorders (such as haemophilia A and B, von Willebrand disease, and factor VII and factor XI deficiency) won’t need any additional therapy during pregnancy or antenatally, Dr Dunkley.

Many women with bleeding disorders will be suitable for spontaneous vaginal delivery, he said.

Levels of clotting factors tend to rise during pregnancy in women with inherited bleeding disorders, which is good for the mum-to-be. Even in women with severe bleeding disorders, clotting factors don’t tend to drop in pregnancy.

“It’s unusual for the mum to have a problem,” Dr Dunkley said. But the baby – if it’s a boy – obviously has a chance of being affected and therefore particular care needs to be taken for delivery of the baby.

“It’s a team approach, involving the obstetrician who will then talk to the anaesthetist or haematologist according to the bleeding disorder and the risk.”