Skip to main content

Inherited Bleeding Disorders in Pregnancy: von Willebrand Disease, Factor XI Deficiency, and Hemophilia A and B Carriers

  • Chapter
Disorders of Thrombosis and Hemostasis in Pregnancy

Abstract

Obstetric management of women with von Willebrand Disease (VWD) and FXI deficiency, and carriers of hemophilia A and B, requires a multi-disciplinary team approach with obstetricians, midwives, hematologists, anesthetists, and neonatologists. This chapter discusses these disorders with particular emphasis on their management during pregnancy, delivery and postpartum. Diagnostic (carrier) testing before becoming pregnant in order to allow appropriate preconception counselling and timely provision of prenatal diagnosis, especially in those who could potentially carry a severely affected baby, are also addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. von Willebrand EA. Hereditar pseudohenofili. Finska Lakarsallskapets Handl. 1926;67:87–112.

    Google Scholar 

  2. Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood. 1987;69:454–9.

    CAS  PubMed  Google Scholar 

  3. James AH, Jamison MG. Bleeding events and other complications during pregnancy and childbirth in women with von Willebrand disease. J Thromb Haemost. 2007;5:1165–9.

    Article  CAS  PubMed  Google Scholar 

  4. Sadler JE, Mannucci PM, Berntorp E, Bochkov N, Meyer D, Peake I, Rodeghiero F, Srivastava A. Impact, diagnosis and treatment of von Willebrand disease. Thromb Haemost. 2000;84(2):160–74.

    CAS  PubMed  Google Scholar 

  5. Kadir RA, Economides DL, Sabin CA, Pollard D, Lee CA. Variations in coagulation factors in women: effects of age, ethnicity, menstrual cycle and combined oral contraceptive. Thromb Haemost. 1999;82:1456–61.

    CAS  PubMed  Google Scholar 

  6. Rodgiero F, Castaman G. von Willebrand Disease: epidemiology. In: Lee CA, Berntorp EE, Hoots WK, editors. Textbook of hemophilia. 2nd ed. London: Wiley-Blackwell; 2010. p. 286–93.

    Google Scholar 

  7. Sadler JE, Budde U, Eikenboom JC, Favaloro EJ, Hill FG, Holmberg L, Ingerslev J, Lee CA, Lillicrap D, Mannucci PM, Mazurier C, Meyer D, Nichols WL, Nishino M, Peake IR, Rodeghiero F, Schneppenheim R, Ruggeri ZM, Srivastava A, Montgomery RR, Federici AB, Working Party on von Willebrand Disease Classification. Update on the pathophysiology and classification of von Willebrand disease: a report of the Subcommittee on von Willebrand Factor. J Thromb Haemost. 2006;4(10):2103–14.

    Article  CAS  PubMed  Google Scholar 

  8. Lak M, Peyvandi F, Mannucci PM. Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease. Br J Haematol. 2000;4:1236–9.

    Article  Google Scholar 

  9. Lee CA, Chi C, Pavord SR, Bolton-Maggs PHB, Pollard D, Hinchcliffe-Wood A, Kadir RA. The obstetric and gynaecological management of women with inherited bleeding disorders – review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors’ Organisation. Haemophilia. 2006;12:301–36.

    Article  CAS  PubMed  Google Scholar 

  10. Kadir RA, Lee CA, Sabin CA, Pollard D, Economides DL. Pregnancy in women with von Willebrand’s disease or factor XI deficiency. Br J Obstet Gynaecol. 1998;105:314–21.

    Article  CAS  PubMed  Google Scholar 

  11. Stirling Y, Woolf L, North WR, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy. Thromb Haemost. 1984;52:176–82.

    CAS  PubMed  Google Scholar 

  12. Ramsahoye BH, Davies SV, Dasani H, Pearson JF. Obstetric management in von Willebrand’s disease: a report of 24 pregnancies and a review of the literature. Haemophilia. 1995;1:140–4.

    Article  Google Scholar 

  13. Rick ME, Williams SB, Sacher RA, McKeown LP. Thrombocytopenia associated with pregnancy in a patient with type IIB von Willebrand disease. Blood. 1987;69:786–9.

    CAS  PubMed  Google Scholar 

  14. Caliezi C, Tsakiris DA, Behringer H, Kuhne T, Marbet GA. Two consecutive pregnancies and deliveries in a patient with von Willebrand’s disease type 3. Haemophilia. 1998;4:845–9.

    Article  CAS  PubMed  Google Scholar 

  15. James AH, Kouides PA, Kadir RA, et al. von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international panel. Am J Obstet Gynecol. 2009;201:12e.1–8.

    Article  Google Scholar 

  16. National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage, clinical guideline CG154, London NICE. 2012. Available at: http://guidance.nice.org.uk/CG154.

  17. Foster PA. The reproductive health of women with von Willebrand disease unresponsive to DDAVP: the results of an international survey. On behalf of the subcommittee on VWF of the SSC of the ISTH. Thromb Haemost. 1995;74:784–90.

    CAS  PubMed  Google Scholar 

  18. Cohen AJ, Kessler CM, Ewenstein BM. Management of von Willebrand disease: a survey on the current clinical practice from the haemophilia centres of North America. Haemophilia. 2001;7:235–41.

    Article  CAS  PubMed  Google Scholar 

  19. Mannucci PM. How I, treat patients with von Willebrand disease. Blood. 2001;97:1915–9.

    Article  CAS  PubMed  Google Scholar 

  20. Sanchez-Luceros A, Meschengieser SS, Turdo K, et al. Evaluation of desmopressin during pregnancy in women with low plasmatic von Willebrand factor level and bleeding history. Thromb Res. 2007;120:387–90.

    Article  CAS  PubMed  Google Scholar 

  21. Castaman G, Tosetto A, Rodeghiero F. Pregnancy and delivery in women with von Willebrand disease and different von Willebrand factor mutations. Abstract As-Mo-029 XXII congress ISTH, Boston. 2009.

    Google Scholar 

  22. Trigg DE, Stergiotou I, Peitsidis P, Kadir RA. A systematic review: the use of desmopressin for treatment and prophylaxis of bleeding disorders in pregnancy. Haemophilia. 2012;18(1):25–33.

    Article  CAS  PubMed  Google Scholar 

  23. Dennis MW, Clough V, Toh CH. Unexpected presentation of type 2N von Willebrand disease in pregnancy. Haemophilia. 2000;6(6):696–7.

    Article  CAS  PubMed  Google Scholar 

  24. Caliezi C, Tsakiris DA, Behringer H, Kuhne T, Marbet GA, Jones BP, Bell EA, Maroof M. Epidural labor analgesia in a parturient with von Willebrand’s disease type IIA and severe preeclampsia. Anesthesiology. 1999;90:1219–20.

    Article  Google Scholar 

  25. Milaskiewicz RM, Holdcroft A, Letsky E. Epidural anaesthesia and von Willebrand’s disease. Anaesthesia. 1990;45:462–4.

    Article  CAS  PubMed  Google Scholar 

  26. Cohen S, Daitch JS, Amar D, Goldiner PL. Epidural analgesia for labor and delivery in a patient with von Willebrand’s disease. Reg Anesth. 1989;14:95–7.

    CAS  PubMed  Google Scholar 

  27. Kadir RA, Lee CA, Sabin CA, Pollard D, Economides DL. Pregnancy in women with von Willebrand’s disease or factor XI deficiency. Br J Obstet Gynaecol. 1998;105:314–32.

    Article  CAS  PubMed  Google Scholar 

  28. Pasi KJ, Collins PW, Keeling DM, et al. Management of von Willebrand disease: a guideline from the UK Haemophilia Centre Doctors’ Organization. Haemophilia. 2004;10:218–31.

    Article  CAS  PubMed  Google Scholar 

  29. Greer IA, Lowe GD, Walker JJ, Forbes CC. Haemorrhagic problems in obstetrics and gynaecology in patients with congenital coagulopathies. BJOG. 1991;98:909–18.

    Article  CAS  Google Scholar 

  30. Hanna W, McCarroll D, McDonald T, et al. Variant von Willebrand disease and pregnancy. Blood. 1981;58:873–9.

    CAS  PubMed  Google Scholar 

  31. Roque H, Funai E, Lockwood CJ. von Willebrand disease and pregnancy. J Matern Fetal Med. 2000;9:257–66.

    Article  CAS  PubMed  Google Scholar 

  32. Chi C, Bapir M, Lee CA, Kadir RA. Puerperal loss (lochia) in women with or without inherited bleeding disorders. Am J Obstet Gynecol. 2010;203(1):56.e1–5.

    Article  Google Scholar 

  33. Rosenthal RL, Dreskin OH, Rosenthal N. New hemophilia-like disease caused by deficiency of a third plasma thromboplastin factor. Proc Soc Exp Biol Med. 1953;82:171–4.

    Article  CAS  PubMed  Google Scholar 

  34. Seligsohn U, Bolton-Maggs PH. Factor XI deficiency. In: Lee CA, Berntorp EE, Hoots WK, editors. Textbook of hemophilia. 2nd ed. London: Wiley-Blackwell; 2010. p. 355–61.

    Chapter  Google Scholar 

  35. Rapaport SI, Proctor RR, Patch NJ, Yettra M. The role of inheritance of PTA deficiency: evidence for the existence of major PTA deficiency and minor PTA deficiency. Blood. 1961;18:149–65.

    CAS  PubMed  Google Scholar 

  36. Seligsohn U. Factor XI, deficiency. Thromb Haemost. 1993;70:68–71.

    CAS  PubMed  Google Scholar 

  37. Bolton-Maggs PHB. Factor XI, deficiency. In: Lee CA, editor. Bailliere’s clinical haematology: haemophilia. London: Bailliere Tindall; 1996. p. 356–67.

    Google Scholar 

  38. Bolton-Maggs PH, Young Wan-Yin B, McCraw AH, Slack J, Kernoff PB. Inheritance and bleeding in fac-tor XI deficiency. Br J Haematol. 1988;69:521–8.

    Article  CAS  PubMed  Google Scholar 

  39. Bolton-Maggs PH, Patterson DA, Wensley RT, Tuddenham EG. Definition of bleeding tendency in factor-XI deficient kindred’s – a clinical and laboratory study. Thromb Haemost. 1995;73:194–202.

    CAS  PubMed  Google Scholar 

  40. Bolton-Maggs PHB. The management of factor XI deficiency. Haemophilia. 1998;4:683–8.

    Article  CAS  PubMed  Google Scholar 

  41. Bolton-Maggs PH, Perry DJ, Chalmers EA, Parapia LA, Wilde JT, Williams MD. The rare coagulation disorders – review with guidelines for management from the UK Doctors’ Organisation. Haemophilia. 2004;10:593–628.

    Article  CAS  PubMed  Google Scholar 

  42. Keeling D, Tait C, Makris M. Guideline on the selection and use of therapeutic products to treat haemophilia and other hereditary bleeding disorders. Haemophilia. 2008;14:671–84.

    Article  CAS  PubMed  Google Scholar 

  43. Peden A, Fairfoul G, Lowrie S, McCardle L, Head MW, Love S, Ward HJT, Cousens SN, Keeling D, Millar CM, Hill FGH, Ironside JW. Variant CJD infection in the spleen of an asymptomatic adult patient with haemophilia. Haemophilia. 2010;16:296–304.

    Article  CAS  PubMed  Google Scholar 

  44. Bolton-Maggs PH, Colvin BT, Satchi BT, Lee CA, Lucas GS. Thrombogenic potential of factor XI concentrate. Lancet. 1994;344(8924):748–9.

    Article  CAS  PubMed  Google Scholar 

  45. Berliner S, Horowitz I, Martinowitz U, Brenner B, Seligsohn U. Dental surgery in patients with severe factor XI deficiency without plasma replacement. Blood Coagul Fibrinolysis. 1992;3:465–74.

    Article  CAS  PubMed  Google Scholar 

  46. O’Connell NM, Riddell AF, Pascoe G, Perry DJ, Lee CA. Recombinant factor VIIa to prevent surgical bleeding in factor XI deficiency. Haemophilia. 2008;14:775–81.

    Article  PubMed  Google Scholar 

  47. Kenet G, Lubetsky A, Luboshitz J, Ravid B, Tamarin I, Varon D, Martinowitz U. Lower doses of rFVIIa therapy are safe and effective for surgical interventions in patients with severe FXI deficiency and inhibitors. Haemophilia. 2009;15(5):1065–73. Epub 2009 May 26.

    Article  CAS  PubMed  Google Scholar 

  48. Seligsohn U. Factor XI, deficiency in humans. J Thromb Haemost. 2009;7 Suppl 1:84–7.

    Article  CAS  PubMed  Google Scholar 

  49. O’Connell NM. Factor XI, deficiency. Semin Hematol. 2004;41:76–81.

    Article  PubMed  Google Scholar 

  50. Chi C, Kulkarni A, Lee CA, Kadir RA. The obstetric experience of women with factor XI deficiency. Acta Obstet Gynecol Scand. 2009;88(10):1095–100.

    Article  CAS  PubMed  Google Scholar 

  51. Myers B, Pavord S, Kean L, Hill M, Dolan G. Pregnancy outcome in factor XI deficiency: incidence of miscarriage, antenatal and postnatal haemorrhage in 33 women with FXI deficiency. BJOG. 2007;114:643–6.

    Article  CAS  PubMed  Google Scholar 

  52. Collins P, Goldman E, Lilley P, Pasi KJ, Lee CA, et al. Clinical experience of factor XI deficiency: the role of fresh frozen plasma and factor XI concentrate. Haemophilia. 1995;1:227–31.

    Article  Google Scholar 

  53. David AL, Paterson-Brown S, Letsky EA. Factor XI deficiency presenting in pregnancy: diagnosis and management. BJOG. 2002;109:840–3.

    Article  PubMed  Google Scholar 

  54. Mavromatidis G, Dinas K, Delkos D, Goutzioulis F, Vosnakis C, Hatzipantelis E. Uneventful caesarean delivery with administration of factor XI concentrate in a patient with severe factor XI deficiency. Int J Hematol. 2007;86:222–4.

    Article  CAS  PubMed  Google Scholar 

  55. Chi C, Lee CA, England A, Hingorani J, Paintsil J, Kadir RA. Obstetric analgesia and anaesthesia in women with inherited bleeding disorders. Thromb Haemost. 2009;101:1104–11.

    CAS  PubMed  Google Scholar 

  56. Bolton-Maggs PH, Wensley RT, Kernoff PB, et al. Production and therapeutic use of a factor XI concentrate from plasma. Thromb Haemost. 1992;67:314–9.

    CAS  PubMed  Google Scholar 

  57. Rizza CR, Rhymes IL, Austen DE, Kernoff PB, Aroni SA. Detection of carriers of haemophilia: a ‘blind’ study. Br J Haematol. 1975;30:447–56.

    Article  CAS  PubMed  Google Scholar 

  58. Lyon MF. Chromatin and gene action in the mammalian X-chromosome. Am J Hum Genet. 1962;14:135–48.

    CAS  PubMed Central  PubMed  Google Scholar 

  59. Plug I, Mauser-Bunschoten EP, Brocker-Vriends AH, van Amstel HK, van der Bom JG, van Diemen-Homan JE, Willemse J, Rosendaal FR. Bleeding in carriers of haemophilia. Blood. 2008;111:1811–5.

    Article  CAS  PubMed  Google Scholar 

  60. Lee CA, Chi C, Shiltagh N, Pollard D, Griffioen A, Dunn N, Kadir RA. Review of a multidisciplinary clinic for women with inherited bleeding disorders. Haemophilia. 2009;15:359–60.

    Article  CAS  PubMed  Google Scholar 

  61. Miller R. Genetic counselling for haemophilia. WFH treatment monograph: No 25 World Federation of Haemophilia. 2002. www.wfh.org.

  62. Ludlam CA, Pasi KJ, Bolton-Maggs P, Collins P, Cumming AM, Dolan G. A framework for genetic service provision for haemophilia and other inherited bleeding disorders. Haemophilia. 2005;11:145–63.

    Article  CAS  PubMed  Google Scholar 

  63. Ljund R, Petrini P, Nilsson IM. Diagnostic symptoms of severe and moderate haemophilia A and B – a survey of 140 cases. Acta Paediatr Scand. 1990;79:196–200.

    Google Scholar 

  64. Dunn NF, Miller R, Griffioen A, Lee CA. Carrier testing in haemophilia A and B: adult carriers and their partners experiences and their views on the testing of young females. Haemophilia. 2008;14:584–92.

    Article  CAS  PubMed  Google Scholar 

  65. United Nations Convention on the Rights of the Child 20. Xi. 1989: TS 44: Cm. 1976. http://www.un.org/Docs/journal/asp/ws.asp?m=A/RES/44/25.

  66. World Health Organization. Proposed international guidelines on ethical issues in medical genetics and genetic services. Geneva: World Health Organization; 1998. p. 1998.

    Google Scholar 

  67. BMA. Consent, rights and choices in health care for children and young people. London: BMJ Books; 2001.

    Google Scholar 

  68. Antonarakis S, Rossiter JP, Young M, Horst J, de Moerloose P, Sommer SS, Ketterling RP, et al. Factor VIII gene inversions in severe hemophilia A: results of an international consortium study. Blood. 1995;86:2206–12.

    CAS  PubMed  Google Scholar 

  69. Giannelli F, Green PM, Somner S. Haemophilia B (sixth edition); a database of point mutations and short editions and deletions. Nucleic Acids Res. 1996;24:103–18.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Kadir RA, Sabin C, Gouldman E, Pollard D, Lee C, Economides DL. Reproductive experience and attitude of carriers of haemophilia. Haemophilia. 2000;6:33–40.

    Article  CAS  PubMed  Google Scholar 

  71. Chi C, Hyett JA, Finning KM, Lee CA, Kadir RA. Non-invasive first trimester determination of fetal gender: a new approach for prenatal diagnosis of haemophilia. BJOG. 2006;113:239–42.

    Article  CAS  PubMed  Google Scholar 

  72. Mujezinovic F, Alfirevic Z. Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review. Obstet Gynecol. 2007;110:687–94.

    Article  PubMed  Google Scholar 

  73. Firth HV, Boyd PA, Chamberlain PF, et al. Analysis of limb reduction defects in babies exposed to chorionic villus sampling. Lancet. 1994;343:1069–71.

    Article  CAS  PubMed  Google Scholar 

  74. RCOG. Amniocentesis and chorionic villus sampling. Green-top guideline no. 8. London: RCOG; 2005. https://www.rcog.org.uk/guidelines.

  75. Kadir RA, Lee CA. Obstetrics and gynaecology: haemophilia. In: Lee CA, Berntorp EE, Hoots WK, editors. Textbook of hemophilia. 2nd ed. London: Wiley-Blackwell; 2010. p. 355–61.

    Google Scholar 

  76. Buscaglia M, Ghisoni L, Bellotti M, et al. Percutaneous umbilical blood sampling: indication changes and procedure loss rate in a nine years’ experience. Fetal Diagn Ther. 1996;11:106–13.

    Article  CAS  PubMed  Google Scholar 

  77. Michaelides K, Tuddenham EG, Turner C, Lavender B, Lavery SA. Live birth following the first mutation specific pre-implantation genetic diagnosis. Thromb Haemost. 2006;95:373–9.

    CAS  PubMed  Google Scholar 

  78. Human Fertilization and Embryology Authority. HFEA guide to infertility and directory of clinics 2005/6. London: Human Fertilisation and Embryology Authority; 2006.

    Google Scholar 

  79. Chi C, Lee CA, Shiltagh N, Khan A, Pollard D, Kadir RA. Pregnancy in carriers of haemophilia. Haemophilia. 2008;14:56–64.

    CAS  PubMed  Google Scholar 

  80. James AH, Hoots K. The optimal mode of delivery for the haemophilia carrier expecting an affected infant is Caesarean delivery. Haemophilia. 2010;16:420–4.

    CAS  PubMed  Google Scholar 

  81. Huq FY, Kadir RA. Management of pregnancy, labour and delivery in women with inherited bleeding disorders. Haemophilia. 2011;17 Suppl 1:20–30.

    Article  PubMed  Google Scholar 

  82. Kadir RA, Economides DL, Braithwaite J, Goldman E, Lee CA. The obstetric experience of carriers of haemophilia. BJOG. 1997;104:803–10.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rezan A. Kadir MB ChB, MRCOG FRCS(Ed), MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Lee, C.A., Kadir, R.A. (2015). Inherited Bleeding Disorders in Pregnancy: von Willebrand Disease, Factor XI Deficiency, and Hemophilia A and B Carriers. In: Cohen, H., O'Brien, P. (eds) Disorders of Thrombosis and Hemostasis in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-15120-5_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-15120-5_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-15119-9

  • Online ISBN: 978-3-319-15120-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics