Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review

M. C. Punt; M. L. Waning; E. P. Mauser-Bunschoten; M. J.H.A. Kruip; J. Eikenboom; L. Nieuwenhuizen; A. B.U. Makelburg; M. H.E. Driessens; J. J. Duvekot; M. Peters; J. M. Middeldorp; K. W.M. Bloemenkamp; R. E.G. Schutgens; A. T. Lely; K. P.M. van Galen

doi:10.1016/j.blre.2021.100826

Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review

M. C. Punt^*, M. L. Waning, E. P. Mauser-Bunschoten, M. J.H.A. Kruip, J. Eikenboom, L. Nieuwenhuizen, A. B.U. Makelburg, M. H.E. Driessens, J. J. Duvekot, M. Peters, J. M. Middeldorp, K. W.M. Bloemenkamp, R. E.G. Schutgens, A. T. Lely, K. P.M. van Galen

^*Corresponding author for this work

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Abstract

Currently, there is no consensus on the optimal management to prevent postpartum hemorrhage (PPH) in hemophilia carriers. We aimed to evaluate peripartum management strategies in relation to maternal and neonatal bleeding outcomes by performing an extensive database search up to August 2020. Seventeen case-reports/series and 11 cohort studies were identified of overall 'poor' quality describing 502 deliveries. The PPH incidence in the individual patient data was 63%; 44% for those women receiving prophylaxis to correct coagulation and 77% for those without (OR 0.23, CI 0.09-0.58) and in cohort data 20.3% (26.8% (11/41) vs. 19.4% (55/284) (OR: 1.53, 95% CI: 0.72-3.24), respectively. Peripartum management strategies mostly consisted of clotting factor concentrates, rarely of desmopressin or plasma. Tranexamic acid appears promising in preventing secondary PPH, but was not used consistently. Neonatal bleeding was described in 6 affected male neonates, mostly after instrumental delivery or emergency CS, but insufficient information was provided to reliably investigate neonatal outcome in relation to management. The high PPH risk seems apparent, at most mildly attenuated by prophylactic treatment. Prospective cohort studies are needed to determine the optimal perinatal management in hemophilia.

Original language	English
Article number	100826
Pages (from-to)	1-8
Journal	Blood Reviews
Volume	49
Early online date	20 Mar 2021
DOIs	https://doi.org/10.1016/j.blre.2021.100826
Publication status	Published - Sept 2021

Keywords

Hemophilia
Peripartum period
Postpartum hemorrhage
Pregnancy

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Punt, M. C., Waning, M. L., Mauser-Bunschoten, E. P., Kruip, M. J. H. A., Eikenboom, J., Nieuwenhuizen, L., Makelburg, A. B. U., Driessens, M. H. E., Duvekot, J. J., Peters, M., Middeldorp, J. M., Bloemenkamp, K. W. M., Schutgens, R. E. G., Lely, A. T., & van Galen, K. P. M. (2021). Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review. Blood Reviews, 49, 1-8. Article 100826. https://doi.org/10.1016/j.blre.2021.100826

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title = "Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review",

abstract = "Currently, there is no consensus on the optimal management to prevent postpartum hemorrhage (PPH) in hemophilia carriers. We aimed to evaluate peripartum management strategies in relation to maternal and neonatal bleeding outcomes by performing an extensive database search up to August 2020. Seventeen case-reports/series and 11 cohort studies were identified of overall 'poor' quality describing 502 deliveries. The PPH incidence in the individual patient data was 63%; 44% for those women receiving prophylaxis to correct coagulation and 77% for those without (OR 0.23, CI 0.09-0.58) and in cohort data 20.3% (26.8% (11/41) vs. 19.4% (55/284) (OR: 1.53, 95% CI: 0.72-3.24), respectively. Peripartum management strategies mostly consisted of clotting factor concentrates, rarely of desmopressin or plasma. Tranexamic acid appears promising in preventing secondary PPH, but was not used consistently. Neonatal bleeding was described in 6 affected male neonates, mostly after instrumental delivery or emergency CS, but insufficient information was provided to reliably investigate neonatal outcome in relation to management. The high PPH risk seems apparent, at most mildly attenuated by prophylactic treatment. Prospective cohort studies are needed to determine the optimal perinatal management in hemophilia.",

keywords = "Hemophilia, Peripartum period, Postpartum hemorrhage, Pregnancy",

author = "Punt, {M. C.} and Waning, {M. L.} and Mauser-Bunschoten, {E. P.} and Kruip, {M. J.H.A.} and J. Eikenboom and L. Nieuwenhuizen and Makelburg, {A. B.U.} and Driessens, {M. H.E.} and Duvekot, {J. J.} and M. Peters and Middeldorp, {J. M.} and Bloemenkamp, {K. W.M.} and Schutgens, {R. E.G.} and Lely, {A. T.} and {van Galen}, {K. P.M.}",

note = "Funding Information: We would like to acknowledge the valuable support of Bianca Kramer (UMC Utrecht Librarian) regarding the search string for the databases and Pauline Heus (Cochrane) for her advice on our protocol. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2021",

month = sep,

doi = "10.1016/j.blre.2021.100826",

language = "English",

volume = "49",

pages = "1--8",

journal = "Blood Reviews",

issn = "0268-960X",

publisher = "Churchill Livingstone",

}

Punt, MC, Waning, ML, Mauser-Bunschoten, EP, Kruip, MJHA, Eikenboom, J, Nieuwenhuizen, L, Makelburg, ABU, Driessens, MHE, Duvekot, JJ, Peters, M, Middeldorp, JM, Bloemenkamp, KWM , Schutgens, REG , Lely, AT & van Galen, KPM 2021, 'Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review', Blood Reviews, vol. 49, 100826, pp. 1-8. https://doi.org/10.1016/j.blre.2021.100826

TY - JOUR

T1 - Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers

T2 - A systematic review

AU - Punt, M. C.

AU - Waning, M. L.

AU - Mauser-Bunschoten, E. P.

AU - Kruip, M. J.H.A.

AU - Eikenboom, J.

AU - Nieuwenhuizen, L.

AU - Makelburg, A. B.U.

AU - Driessens, M. H.E.

AU - Duvekot, J. J.

AU - Peters, M.

AU - Middeldorp, J. M.

AU - Bloemenkamp, K. W.M.

AU - Schutgens, R. E.G.

AU - Lely, A. T.

AU - van Galen, K. P.M.

N1 - Funding Information: We would like to acknowledge the valuable support of Bianca Kramer (UMC Utrecht Librarian) regarding the search string for the databases and Pauline Heus (Cochrane) for her advice on our protocol. Publisher Copyright: © 2021 The Authors

PY - 2021/9

Y1 - 2021/9

N2 - Currently, there is no consensus on the optimal management to prevent postpartum hemorrhage (PPH) in hemophilia carriers. We aimed to evaluate peripartum management strategies in relation to maternal and neonatal bleeding outcomes by performing an extensive database search up to August 2020. Seventeen case-reports/series and 11 cohort studies were identified of overall 'poor' quality describing 502 deliveries. The PPH incidence in the individual patient data was 63%; 44% for those women receiving prophylaxis to correct coagulation and 77% for those without (OR 0.23, CI 0.09-0.58) and in cohort data 20.3% (26.8% (11/41) vs. 19.4% (55/284) (OR: 1.53, 95% CI: 0.72-3.24), respectively. Peripartum management strategies mostly consisted of clotting factor concentrates, rarely of desmopressin or plasma. Tranexamic acid appears promising in preventing secondary PPH, but was not used consistently. Neonatal bleeding was described in 6 affected male neonates, mostly after instrumental delivery or emergency CS, but insufficient information was provided to reliably investigate neonatal outcome in relation to management. The high PPH risk seems apparent, at most mildly attenuated by prophylactic treatment. Prospective cohort studies are needed to determine the optimal perinatal management in hemophilia.

AB - Currently, there is no consensus on the optimal management to prevent postpartum hemorrhage (PPH) in hemophilia carriers. We aimed to evaluate peripartum management strategies in relation to maternal and neonatal bleeding outcomes by performing an extensive database search up to August 2020. Seventeen case-reports/series and 11 cohort studies were identified of overall 'poor' quality describing 502 deliveries. The PPH incidence in the individual patient data was 63%; 44% for those women receiving prophylaxis to correct coagulation and 77% for those without (OR 0.23, CI 0.09-0.58) and in cohort data 20.3% (26.8% (11/41) vs. 19.4% (55/284) (OR: 1.53, 95% CI: 0.72-3.24), respectively. Peripartum management strategies mostly consisted of clotting factor concentrates, rarely of desmopressin or plasma. Tranexamic acid appears promising in preventing secondary PPH, but was not used consistently. Neonatal bleeding was described in 6 affected male neonates, mostly after instrumental delivery or emergency CS, but insufficient information was provided to reliably investigate neonatal outcome in relation to management. The high PPH risk seems apparent, at most mildly attenuated by prophylactic treatment. Prospective cohort studies are needed to determine the optimal perinatal management in hemophilia.

KW - Hemophilia

KW - Peripartum period

KW - Postpartum hemorrhage

KW - Pregnancy

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U2 - 10.1016/j.blre.2021.100826

DO - 10.1016/j.blre.2021.100826

M3 - Review article

C2 - 33775466

AN - SCOPUS:85103275673

SN - 0268-960X

VL - 49

SP - 1

EP - 8

JO - Blood Reviews

JF - Blood Reviews

M1 - 100826

ER -

Maternal and neonatal bleeding complications in relation to peripartum management in hemophilia carriers: A systematic review

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