{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:09:46Z","timestamp":1787242186515,"version":"build-2736575974"},"reference-count":22,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pregnant persons with bleeding disorders (pwBD) have an increased risk of primary and secondary postpartum hemorrhage (PPH). Patients with von Willebrand disease, a bleeding disorder of unknown cause, or qualitative platelet defects (QPDs) and hemophilia carriers (HC) may or may not naturally achieve an adequately hemostatic state due to the hypercoagulable changes of pregnancy. PwBD greatly benefit from receiving care in a multidisciplinary setting including hematologists, obstetricians, anesthesiologists, and clinical geneticists. Factor levels should be obtained, at minimum, prior to conception as baseline as well as at the 34- to 36-week mark for delivery planning. However, target factor levels for delivery remain controversial given that many bleeding phenotypes do not predictably correlate with levels. Hemostatic therapies include antifibrinolytic agents, desmopressin, factor concentrates, and blood components such as cryoprecipitate, plasma, and platelets. Antifibrinolytics such as tranexamic acid have the most robust evidence for PPH management, though factor concentrates are now routinely utilized in certain circumstances. Blood products are an option for pwBD who have QPDs or when factor concentrates are not available. In patients with certain bleeding disorders, such as HCs, mode-of-delivery discussions must include consideration of the risks both to the affected neonate and to the mother. We favor selecting the mode of delivery based upon maternal indications whenever possible. Post partum, therapies may be continued for days or sometimes weeks after delivery, as pwBD are at high risk for delayed PPH.<\/jats:p>","DOI":"10.1182\/hematology.2025000742","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T14:09:29Z","timestamp":1764943769000},"page":"496-502","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":4,"title":["Pregnancy management for patients with bleeding disorders"],"prefix":"10.1182","volume":"2025","author":[{"given":"Nidhi","family":"Patel","sequence":"first","affiliation":[{"name":"1 Department of Internal Medicine, Providence Portland, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany Samuelson","family":"Bannow","sequence":"additional","affiliation":[{"name":"2 The Hemostasis and Thrombosis Center, Oregon Health & Science University, Portand, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"4","key":"2025120616342713900_hem2025000742C1","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1160\/TH09-10-0704","article-title":"Haemostatic reference intervals in pregnancy","volume":"103","author":"Szecsi","year":"2010","journal-title":"Thromb Haemost"},{"issue":"suppl 1","key":"2025120616342713900_hem2025000742C2","doi-asserted-by":"crossref","first-page":"8458","DOI":"10.1182\/blood-2022-160230","article-title":"Bleeding phenotype does not appear to correlate with factor VIII levels or genetic mutation in an exclusive pediatric cohort of hemophilia a carriers","volume":"140","author":"Larson","year":"2022","journal-title":"Blood"},{"issue":"1","key":"2025120616342713900_hem2025000742C3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/s41525-023-00375-8","article-title":"Population-based prevalence and mutational landscape of von Willebrand disease using large-scale genetic databases","volume":"8","author":"Seidizadeh","year":"2023","journal-title":"NPJ Genom Med"},{"issue":"8","key":"2025120616342713900_hem2025000742C4","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1111\/jth.15397","article-title":"A new hemophilia carrier nomenclature to define hemophilia in women and girls: communication from the SSC of the ISTH","volume":"19","author":"van Galen","year":"2021","journal-title":"J Thromb Haemost"},{"issue":"1","key":"2025120616342713900_hem2025000742C5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1365-2516.2007.01561.x","article-title":"Pregnancy in carriers of haemophilia","volume":"14","author":"Chi","year":"2008","journal-title":"Haemophilia"},{"issue":"3","key":"2025120616342713900_hem2025000742C6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/j.1365-2516.2009.02144.x","article-title":"The optimal mode of delivery for the haemophilia carrier expecting an affected infant is vaginal delivery","volume":"16","author":"Ljung","year":"2010","journal-title":"Haemophilia"},{"key":"2025120616342713900_hem2025000742C7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/jth.12199","article-title":"Genotyping and phenotyping of platelet function disorders","volume":"11 (suppl 1)","author":"Watson","year":"2013","journal-title":"J Thromb Haemost"},{"key":"2025120616342713900_hem2025000742C8","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.cca.2022.09.016","article-title":"Platelet aggregation in normal pregnancy","volume":"536","author":"Su","year":"2022","journal-title":"Clin Chim Acta"},{"issue":"12","key":"2025120616342713900_hem2025000742C9","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1111\/jth.15872","article-title":"Reproductive health and hemostatic issues in women and girls with congenital factor VII deficiency: a systematic review","volume":"20","author":"Abdul-Kadir","year":"2022","journal-title":"J Thromb Haemost"},{"issue":"6","key":"2025120616342713900_hem2025000742C10","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1182\/bloodadvances.2023012186","article-title":"Congenital fibrinogen disorders: a retrospective clinical and genetic analysis of the prospective rare bleeding disorders database","volume":"8","author":"Mohsenian","year":"2024","journal-title":"Blood Adv"},{"issue":"2","key":"2025120616342713900_hem2025000742C11","doi-asserted-by":"crossref","first-page":"447","DOI":"10.3390\/nu12020447","article-title":"Iron deficiency and iron deficiency anemia: implications and impact in pregnancy, fetal development, and early childhood parameters","volume":"12","author":"Means RT","year":"2020","journal-title":"Nutrients"},{"issue":"2","key":"2025120616342713900_hem2025000742C12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/ejh.13250","article-title":"Pregnancy and delivery in women with von Willebrand disease","volume":"103","author":"Castaman","year":"2019","journal-title":"Eur J Haematol"},{"issue":"4","key":"2025120616342713900_hem2025000742C13","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/hae.12635","article-title":"Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey","volume":"21","author":"Stoof","year":"2015","journal-title":"Haemophilia"},{"issue":"6","key":"2025120616342713900_hem2025000742C14","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1111\/hae.13067","article-title":"Obstetric bleeding among women with inherited bleeding disorders: a retrospective study","volume":"22","author":"Hawke","year":"2016","journal-title":"Haemophilia"},{"issue":"suppl 1","key":"2025120616342713900_hem2025000742C15","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1182\/blood-2024-207022","article-title":"Postpartum hemorrhage in hemophilia A and B carriers after enhanced prophylactic clotting factor suppletion: the pregnancy and inherited bleeding disorders study (PRIDES)","volume":"144","author":"de Vaan","year":"2024","journal-title":"Blood"},{"issue":"1","key":"2025120616342713900_hem2025000742C16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1182\/bloodadvances.2020003264","article-title":"ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease","volume":"5","author":"Connell","year":"2021","journal-title":"Blood Adv"},{"issue":"4","key":"2025120616342713900_hem2025000742C17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.tmrv.2018.06.003","article-title":"Inherited bleeding disorders in the obstetric patient","volume":"32","author":"Bannow","year":"2018","journal-title":"Transfus Med Rev"},{"key":"2025120616342713900_hem2025000742C18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/1745-6215-11-40","article-title":"The WOMAN trial (World Maternal Antifibrinolytic trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double blind placebo controlled trial","volume":"11","author":"Shakur","year":"2010","journal-title":"Trials"},{"issue":"10","key":"2025120616342713900_hem2025000742C19","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.3324\/haematol.2018.209619","article-title":"Mode of delivery in hemophilia: vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and other major bleeds","volume":"104","author":"Andersson","year":"2019","journal-title":"Haematologica"},{"issue":"3","key":"2025120616342713900_hem2025000742C20","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.1365-2516.2009.02142.x","article-title":"The optimal mode of delivery for the haemophilia carrier expecting an affected infant is caesarean delivery","volume":"16","author":"James","year":"2010","journal-title":"Haemophilia"},{"issue":"3","key":"2025120616342713900_hem2025000742C21","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/j.1651-2227.1991.tb11853.x","article-title":"Vitamin K to neonates. Peroral versus intramuscular administration","volume":"80","author":"J\u00f8rgensen","year":"1991","journal-title":"Acta Paediatr Scand"},{"issue":"suppl 9","key":"2025120616342713900_hem2025000742C22","doi-asserted-by":"crossref","first-page":"29S","DOI":"10.1177\/1076029618807583","article-title":"A practical guide to the management of the fetus and newborn with hemophilia","volume":"24","author":"Moorehead","year":"2018","journal-title":"Clin Appl Thromb Hemost"}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ashpublications.org\/hematology\/article-pdf\/2025\/1\/496\/2470367\/496patel.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/ashpublications.org\/hematology\/article-pdf\/2025\/1\/496\/2470367\/496patel.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T21:34:34Z","timestamp":1765056874000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2025\/1\/496\/556872\/Pregnancy-management-for-patients-with-bleeding"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12,5]]},"published-print":{"date-parts":[[2025,12,5]]}},"URL":"https:\/\/doi.org\/10.1182\/hematology.2025000742","relation":{},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,5]]},"published":{"date-parts":[[2025,12,5]]}}}