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Pregnancy And Post-Partum Issues

 

Pre-Pregnancy

Women with bleeding disorders can have successful pregnancies and healthy babies. If you have been diagnosed with a bleeding disorder or if you are a carrier of a gene for a bleeding disorder such as hemophilia, start preparing for your pregnancy before you become pregnant. Being prepared and having the right healthcare team will help  ensure that you get the proper care throughout your pregnancy.

If you and/or your partner have a bleeding disorder, you may want to take advantage of genetic counseling, a service offered by many hemophilia treatment centers (HTCs). A genetic counselor can help you understand the risk of having a baby with a bleeding disorder. In addition to helping you gather information and determining the best family planning options for you, genetic counseling sessions provide families a safe, caring place and a designated time to talk.

If you have a bleeding disorder and you are pregnant or plan to become pregnant, have a general health screening about 3-6 months prior to becoming pregnant or early in your pregnancy. This is also a good time to speak with your provider at your HTC and an OB/Gyn who has experience providing reproductive care for women with bleeding disorders.

If you wish to minimize your chances of having a child with a bleeding disorder, here are some options:

  • For the woman who is a carrier of hemophilia:
    • You may choose not to have your own biological children. Instead, you may choose nonbiological options, such as adoption or foster parenting.
    • You may choose to have tests performed early in a natural pregnancy, such as chorionic villus sampling (CVS) or amniocentesis, to determine if the fetus carries the gene for hemophilia. You can then consider whether to continue or terminate your pregnancy. Check with your doctor for the best time to do these tests.
    • You can choose to try to conceive using an assisted reproductive technology method. For example, you can try in vitro fertilization (IVF), using either your own egg(s) or donor egg(s). If you use donor eggs, any child born will not carry the hemophilia gene, assuming the donor is not a carrier of hemophilia.
    • If you use your own eggs, then during the IVF procedure, pre-implantation genetic diagnosis (PGD) testing can be performed to determine the presence or absence of the hemophilia gene and the sex of the embryo. This knowledge can be used to choose an embryo without the hemophilia gene to minimize the risk of having a child with a bleeding disorder.
  • For the man who has hemophilia:
    • You may choose not to have your own biological children. Instead, you may choose nonbiological options, such as adoption or foster parenting.
    • You may choose to use artificial insemination with donor sperm. If the mother is not a hemophilia carrier, then any child born will not have the hemophilia gene, assuming the donor does not have hemophilia.
    • You may decide to have prenatal diagnosis performed by chorionic villus sampling (CVS) or amniocentesis and carry only a male fetus to term, since all female fetuses will be carriers of hemophilia.
    • You may choose to try to conceive using in vitro fertilization (IVF) and have pre-implantation genetic diagnosis (PGD) testing done. You can then decide whether to transfer only male embryos or any embryos determined not to carry the hemophilia gene.
    • If the mother has a fertility problem, you may choose to try IVF using donor sperm from a donor who does not have hemophilia. Any fetuses conceived in this manner will not carry the hemophilia gene.

During Pregnancy

During pregnancy, doing the following will help to prepare for a smooth and uneventful pregnancy, labor and delivery:

  • Make sure you are immunized against hepatitis A and B.
  • Think about using a high-risk healthcare team affiliated with an HTC.
    • Your health team should include an obstetrician, a hematologist and an anesthesiologist who will be present at the birth. All of these physicians should have experience assisting women with bleeding disorders through the pregnancy, birth and aftercare experience.
  • If you are a carrier for hemophilia, have your factor VIII level determined during the third trimester. If you have VWD, have blood tests done in the third trimester to determine levels of von Willebrand factor and factor VIII. This will help your doctors determine if you will need clotting factor or other medications to prevent bleeding during labor and delivery.

Before your baby is born

If you are a hemophilia carrier, there is a 50% chance that a boy baby will be born with hemophilia. Special testing for hemophilia can be planned before the baby’s delivery so that a sample of blood can be drawn from the umbilical cord (which connects the mother and baby before birth). The blood sample can be tested to find out right away whether the baby has hemophilia. Testing can also be done on blood drawn from a vein soon after a male baby is born. It is important to know as soon as possible after birth whether a baby has hemophilia so that special care can be given to prevent bleeding complications.

After delivery

Women who carry the gene for hemophilia and those with VWD are at risk of serious bleeding after delivering the baby. During pregnancy the body naturally makes higher amounts of factor VIII and VWF; these factors drop back to lower levels after delivery. If a woman has low levels of clotting factor after delivery or Cesarean section, she may experience severe bleeding that lasts a long time. This is called postpartum hemorrhage and is another reason to deliver in a facility affiliated with an HTC. All women should be pay attention for  possible bleeding up to a few weeks after delivery and have a plan in place to address heavy bleeding.