By PPH Foundation
For many women, childbirth is the first time an underlying bleeding disorder becomes clinically evident. In settings where routine screening for coagulation abnormalities is limited, conditions such as haemophilia carriers or von Willebrand disease may go undiagnosed until a woman experiences excessive bleeding after delivery. This makes postpartum haemorrhage not only an obstetric emergency, but in some cases, the first signal of an underlying haematological vulnerability.
Evidence shows that inherited bleeding disorders significantly increase the risk and severity of postpartum haemorrhage. A population-based cohort study by Hews Girard et al, 2023 found that women with bleeding disorders had markedly higher rates of PPH compared to the general population. Similarly, Niu et al, 2023 reported that such women face up to two times higher risk of PPH and significantly increased likelihood of severe haemorrhage requiring intervention. These findings underscore the need to integrate haemostatic considerations into routine maternal care.
Beyond risk identification, emerging research highlights practical solutions that can reduce these complications. Studies show that antenatal screening for bleeding history, combined with targeted laboratory testing where feasible, allows early identification of at-risk women. The use of prophylactic therapies such as tranexamic acid and clotting factor replacement has been shown to significantly reduce bleeding severity when administered promptly. In addition, the WHO recommended use of tranexamic acid within three hours of birth has been associated with reduced mortality from bleeding, as demonstrated in the WOMAN Trial, a large multicountry randomized study.
Further evidence points to the importance of multidisciplinary care, where obstetricians, haematologists and laboratory teams work together to develop individualized birth plans. Standardized care bundles, including early recognition, rapid response protocols and access to blood products, have also been shown to improve outcomes in women at high risk of PPH.
Reflecting on this, Prof Moses Obimbo, the End PPH Initiative Project Lead notes that, “Postpartum haemorrhage must be approached not only as an obstetric event, but as a systems condition that requires anticipation. Where bleeding disorders exist, preparedness is what determines survival.” He emphasizes that strengthening screening, preparedness and response systems is critical in preventing avoidable maternal deaths.
As the world marks World Hemophilia Day, the message is clear, improving maternal survival requires looking beyond the obvious and addressing hidden risks. Integrating bleeding disorder awareness, early detection and targeted interventions into maternal health systems is a necessary step towards ending preventable deaths from postpartum haemorrhage.
Sources
Hews-Girard JC, Galica J, Goldie C, James P, Tranmer JE. Identifying the effect of inherited bleeding disorders on the development of postpartum hemorrhage, a population based retrospective cohort study. Research and Practice in Thrombosis and Haemostasis. 2023,7(2):100104.
Niu B, Duffett L, El-Chaâr D, Tinmouth A, Wang TF, Khalife R. Bleeding disorders and postpartum hemorrhage by mode of delivery, a retrospective cohort study. Research and Practice in Thrombosis and Haemostasis. 2023,7(4):100166.
WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage. The Lancet. 2017,389(10084):2105–2116.
World Health Organization. WHO recommendation on tranexamic acid for the treatment of postpartum haemorrhage. Geneva, WHO, 2017.
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