Inherited Bleeding Disorders in Pregnancy: Obstetric Management and Outcomes From a Tertiary Care Centre.

OBJECTIVE: This study aimed to evaluate the obstetric management, complications and clinical characteristics of pregnant women diagnosed with hereditary coagulation factor deficiencies at a tertiary obstetric centre over a 10-year period.

METHODS: We retrospectively reviewed a total of 19 pregnancies in 17 women with hereditary coagulation factor deficiencies who delivered at a tertiary referral centre between January 2015 and April 2025. Clinical data including deficient factor type and levels, delivery mode, maternal outcomes and treatments were collected from hospital records.

RESULTS: Von Willebrand disease was the most frequent diagnosis (37%), followed by factor XI (21%), factor VII (16%), factor X (11%) and factor XIII deficiency in one pregnancy (5%). One patient had combined deficiencies of von Willebrand factor, factor V, and factor VIII. Fifteen pregnancies (78%) resulted in term delivery, two (11%) were late preterm, and two (11%) ended in early pregnancy loss. Cesarean delivery was performed in 11 pregnancies (58%), all for obstetric indications. Postpartum haemorrhage occurred in four pregnancies (24%), including one case (6%) requiring laparotomy due to intra-abdominal bleeding. Haemate-P was administered in four pregnancies (21%), with no haemorrhagic complications. One patient developed transfusion-associated circulatory overload following fresh frozen plasma administration for factor XI deficiency. Factor activity levels were not consistently correlated with bleeding outcomes, highlighting substantial clinical variability.

CONCLUSION: Hereditary coagulation factor deficiencies present complex challenges in obstetric care. Individualized delivery planning, prophylactic replacement strategies and close postpartum monitoring are essential. Management in multidisciplinary centres is critical to optimizing maternal and neonatal outcomes.

PLAIN LANGUAGE SUMMARY: Some women have inherited conditions that affect how their blood clots, called hereditary coagulation factor deficiencies. During pregnancy and childbirth, these conditions may increase the risk of bleeding for both mothers and babies. We reviewed the medical records of 17 pregnant women with different types of inherited clotting factor deficiencies who gave birth at a large tertiary care hospital between 2015 and 2025. The women had conditions such as von Willebrand disease and deficiencies of Factors VII, X, XI and XIII. We found that pregnancy and delivery outcomes were very different from one woman to another. Some women with very low clotting factor levels experienced no bleeding problems, while others had significant bleeding despite having near-normal levels. Careful planning and teamwork between specialists-including obstetricians, haematologists and anaesthesiologists-were essential to ensure safe deliveries. Treatments such as factor replacement, Haemate-P and fresh frozen plasma were used when necessary. Our study highlights the importance of individualized care for pregnant women with rare bleeding disorders. Early involvement of a multidisciplinary team and close monitoring before, during and after childbirth can help prevent complications and improve outcomes for both mothers and babies.