cquired Bleeding Disorders: Haemostatic Management in Pregnancy and Postpartum

The spectrum of acquired bleeding disorders encountered in pregnancy is wide with many underlying causes. They are associated with an increased risk of bleeding complications during pregnancy, and especially during the delivery and postpartum period. Some of these conditions may also impact on the foetus/newborn, putting the foetus at risk of bleeding complications during birth. Frequently these disorders present with symptoms and laboratory findings resembling more common obstetric conditions; this, together with the rarity of some of these conditions, makes early diagnosis and management challenging. High index of suspicion, access to pathways for diagnosis and management, a multi-disciplinary team approach involving obstetricians, haematologists, anaesthetists and an experienced haemostasis laboratory team are crucial for early diagnosis and effective management. Postpartum haemorrhage complicates 5–8% of all deliveries, and if not diagnosed and controlled early, it can be associated with coagulopathy leading to a massive haemorrhage. Understanding pregnancy-induced changes in the coagulation system and the impact on laboratory test results are essential for early diagnosis and timely correction of haemostatic defects to improve maternal outcome. This chapter addresses acquired bleeding disorders encountered in pregnancy including thrombocytopenia and acquired coagulation factor deficiencies and coagulopathies associated with obstetric haemorrhage.