Coagulation Disorders and Pregnancy
By: Ghelle Sagucio
Most coagulation disorders are sex-linked or occur only in
males and so have little effect on pregnancies.
I. Von Willebrand's disease – is an inherited autosomal
dominant disorder that occurs in women.
S/S: menorrhagia or frequent episodes of epistaxis.
Along with a factor VIII defect, there is also an inability of the
platelets to aggregate.
In addition, the blood vessels cannot constrict and aid in
coagulation.
Bleeding time is prolonged, with most hemorrhages occurring
from mucous membrane sites (Friedman & Rodgers, 2004).
II. Christmas disease or Hemophilia B, caused by factor IX
deficiency, is transmitted as a sex-linked recessive trait so the
actual disease occurs only in males.
Female carriers may have such a reduced level of this factor
(only 33% of normal) that hemorrhage with labor or a
spontaneous miscarriage can be a serious complication.
Treatment:
 Carriers of the disorder need to be identified before
pregnancy.
 Only approximately 15% of people with hemophilia have
this form.
 Infusion of factor
 Percutaneous umbilical cord sampling
III. Hemophilia C or plasma thromboplastin antecedent
deficiency, caused by factor XI deficiency, is transmitted as an
autosomal recessive trait occurring in both sexes.
S/S - generally mild compared with those in children with factor
VIII or factor IX deficiencies.
Treatment: Bleeding episodes are treated with administration of
desmopressin (DDAVP) or transfusion of fresh blood or plasma.
IV. Idiopathic thrombocytopenic purpura (ITP) a decreased
number of platelets can occur at any time in life and so
occasionally occurs during pregnancy.
“Idiopathic” means that the cause of the condition isn’t known.
“Thrombocytopenic” means there’s a lower than normal number
of platelets in the blood. “Purpura” refers to purple bruises
caused by bleeding under the skin.
S/S: Minute petechiae or large ecchymoses appear on a
woman’s body. Frequent nosebleeds may occur.
Findings: Laboratory studies reveal a marked thrombocytopenia
(platelet count may be as low as 20,000 mm3 from a usual
150,000 mm3)
The illness usually runs a 1-3 month limited course but because
symptoms are similar to HELLP Syndrome (Hemolytic anemia
Elevated Liver enzymes and Low Platelet count), they are
frightening when they occur during pregnancy.
Treatment:
 Platelet transfusion plasmapheresis
 Oral prednisone
 menorrhagia Early identification
- Factor VIII Defect
Replacement of
epistaxis - Inherited disorder in women cryoprecipitates
- Inability of platelets to
Sign &Symptoms aggregate
- HELLP Syndrome Management
- Prolonged bleeding time
- Ecchymoses
- Epistaxis
- Petichiae
Von Willebrand’s
Sign &Symptoms Disease

Complication

Complication Hemorrhage
Idiopathic
- Increased Bleeding Thrombocytopenic COAGULATIO Hemophilia B Spontaneous
- Crosses placenta
and affects
Purpura
N DISORDERS Miscarriage

newborn with - Christmas Disease

illness - Unknown cause - Factor IX Defect
Management
- Autoimmune Illness - Sex-linked in male
Early identification
Sign &Symptoms Hemophilia C
- Early Identification Factor IX Concentrate
- Platelet Transfusion desmopressin
- Oral Prednisone - Plasma thromboplastin Factor IX Infusion
transfusion of fresh antecedent deficiency
- Factor XI Defect Percutaneous Umbilical
blood or plasma Cord Sampling
- Autosomal: both sexes

generally mild compared

with factor VIII or factor IX
deficiencies