Pregnancy and preconception advice for a personal or family history of bleeding or known bleeding disorder.
The referral pathway depends on whether or not the patient is currently pregnant, and the clinical urgency:
- Preconception: refer routinely to Department of Haematology at RIE
- Pregnant: Combined Haematology Obstetric Clinic RIE or SJH. As a general rule, referrals should be made through the locality consultant obstetrician.
- Pregnant and known or potential carriers of haemophilia: please fast track and refer directly and urgently to Haematology RIE.
- Severe current symptoms (pregnant or not): refer urgently.
Please note the separate guidance for thrombocytopenia in pregnancy
C.M & L.W 31-07-23
Who to refer:
PRECONCEPTION:
1. Patient with known bleeding disorder: is the patient already registered at Edinburgh Haemophilia Centre?
Yes: inform patient’s consultant of her plans for pregnancy
No: refer to RIE Haematology.
2. Suspected bleeding disorder: clinical history is key.
Patients are best referred before pregnancy, and refer if:
- 1 minor bleeding symptom (e.g. easy bruising and menorrhagia) or
- 1 major symptom e.g. spontaneous haemarthrosis or
- unexplained/excessive surgical bleeding.
3. Current severe symptoms: telephone on call consultant for haematology at RIE.
4. Family history of bleeding disorder. Please ask about a) diagnosis b) relationship of index case to patient c) any other family members affected? d) has your patient had any haemorrhagic symptoms? Refer to Haematology RIE.
ALREADY PREGNANT:
- Refer patients falling into any of the above categories to the Haematology Department RIE as early as possible in pregnancy.
- Current severe haemorrhagic symptoms in context of known or suspected bleeding disorder. Please assess if PV bleeding occurring:
- Yes: refer to obstetric / gynaecology triage and inform haematology on call.
- No (other significant bleeding manifestations): refer urgently to haematology RIE if < 20 weeks; if > 20weeks, send to obstetric triage and telephone on call consultant haematologist to inform and discuss.
Who not to refer:
- Women with a personal or family history of bleeding who have already had the disorder or carriership of the disorder excluded.
- Women with an isolated history of antepartum or postpartum haemorrhage. Such women should be discussed with a consultant obstetrician and may require referral to a consultant obstetrician for preconception counselling. They should be reviewed at a consultant antenatal clinic during the next pregnancy. This will usually be arranged by the community midwives.
Please note the separate guidance for thrombocytopenia in pregnancy.
How to refer:
Please see above for detail.
All patients should be referred to RIE Haematology:
- Preconception – routine Referral to RIE Haematology.
- Currently Pregnant: urgent referral via the locality consultant obstetrician to Haematology RIE.
- Known or potential carriers of Haemophilia: fast track by referring urgently and directly to Dept of Haematology RIE and to locality consultant obstetrician (for information only)
Severe current Symptoms (pregnant or not): refer urgently: see above.
Please arrange:
- FBC
- Coagulation screen
- LFTs and U&Es.
Pavord S, Rayment R, Madan B, Cumming T, Lester W, Chalmers E, Myers B, Maybury H, Tower C, Kadir R on behalf of the Royal College of Obstetricians and Gynaecologists. Management of Inherited Bleeding Disorders in Pregnancy. Green-top Guideline No. 71. BJOG 2017; 124:e193–e263.
Green Top Guidelines can be found here: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/
