Laboratory monitoring during pregnancy and post-partum hemorrhage in women with von Willebrand disease.
Laboratory monitoring during pregnancy and post-partum hemorrhage in women with von Willebrand disease.
复制标题
患有冯维勒布兰德病的妇女怀孕期间和产后出血的实验室监测。
DOI：
10.1111/jth.14696
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Vesely,SaraK
中科院分区：
文献类型：
--
作者：
O'Brien,SarahH;Stanek,JosephR;Kaur,Dominder;McCracken,Katherine;Vesely,SaraK
背景循证指南建议在妊娠晚期获得血管性血友病因子（vonWillebrand factor，VWF）水平，以便于对患有血管性血友病（vonWillebrand disease，VWD）的妇女进行围产期计划。以及怀孕后生殖出血的频率。患者/方法患者数据从Truven Health MarketScan研究数据库获得。使用国际疾病分类-9个代码来识别患有VWD的妇女和婴儿分娩的证据。我们将妊娠晚期监测定义为分娩前3个月内VWF水平的实验室声明。研究的临床结果包括产后出血（PPH）和月经大量出血（HMB）。ResultsWe确定了2238个独特的孕妇VWD。其中，32%（n = 714）接受了妊娠晚期VWF水平检测。婴儿分娩后6周内，6.5%的女性记录了与PPH一致的诊断代码。接受VWF监测的女性PPH发生率（4.9%）显著低于未接受监测的女性（7.3%），（风险差异为-2.4%，95%CI为-4.4%至0.3%，P = 0.023）。与HMB一致的诊断代码记录为4.7%的妇女在3个月后，婴儿delivery.ConclusionsThird-trimester VWF监测与PPH的风险较低，但测试进行了只有三分之一的投保孕妇VWD在美国，尽管专家的建议。
BackgroundEvidence‐based guidelines recommend that von Willebrand factor (VWF) levels be obtained in the third trimester of pregnancy to facilitate peripartum planning for women with von Willebrand disease (VWD).ObjectivesTo identify the frequency of third trimester monitoring in a nationally representative sample of pregnant women with VWD in the United States, as well as the frequency of reproductive bleeding after pregnancy.Patients/MethodsPatient data were obtained from the Truven Health MarketScan Research Databases. International Classification of Diseases‐9 codes were used to identify women with VWD and evidence of infant delivery. We defined third trimester monitoring as a laboratory claim for VWF levels during the 3 months before delivery. Clinical outcomes studied included postpartum hemorrhage (PPH) and heavy menstrual bleeding (HMB).ResultsWe identified 2238 unique pregnant females with VWD. Of these, 32% (n = 714) underwent third‐trimester testing of VWF levels. Diagnostic codes consistent with PPH were recorded for 6.5% of women in the 6 weeks after infant delivery. The frequency of PPH in women who underwent VWF monitoring (4.9%) was significantly lower than in those who did not undergo monitoring (7.3%), (risk difference −2.4%, 95% CI −4.4% to −0.3%,P= .023). Diagnostic codes consistent with HMB were recorded for 4.7% of women in the 3 months after infant delivery.ConclusionsThird‐trimester VWF monitoring was associated with a lower risk of PPH, but testing was performed in only one‐third of insured pregnant women with VWD in the United States despite expert recommendations.