Essential Thrombocythemia: Symptoms, Causes, and More
What Happens If You Have Hemophilia During Pregnancy?
Hemophilia affects pregnancies in individuals who are genetic carriers of hemophilia or who have the condition. It can lead to unusual bleeding and be passed on to the baby. Prenatal care is essential for individuals with hemophilia.
Hemophilia is a rare genetic bleeding disorder that affects your blood's ability to clot, leading to excessive bleeding. Certain clotting proteins, or clotting factors, are low or absent in this condition. There are different types of hemophilia and levels of severity.
Most often, hemophilia happens in people assigned male at birth due to a recessive mutation on the X chromosome. People assigned female at birth who have mild hemophilia symptoms usually have one healthy X chromosome, making them carriers. On rare occasions, they can have two affected X chromosomes and have hemophilia. It is unknown what percentage of people assigned female at birth have hemophilia.
Several types of bleeding disorders, such as von Willebrand disease, thrombocytopenia, and different types of hemophilia, can affect an individual during pregnancy. It is essential to know which condition you have so you can get the correct treatment.
Learn more about hemophilia.
It is important to have a healthcare team in place if you have hemophilia or are a carrier and are pregnant. Your team may include:
If you have hemophilia, you have a higher chance of bleeding complications during pregnancy. Your doctors will monitor your clotting factors through blood draws.
Your anesthesiologist may not recommend an epidural for labor pain management because of the chance of bleeding around the injection site. Be ready for different pain management options. The level of your clotting factors will help your healthcare professional determine if an epidural is safe for you.
The most significant effect hemophilia has on your pregnancy is after delivery. Parents who carry the gene are at high risk for heavy bleeding after delivery. Once you deliver, the higher levels of clotting factors during pregnancy fall back to lower levels.
Excessive bleeding after giving birth is called postpartum hemorrhage and requires emergency treatment. Hemorrhage can happen right after you give birth or several weeks later.
If you are a carrier for hemophilia, your ability to clot is usually enough to prevent bleeding symptoms during pregnancy. If you have the rare condition of having two affected X chromosomes, you will most likely have more severe symptoms.
Symptoms of hemophilia during pregnancy are similar to the symptoms you have when you're not pregnant:
Parents can pass on the hemophilia gene to their babies. It is most likely to affect male children as they only have one X chromosome. You can find out if you are having a male baby through ultrasound or even earlier through noninvasive prenatal testing (NIPT)
You can have special testing for hemophilia in your fetus through amniocentesis, chorionic villus sampling (CVS), or fetal cord blood sampling during pregnancy.
If you are a carrier for hemophilia, your XY baby has a 50% chance of having hemophilia. Your XX baby has a 50% chance of being a carrier. It is a much more severe condition for children assigned male at birth than those assigned female.
Your doctor will take special precautions when you give birth if you have hemophilia or are a carrier and have a male baby. They will try to avoid using forceps or a vacuum to assist with delivering your baby. These devices can cause bleeding in your baby's brain if they have hemophilia.
If you are having an XY baby, your doctor will also try to avoid using a fetal scalp electrode to monitor your baby's heart rate. This device can cause bleeding from the scalp in a baby with hemophilia.
You may need treatment for low clotting factors from hemophilia during pregnancy and after delivery. Treatment includes:
Your treatment plan depends on the severity of your hemophilia. Treatment also involves managing any bleeding events. A delivery plan must include where you deliver and medications to give to prevent postpartum hemorrhage.
The outlook for pregnant people with hemophilia has improved significantly over the past few decades. There have been advances in medical knowledge and treatment options.
You can have a healthy pregnancy and delivery with proper medical care and close monitoring. It is essential to follow the instructions of your healthcare team.
Can I have a vaginal delivery if I have hemophilia?Vaginal delivery is often possible for individuals with hemophilia. It will depend on your specific circumstances. It may be a good idea to communicate closely with your healthcare team to determine the safest way to deliver your baby.
As a carrier for hemophilia, am I at increased risk for miscarriage?You are not usually considered at increased risk for miscarriage unless you have low levels of fibrinogen of factor XIII. This is one reason why it's important for a healthcare professional to monitor your clotting factors.
Can my baby be circumcised if I have hemophilia?If you plan to circumcise your baby, it is best to first find out if they have hemophilia. Circumcision is the number one cause of bleeding for babies with hemophilia. If your baby does have the condition, it is best to avoid circumcision.
Having hemophilia or being a carrier during pregnancy requires working with your healthcare team. Special care must be taken if you are having a baby with XY chromosomes.
You can have a safe pregnancy and delivery with proper medical care, close monitoring, and following your treatment plan.
Bleeding Before Your Period Date? Here Are Potential Causes
Menstruation is a normal process of the female reproductive system. Commonly referred to as a period, it occurs when the lining of the uterus, also called endometrium, thickens to prepare for a potential pregnancy. However, when fertilisation of an egg doesn't happen, hormone levels drop, causing the endometrial lining to shed. This shedding, in the form of vaginal bleeding, is the menstrual period. The entire cycle typically lasts about 28 days, but it can vary from person to person - some people even have the tendency to spot or bleed much earlier than the due date.
In an interaction with the OnlyMyHealth team, Dr Smita Satpathy, Senior Consultant-Obstetrics and Gynecology, CARE Hospitals, Bhubaneswar, shares various causes that can lead to bleeding before period date.
Also Read: How Menstrual Symptoms Change In Your 20s, 30s, And 40s
The Length Of The Menstrual CycleInterestingly, a woman will have around 480 periods, or fewer if they have any pregnancies, during their lifetime.
According to the UK National Health Services (NHS), the length of the menstrual cycle varies from woman to woman, but the average is to have periods every 28 days.
"Regular cycles that are longer or shorter than this, from 23 to 35 days, are normal. The menstrual cycle is the time from the first day of a woman's period to the day before her next period," the health body further shares.
What Causes Bleeding Before Menstruation DateDr Satpathy says, "Bleeding before your expected period date can have various causes, and it's essential to consider your individual circumstances and consult a healthcare professional if you're concerned about any irregular bleeding."
Here are some potential causes of bleeding before your period date:
Implantation bleeding: When a fertilised egg attaches to the uterine lining, it can cause mild spotting or bleeding. This typically occurs about 6-12 days after ovulation, which may be before your expected period. Ovulation is the release of a mature egg from the ovary that can potentially be fertilised by sperm.
Hormonal imbalances: Fluctuations in hormone levels, such as oestrogen and progesterone, can lead to irregular bleeding. Conditions like Polycystic Ovary Syndrome (PCOS) or thyroid disorders can contribute to such hormonal imbalances.
Birth control: If you are on hormonal birth control methods like birth control pills, patches, or IUDs, spotting or breakthrough bleeding can occur as your body adjusts to the hormones.
Stress: High levels of stress can disrupt your menstrual cycle and cause spotting or bleeding before your period. Stress can affect hormone levels and lead to irregularities.
Sexually Transmitted Infections (STIs): Sexually Transmitted Infections (STIs) are infections that can be transmitted through sexual contact, including vaginal, anal, or oral sex. These include chlamydia or gonorrhoea that can cause bleeding between periods.
Endometriosis: This condition occurs when the tissue lining the uterus (endometrium) grows outside the uterus. It can cause heavy bleeding, pain, and irregular periods.
Perimenopause: Perimenopause refers to the transitional period leading up to menopause, which is the point in a woman's life when her menstrual cycles cease permanently. It starts in a woman's 40s but can begin earlier or later, and it can last for several years. As you approach menopause, your hormone levels can become erratic, leading to irregular bleeding patterns.
Thyroid disorders: Thyroid problems, such as hypothyroidism or hyperthyroidism, can impact your menstrual cycle and cause abnormal bleeding.
Also Read: Menstrual Health: Expert Decodes 5 Menstrual Disorders
Steps To TakeHere are some steps to take if you have irregular periods:
Note that some degree of irregularity in menstrual cycles is common, but if you notice a significant change or are concerned about your bleeding patterns, and the accompanying symptoms, it's best to consult a healthcare professional for guidance and to rule out any underlying issues.
What's The Difference Between Von Willebrand Disease Vs. Hemophilia?
Von Willebrand disease and hemophilia are bleeding disorders caused by issues with clotting factors. These conditions share similar symptoms, but identifying which one a person has is key to effective treatment.
When you get a cut or scrape, the platelets in your blood stick together and form a plug. Proteins in the blood — clotting factors — hold that plug in place, preventing prolonged bleeding and allowing the injured area to heal.
With bleeding disorders, these proteins do not work properly and do not stop the blood from flowing out of the blood vessel.
Von Willebrand disease and hemophilia are the most commonly inherited bleeding disorders. That means that these conditions are often present at birth — caused by a person's genes.
Here's more about how these conditions are similar, what their differences are, and how each is treated.
Learn more about bleeding disorders.
People with Von Willebrand disease (VWD) have issues with a protein called von Willebrand factor. When the levels of this protein are low or not functioning as they should, the blood cannot clot properly.
While rare, VWD is the most common inherited bleeding disorder classified into three main types:
Hemophilia is a rare genetically inherited bleeding disorder that can also range from mild to severe. People with hemophilia have deficiencies in the amount of either factor VIII (type A) or factor IX (type B). As with VWD, issues with these clotting factors can cause bleeding that does not stop.
It can be difficult to tell these two conditions apart with just a physical examination. One of the main differences is that hemophilia primarily affects males, whereas VWD affects both females and males. Another difference is that VWD tends to be milder than hemophilia.
If you believe you have a clotting disorder, your doctor will need to run coagulation tests to see exactly which protein is preventing your blood from clotting.
The signs and symptoms of VWD and hemophilia are similar.
Shared symptoms include:
Where symptoms differ is that people with VWD may experience particularly heavy periods and bleeding from the nose and gums.
People with hemophilia may be more likely to experience painful or stiff joints and muscles from internal bleeding.
Treatment for hemophilia involves using synthetic injectable clotting factors to replace those that are missing or not working as they should. Healthcare professionals can prescribe these medications to prevent bleeding or to stop active bleeding.
Treatment for VWD depends on the severity. Individuals with mild VWD may not need treatment besides avoiding medications, such as aspirin, that thin the blood.
Those with more severe VWD may need medication to increase the levels of von Willebrand factor in their blood or in injected blood factors.
If you have either condition, speak with your doctor — a hematologist — before any surgeries, dental work, pregnancy/birth, or in any other event where the chance of bleeding increases.
A person is more likely to have VWD or hemophilia if they have a family history of the condition. The likelihood is higher if one or both parents have a bleeding disorder or otherwise carry an affected gene.
Again, males are at higher risk of having hemophilia than females. By contrast, VWD affects males and females in equal numbers, though women tend to experience more serious symptoms due to menstrual periods, pregnancy, and birth.
Currently, there is no cure for VWD or hemophilia. That said, the outlook depends on the severity of the condition.
People with mild types of VWD may lead relatively typical lives and only need synthetic clotting factors when they are injured or having surgery. Those with hemophilia and more severe types of VWD may need preventive clotting factors to avoid excessive bleeding in everyday life.
Are VWD and hemophilia always inherited?No. While rare, these conditions can also be acquired as part of another medical condition or after taking certain medications.
How many people are affected by these conditions?Experts estimate that VWD affects 1% of the population, regardless of sex. They estimate that hemophilia affects 1 in every 5,000 male births.
Why is hemophilia rare in females?Since hemophilia is carried on the X chromosome, and females have two X chromosomes, the chances of having one healthy X chromosome are more likely, meaning hemophilia is rare in females.
Males have only one X chromosome, so if that X chromosome is affected, that male will have hemophilia.
You cannot necessarily tell which bleeding disorder you have from the symptoms alone. One valuable clue to the type is that both VWD and hemophilia are genetically inherited and may run in your family.
Your doctor or healthcare professional can order blood tests to determine which clotting factor isn't functioning properly and prescribe appropriate medications to prevent and treat excessive bleeding.
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