Reproductive Health Needs in Patients with Bleeding Disorders

Introduction: The U.S. Supreme Court’s ruling to overturn Roe v. Wade may impact access to high quality reproductive healthcare for women across the United States. This includes women with bleeding disorders as well, potentially increasing the need for illegal abortions while increasing the risk of bleeding with higher rates of complications. This study aims to assess and establish the prevalence of surgical and medical abortions, including bleeding complications and utilization of emergency contraception in persons with bleeding disorders

Methods: This is a retrospective cohort study conducted with deidentified data obtained from TriNetX Research Network, aggregating health records from 66 US Healthcare Organizations (>81 million patients) from 2007-2022.ICD10 codes were used to query the data. Cases were defined as females, between ages 10-45 years with Hemophilia A, Hemophilia B, Hemophilia A and B carriers, von Willebrand Disease (vWD); not in menopause. Controls were defined as females, between ages 10-45 years, who do not have Hemophilia A, Hemophilia B, vWD, not Hemophilia A and B carriers and not in menopause. The prevalence rates of any abortion, procedures for abortion, bleeding complications, medical termination with misoprostol/mifepristone, ectopic pregnancy, molar pregnancy, use of emergency contraception, use of oral contraceptive pills (OCP), intra-uterine devices (IUD), subcutaneous implants were calculated, and compared to controls.

Results: We identified 19,733 cases and 23,923,130 controls. Among cases, 1941 (9.8%) patients had a documented abortion (induced/spontaneous/missed) and 76 cases (0.4%) had a medication induced abortion with misoprostol/mifepristone. Among cases, 489 patients (2.5%) had abortion listed as a procedure code. Ectopic pregnancy occurred in 354 cases (1.8%) and molar pregnancy occurred in 88 cases (0.4%). Emergency contraception with levonorgestrel 1.5mg (Plan B/ 0ther brands) was used by 73 cases (0.4%). 44 cases (0.2%) had delayed or excessive hemorrhage following induced abortion/incomplete spontaneous abortion/ectopic/molar

Prevalence of use of hormonal contraception in patients with bleeding disorders include – combined OCP (9.6%), IUD (7.6%) and subcutaneous implant (0.4%).

Prevalence rate of all of the above was significantly higher in patients with bleeding disorders when compared to controls (Table 1)

Conclusions: Our study suggests persons with bleeding disorders have a significant need for high quality reproductive health care with emergency contraception and medical and surgical abortions being utilized at a higher rate than the general population. Though limited data, there was a trend towards increased rates of delayed or excessive hemorrhage following induced or spontaneous abortion or ectopic pregnancy in patients with bleeding disorders. Further analyses to look at all outcomes in bleeding disorder patients is ongoing from the database. A prospective registry to establish bleeding outcomes resulting from reproductive health-related procedures is urgently needed.