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Poster Networking

Women's Hemostasis and Thrombosis

PB0478 - Outcomes of pregnant hematological patients managed in a combined Obstetrics-Gynecology-Hematology Clinic

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall
Background: Hematological conditions in pregnancy add a layer of complexity to pregnancy management1. Such patients are at risk of poorer outcomes2,3, exacerbating either bleeding or prothrombotic tendencies4,5. Studies have demonstrated benefits of multidisciplinary management in pregnant patients with underlying hematological conditions6, yet outcome data remain limited. The joint Obstetrics-Gynecology-Hematology (OGH) clinic at Singapore General Hospital (SGH) was first introduced in 2017 to improve care of these high-risk pregnancies.

Aims: To describe perinatal outcomes of patients with thrombosis and hemostatic (T&H) conditions seen in the OGH clinic.

Methods: Clinical audit OGH data from January 2017 to December 2022 were reviewed. Data from all pregnancies in 2022 at SGH were used as comparator comprising of 1587 in-hospital births.

Results: There were 129 OGH patients, of which 74 were T&H cases with a mean age of 334 years. The rest were red cell related conditions. Five main categories of underlying T&H conditions were venous thromboembolism (VTE) (24.0%), thrombocytopenia (20.2%), thrombophilia (7.8%), bleeding disorders (5.4%) and myeloproliferative neoplasms (2.3%). The mean gestational age at delivery was 37.42.0 weeks (vs 37.72.1 weeks in the baseline group, P>0.05). Fifty-two (40.3%) OGH patients underwent normal vaginal delivery, while 29 (22.5%) and 23 (17.8%) underwent elective and emergency caesarian section respectively (vs 53.6%, P>0.05; 12.4%, P>0.05; 16.9%, P>0.05 in the baseline group). Seven (5.4%) OGH patients suffered post-partum hemorrhage, of which 3 had underlying VTE and 2 had thrombocytopenia. There were no peripartum thrombotic complications. Regarding fetal outcomes, 22.5% of the deliveries from OGH patients had neonatal complications with 4.7% requiring Neonatal ICU admission (vs 13.6%, P>0.05; 7.7%, P>0.05 in the baseline group). Importantly, there were no neonatal bleeding or thrombotic complications.

Conclusion(s): The perinatal outcomes of pregnant patients seen in the OGH clinic at SGH are comparable to those of general pregnancies, demonstrating the ability to mitigate risks through a multidisciplinary approach.