The Experience of Postpartum Bleeding in Women with Inherited Bleeding Disorders
Bibliographic record
Abstract
Abstract Introduction and Objective: Women with inherited bleeding disorders have a maternal mortality rate nearly ten times higher than women without bleeding disorders. To date, the postpartum bleeding these women experience has not been well studied. Postpartum hemorrhage (PPH) affects 6% of all deliveries and is the leading cause of maternal death worldwide (19.7%). The incidence of PPH in women with inherited bleeding disorders is greater than unaffected women however estimates of relative risk are highly variable. In this high-risk population, we set out to explore the experience with, understanding of and attitudes regarding postpartum bleeding. Materials and Methods: This qualitative study involved focused interviews of women with inherited bleeding disorders about postpartum bleeding. Women followed at a multidisciplinary clinic for women with inherited bleeding disorders who have experienced childbirth within the last 5 years were included in the study. The interview style was semi-structured and questions were designed in collaboration with a qualitative methodologist. Interviews continued until the point of saturation of themes. All interviews were transcribed and then analyzed using qualitative descriptive analysis. Results: We interviewed ten women with inherited bleeding disorders. Saturation of themes occurred after six interviews. Themes that emerged include normalization of excessive bleeding, difficulty distinguishing normal from abnormal postpartum bleeding and empowerment of women by having a clear delivery care plan. Although these women felt generally prepared for immediate postpartum bleeding, there was less awareness regarding delayed postpartum hemorrhage. Conclusion: To our knowledge this is the first study to assess the experience of postpartum bleeding in women with inherited bleeding disorders. Our analysis shows that these women become desensitized to heavy vaginal bleeding. As a result, excessive postpartum bleeding was not recognized by many of the women we interviewed. We also highlight the importance of a multidisciplinary delivery care plan for these women. We have identified key areas for targeted intervention for these patients and their healthcare providers. Disclosures Sholzberg: Octapharma: Research Funding; CSL Behring: Research Funding; Amgen: Research Funding; Shire: Research Funding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".