By Duke Medicine News and Communications

Durham, N.C.-- A unique clinic at Duke University Medical Center is dedicated to helping pregnant women with potentially life-threatening bleeding and clotting problems have successful pregnancies.

Partially funded by the Centers for Disease Control, the Women's Hemostasis and Thrombosis Clinic at Duke University Medical Center is the only such clinic in the U.S. dedicated solely to female reproductive bleeding and clotting issues for women. The clinic brings specialists in high-risk obstetrics and gynecology together with hematologists so patients can benefit from their combined knowledge in one clinic.

Andra James, M.D., director of the clinic, said that bleeding and clotting disorders are under-diagnosed and can impact reproductive outcomes. "Clotting disorders may interfere with circulation of the blood to the baby that can result in detrimental or life-threatening conditions to the baby. On the other hand, a bleeding disorder during childbirth can result in profound hemorrhage," she said. "It's important that women and their physicians know these conditions exist so they can be tested for them and properly followed during pregnancy."

Most clotting disorders are inherited, but James said that birth control pills also make a woman four-times more likely to develop a blood clot, and pregnancy makes a woman five times more likely. Approximately one in 1,000 women develops a blood clot during pregnancy. Trauma, cancer, prolonged bed rest and surgery can also increase a woman's risk of developing a blood clot. Treatment usually involves anticoagulation medications.

"Many women come to our clinic after losing several pregnancies," James said. "Often these problems are related to an underlying clotting disorder. Once we address the clotting issues, most of these women go on to have happy, healthy babies."

The most common bleeding disorder is von Willebrand's disease, which, according to the National Hemophilia Foundation, affects 2.8 million women and girls in the United States. The disease is genetic and caused by a defect or deficiency of an essential blood clotting protein. James said a huge problem for women with von Willebrand's disease is correct diagnosis.

"There is no easy test for von Willebrand's disease and it often goes undiagnosed," she said. "In a recent survey of women who were ultimately diagnosed with von Willebrand's disease, the average length of time until diagnosis was 16 years."

Pregnancy increases a woman's clotting factor levels, so women with von Willebrand's are partially protected before delivery; however, the greatest danger is after delivery when these women are most susceptible to hemorrhaging. Women with this bleeding disorder who are not pregnant may find some relief by taking birth control pills, because the hormones in the pills also increase clotting factor levels. But for women who cannot take oral contraceptives or do not respond to them, other therapies are available.

In addition to creating individual treatment plans for women with bleeding and clotting disorders, the physicians at the Duke clinic keep records of women with these disorders to provide a database for future research. In the future they will also collect tissue and DNA samples to further advance the study and understanding of bleeding and clotting disorders in women.