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Unique Duke Clinic Aims at Preventing Bleeding, Clotting in Pregnant Women

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Duke Health News 919-660-1306

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.

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