Mode of delivery and risk of intracranial haemorrhage in newborns with severe haemophilia A: a multicentre study in Gulf region

Abstract

Normal vaginal delivery is still considered a safe journey through the birth canal for haemophilic newborns particularly in this area of the world. Larger prospective studies might be needed to define an evidence-based optimal mode of delivery for the haemophilia carrier expecting an affected child.

Updated Australian consensus statement on management of inherited bleeding disorders in pregnancy

“…Instrumental deliveries should be avoided because of the increased risk of intracranial haemorrhage. However, where an instrumental delivery is deemed unavoidable, a forceps delivery by an experienced accoucheur is preferred over vacuum extraction . Use of fetal scalp blood sampling, mid‐cavity manipulation, scalp electrodes and a prolonged labour should also be avoided if possible …”

Women with bleeding disorders: Clinical and psychological issues

“…Compared to infants born by spontaneous vaginal birth (SVB) infants born by assisted vaginal birth were over four times more likely to have a symptomatic ICH. In some parts of the world, especially where women have larger families, vaginal birth is the preferred mode of birth, and is more socially acceptable and more suitable for families willing for large number of children 34. The greatest risk of cranial haemorrhage is in infants born to women whose haemophilia gene status is unknown.…”

“…Women have a higher risk of bleeding following CS and after two or more CS there is significant increase in the risk of placenta accreta 33. In some parts of the world, especially where women have larger families, vaginal birth is the preferred mode of birth, and is more socially acceptable and more suitable for families willing for large number of children 34. However, assisted or instrumental birth with rotational (high cavity) forceps and especially vacuum (Ventouse or Kiwi Cup) should be avoided in infants knows to have bleeding disorders as the risk of ICH and ECH is unacceptably high.…”

Neonatal Hemostatic Disorders: Issues and Challenges

“…61 There is universal agreement of avoidance of instrumental delivery, fetal scalp electrodes, and blood sampling in pregnancies at risk of carrying an affected fetus. 49,51,[60][61][62] As previously stated, cranial bleeding appears to be less frequently reported following elective cesarean delivery; however, it does not eliminate the risk altogether. 51,61,63 Consequently, management decision regarding delivery should take into consideration maternal and fetal hemophilia status, bleeding risks, prior labor experience, and mothers' reproductive expectations.…”

“…Controversy exists regarding the optimal mode of delivery for carriers expecting a child known to have or being at risk of hemophilia, since it has consequences both for the mother and the child. 49,59,60 In a recent meta-analysis, compared with vaginal delivery, planned cesarean section (CS) was reported to have lower risk of ICH (odds ratio: 0.34 [95% confidence interval: 0.14-0.83, p ¼ 0.018]). 61 There is universal agreement of avoidance of instrumental delivery, fetal scalp electrodes, and blood sampling in pregnancies at risk of carrying an affected fetus.…”