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Ferrata Storti Foundation
Haematologica 2019 Volume 104(10):2100-2106
Coagulation & its Disorders
Mode of delivery in hemophilia: vaginal delivery and Cesarean section carry similar risks for intracranial hemorrhages and other major bleeds
Nadine G. Andersson,1,2 Elizabeth A. Chalmers,3 Gili Kenet,4 Rolf Ljung,2 Anne Mäkipernaa,5 Hervé Chambost;6 on behalf of the PedNet Haemophilia Research Foundation
1Centre for Thrombosis and Hemostasis, Skåne University Hospital, Malmö, Sweden;
23
Lund University, Department of Clinical Sciences, Lund, Sweden; Department of
Haematology, Royal Hospital for Children, Glasgow, UK; 4National Hemophilia Center, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Israel; 5Children’s Hospital and Hematology, Comprehensive Cancer Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland and 6Pediatric Haematology Oncology Department, Children Hospital La Timone, AP-HM, and Aix Marseille Université, INSERM, INRA, C2VN, Faculté de Médecine, Marseille, France
ABSTRACT
The optimal mode of delivery for a pregnant hemophilia carrier is still a matter of debate. The aim of the study was to determine the incidence of intracranial hemorrhage and other major bleeds in neonates with moderate and severe hemophilia in relationship to mode of delivery and known family history. A total of 926 neonates, 786 with severe and 140 with moderate hemophilia were included in this PedNet multicenter study. Vaginal delivery was performed in 68.3% (n=633) and Cesarean section in 31.6% (n=293). Twenty intracranial hemorrhages (2.2%) and 44 other major bleeds (4.8%) occurred. Intracranial hemorrhages occurred in 2.4% of neonates fol- lowing vaginal delivery compared to 1.7% after Cesarean section (P=not significant); other major bleeds occurred in 4.2% born by vagi- nal delivery and in 5.8% after Cesarean section (P=not significant). Further analysis of subgroups (n=813) identified vaginal delivery with instruments being a significant risk factor for both intracranial hemor- rhages and major bleeds (Relative Risk: 4.78-7.39; P<0.01); no other sig- nificant differences were found between vaginal delivery without instruments, Cesarean section prior to and during labor. There was no significant difference in frequency for intracranial hemorrhages and major bleeds between a planned Cesarean section and a planned vagi- nal delivery. Children with a family history of hemophilia (n=466) were more likely to be born by Cesarean section (35.8% vs. 27.6%), but no difference in the rate of intracranial hemorrhages or major bleeds was found. In summary, vaginal delivery and Cesarean section carry similar risks of intracranial hemorrhages and major bleeds. The ‘PedNet Registry’ is registered at clinicaltrials.gov identifier: 02979119.
Introduction
The optimal mode of delivery for a known hemophilia carrier, i.e. either vaginal delivery (VD) or Cesarean section (CS), is still a matter of debate. A carrier may have an increased bleeding risk herself that might need to be taken into account in the obstetric planning but, from the fetal point of view, the key question is how the mode of delivery may impact on the risk of major bleeds, and in particular intracranial hemorrhages (ICH). These life threatening bleeds can also impair the outcome in survivors due to serious neurological sequelae.1,2 Moreover, the require-
Correspondence:
NADINE G. ANDERSSON
nadine.gretenkort_andersson@med.lu.se
Received: October18,2018. Accepted: February14,2019. Pre-published: February 21, 2019.
doi:10.3324/haematol.2018.209619
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/10/2100
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