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Haematologica. 2019 Feb 21. pii: haematol.2018.209619. doi: 10.3324/haematol.2018.209619. [Epub ahead of print]

Mode of delivery in hemophilia: Vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and major bleeds.

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Centre for Thrombosis and Hemostasis, Skane University Hospital, Malmö, Sweden;
Department of Haematology, Royal Hospital for Children, Glasgow, UK.
National Hemophilia Center, Sheba Medical Center, Tel Aviv University, Israel.
Lund University, Department of Clinical Sciences, Lund, Sweden.
Children's Hospital and Hematology, Helsinki University Hospital, Finland.
Pediatric Haematology Oncology Dept, Children Hospital La Timone, Aix Marseille University.


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 multicentre study. Vaginal delivery was performed in 68.3% (n=633) and Cesarean section in 31.6% (n=293). Twenty intracranial hemorrhages (2.2%) and forty-four other major bleeds (4.8%) occurred. Intracranial hemorrhages occurred in 2.4% of neonates following vaginal delivery compared to 1.7% after Cesarean section (P=ns); other major bleeds occurred in 4.2% born by vaginal delivery and in 5.8% after Cesarean section (P=ns). Further analysis of subgroups (n=813) identified vaginal delivery with instruments being a significant risk factor for both intracranial hemorrhages and major bleeds (RR 4.78-7.39, p<0.01); no other significant differences were found between vaginal delivery without instruments, Cesarean section prior and during to labor. The frequency for intracranial hemorrhages and major bleeds for a planned Cesarean section and a planned vaginal delivery showed no significant difference. Children with a family history of haemophilia (n=466) were more likely born by Cesarean section (35.8% vs. 27.6%) but no difference in the rate of intracranial hemorrhages or major bleeds were found. In summary, vaginal delivery and Cesarean section carry similar risks of intracranial hemorrhages and major bleeds. The PedNet Registry is registered at at NCT02979119.


Blood Coagulation and Fibrinolysis; Disorders of Coagulation and Fibrinolysis; Hemophilia; Intracranial hemorrhage; Mode of delivery in hemophilia

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