Mode of delivery in hemophilia: vaginal delivery and Cesarean section carry similar risks for intracranial hemorrhages and other major bleeds

Nadine G Andersson, Elizabeth A Chalmers, Gili Kenet, Rolf Ljung, Anne Mäkipernaa, Hervé Chambost, PedNet Haemophilia Research Foundation, Nadine G Andersson, Elizabeth A Chalmers, Gili Kenet, Rolf Ljung, Anne Mäkipernaa, Hervé Chambost, PedNet Haemophilia Research Foundation

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 following vaginal delivery compared to 1.7% after Cesarean section (P=not significant); other major bleeds occurred in 4.2% born by vaginal 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 hemorrhages and major bleeds (Relative Risk: 4.78-7.39; P<0.01); no other significant 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 vaginal 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.

Copyright© 2019 Ferrata Storti Foundation.

References

    1. Stieltjes N, Calvez T, Demiguel V, et al. Intracranial haemorrhages in French haemophilia patients (1991-2001): clinical presentation, management and prognosis factors for death. Haemophilia. 2005;11(5):452-458.
    1. Klinge J, Auberger K, Auerswald G, Brackmann HH, Mauz-Korholz C, Kreuz W. Prevalence and outcome of intracranial haemorrhage in haemophiliacs--a survey of the paediatric group of the German Society of Thrombosis and Haemostasis (GTH). Eur J Pediatr. 1999;158 Suppl 3:S162-165.
    1. Gouw SC, van der Bom JG, Marijke van den Berg H. Treatment-related risk factors of inhibitor development in previously untreated patients with hemophilia A: the CANAL cohort study. Blood. 2007;109(11):4648-4654.
    1. Kulkarni R, Lusher JM. Intracranial and extracranial hemorrhages in newborns with hemophilia: a review of the literature. J Pediatr Hematol Oncol. 1999;21(4):289-295.
    1. Ljung R, Lindgren AC, Petrini P, Tengborn L. Normal vaginal delivery is to be recommended for haemophilia carrier gravidae. Acta Paediatr. 1994;83(6):609-611.
    1. Revel-Vilk S, Golomb MR, Achonu C, et al. Effect of intracranial bleeds on the health and quality of life of boys with hemophilia. J Pediatr. 2004;144(4):490-495.
    1. Davies J, Kadir RA. Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta-analysis of the literature. Haemophilia. 2016;22(1):32-38.
    1. Richards M, Lavigne Lissalde G, Combescure C, et al. Neonatal bleeding in haemophilia: a European cohort study. Br J Haematol. 2012;156(3):374-382.
    1. Nazir HF, Al Lawati T, Beshlawi I, et al. Mode of delivery and risk of intracranial haemorrhage in newborns with severe haemophilia A: a multicentre study in Gulf region. Haemophilia. 2016;22(3):e134-138.
    1. Ljung R. The optimal mode of delivery for the haemophilia carrier expecting an affected infant is vaginal delivery. Haemophilia. 2010;16(3):415-419.
    1. James AH, Hoots K. The optimal mode of delivery for the haemophilia carrier expecting an affected infant is caesarean delivery. Haemophilia. 2010;16(3):420-424.
    1. Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. 1999;341(23):1709-1714.
    1. Kasper CK, Lin JC. Prevalence of sporadic and familial haemophilia. Haemophilia. 2007;13(1):90-92.
    1. Fischer K, Ljung R, Platokouki H, et al. Prospective observational cohort studies for studying rare diseases: the European PedNet Haemophilia Registry. Haemophilia. 2014;20(4):e280-286.
    1. Chambost H, Gaboulaud V, Coatmelec B, Rafowicz A, Schneider P, Calvez T. What factors influence the age at diagnosis of hemophilia? Results of the French hemophilia cohort. J Pediatr. 2002;141(4):548-552.
    1. Stoll BJ, Hansen NI, Bell EF, et al. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. Jama. 2015;314(10):1039-1051.
    1. Ljung RC. Intracranial haemorrhage in haemophilia A and B. Br J Haematol. 2008;140(4):378-384.
    1. Palomo Bravo A, Nunez R, Gutierrez Pimentel MJ, Nieto MD, Cos C, Perez R. Haemophilia neonates: mode of delivery and perinatal complications. Haemophilia. 2016;22(3):e225-228.
    1. Chalmers EA, Alamelu J, Collins PW, et al. Intracranial haemorrhage in children with inherited bleeding disorders in the UK 2003-2015: A national cohort study. Haemophilia. 2018;24(4):641-647.
    1. Kulkarni R, Presley RJ, Lusher JM, et al. Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System. Haemophilia. 2017;23(2):207-214.
    1. Martensson A, Tedgard U, Ljung R. Prenatal diagnosis of haemophilia in Sweden now more commonly used for psychological preparation than termination of pregnancy. Haemophilia. 2014;20(6):854-858.
    1. Witmer CM. Low mortality from intracranial haemorrhage in paediatric patients with haemophilia. Haemophilia. 2015;21(5):e359-363.

Source: PubMed

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