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

Research output: Contribution to journalArticle


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 identifier: 02979119.


  • Nadine G Andersson
  • Elizabeth A Chalmers
  • Gili Kenet
  • Rolf Ljung
  • Anne Mäkipernaa
  • Hervé Chambost
  • PedNet Haemophilia Research Foundation
External organisations
  • Royal Hospital for Sick Children, Glasgow
  • Skåne University Hospital
  • Sheba Medical Center
  • Helsinki University Central Hospital
  • La Timone University Hospital
  • Aix-Marseille University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Hematology
  • Pediatrics
Original languageEnglish
Pages (from-to)2100-2106
Number of pages7
Issue number10
Early online date2019
Publication statusPublished - 2019
Publication categoryResearch