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

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Mode of delivery in hemophilia : Vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and major bleeds. / Andersson, Nadine G; Chalmers, Elizabeth A; Kenet, Gili; Ljung, Rolf; Mäkipernaa, Anne; Chambost, Hervé; PedNet Haemophilia Research Foundation.

I: Haematologica, 21.02.2019.

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Andersson, Nadine G ; Chalmers, Elizabeth A ; Kenet, Gili ; Ljung, Rolf ; Mäkipernaa, Anne ; Chambost, Hervé ; PedNet Haemophilia Research Foundation. / Mode of delivery in hemophilia : Vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and major bleeds. I: Haematologica. 2019.

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TY - JOUR

T1 - Mode of delivery in hemophilia

T2 - Haematologica-The Hematology Journal

AU - Andersson, Nadine G

AU - Chalmers, Elizabeth A

AU - Kenet, Gili

AU - Ljung, Rolf

AU - Mäkipernaa, Anne

AU - Chambost, Hervé

AU - PedNet Haemophilia Research Foundation

N1 - Copyright © 2019, Ferrata Storti Foundation.

PY - 2019/2/21

Y1 - 2019/2/21

N2 - 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 ClinicalTrials.gov at NCT02979119.

AB - 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 ClinicalTrials.gov at NCT02979119.

U2 - 10.3324/haematol.2018.209619

DO - 10.3324/haematol.2018.209619

M3 - Article

JO - Haematologica-The Hematology Journal

JF - Haematologica-The Hematology Journal

SN - 1592-8721

ER -