Mode of delivery and risk of intracranial haemorrhage in newborns with severe haemophilia A: a multicentre study in Gulf region

摘要

Introduction: The optimum mode of delivery in a known carrier of a haemophilia A is still an issue of debate. Aim: This study was conducted to report a multicentre experience in Gulf Cooperation Council GCC) on the incidence of intracranial haemorrhage ICH) in newborns with severe haemophilia A delivered by different modalities. Methods: We have conducted a retrospective/prospective multicentre cohort study including a total of seven hospitals distributed in four GCC countries between 1998 and Jan 2015. A total of 163 patient with severe haemophilia A factor VIII <1%) were enrolled in this study, age ranged between 2 weeks to 18 years. Results: Most of the patients were born by spontaneous vaginal delivery SVD) 131, 80.4%), whereas 26 patients 16%) were born by CS and only six patients were born by instrumental delivery 3.7%), five of them by vacuum and one was delivered using forceps. Five out of 163 patients developed ICH during the first 2 weeks of life 3.1%). Two of them were born by SVD 2/131; 1.5%) and two were born by instrumental delivery 2/6; 33.3%). Only one patient among those who were born by caesarean section developed ICH 1/26; 3.8%). Assisted vaginal delivery was associated with a significant risk of ICH, in comparison to SVD and CS P = 0.0093). Conclusion: Normal vaginal delivery is still considered a safe journey through the birth canal for haemophilic newborns particularly in this area of the world. Larger prospective studies might be needed to define an evidence-based optimal mode of delivery for the haemophilia carrier expecting an affected child.