MOde of delivery in women with inherited bleeding disorders

Abstract

Women with inherited bleeding disorders (IBD) and their infants are at risk of bleeding complications at the time of childbirth. The aim of this study was to report mode of delivery and rates of postpartum haemorrhage (PPH) and intracranial haemorrhage (ICH) in a cohort of women with IBD. Methods 35 women with IBD who attended a specialised obstetric haematology clinic and delivered between January 2009 and June 2011 were identified. Charts were reviewed and patient demographics, mode of onset of labour and delivery, anaesthesia, PPH and ICH in neonates were recorded. Results The following bleeding disorders were identified, 16 Von Willebrands disease, 3 Haemophilia A, 2 Christmas disease, 7 Haemophilia carriers, 1 Factor V, 1 Factor XII deficiency, 2 combined deficiency disorder and 3 had bleeding disorders of unknown aetiology with a positive family history. The mean age was 30.3 years (+/- 7 SD) and the mean gestational age at delivery was 39 weeks (+/- 1 SD). 54 % were primparous. Labour began spontaneously in 16 women, 13 were induced and 6 had an elective caesarean section (CS) for obstetric indications. 13 women had an epidural, six spinal and three received general anaesthesia. 21 women had a spontaneous vaginal delivery, 5 required assisted delivery and 3 and 6 women had emergency and elective CS respectively. The third stage was actively managed and there was no PPH. There was no case of ICH in the neonate. Conclusion Vaginal delivery was achieved safely in 90% of women with IBD in the absence of obstetric indications for elective CS and remains a feasible option in this group of women.