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Abstract
Background Haemophilia and von Willebrand’s disease (vWD) are inherited bleeding disorders that present significant obstetric challenges, including risks of neonatal intracranial haemorrhage and postpartum haemorrhage (PPH). The ideal mode of delivery can also be controversial.
Aims To assess the obstetric management of haemophilia carriers and vWD patients within the Leeds Teaching Hospitals Trust and to identify any maternal/neonatal complications.
Method 10 year retrospective audit of 24 women (10 haemophilia carriers; 14 vWD patients) identified from the Obstetric-Haematology Clinic between 2001 and 2011 in Leeds. Maternal and neonatal management was compared to the BJH guidelines.1, 2
Results From the 10 haemophilia patients, 9 had antenatal gender identification (7 were male and 5 affected). There were 4 PPHs in the vWD group (not exceeding 800 mls). Amongst the haemophilia patients 9 had a normal delivery and 1 had an elective C-section. In the vWD group 11 had normal deliveries, 2 had elective C-sections and 1 had a rotational forceps. 1 fetal blood sample was performed in the haemophilia group and 2 fetal scalp electrodes were used in the vWD group (both contraindicated). There was no neonatal morbidity amongst the haemophiliac patients but 4 babies in the vWD group sustained bruising/prolonged bleeding which were forceps and im vitamin K-related respectively.
Conclusions Vaginal delivery was the preferred mode of delivery and was not associated with any significant maternal or neonatal morbidity. Managing these patients through a multidisciplinary approach optimises their antenatal care and ensures that an intrapartum management plan is discussed and clearly documented.
References
Lee C, Chi C, Povard S et al, The obstetric and gynaecological management of women with inherited bleeding disorders – review with guidelines produced by the taskforce of UK Haemophilia Centre Doctors Organisation. Haempohilia 2006;12:301–36.
Calmers E, Williams M, Brennand J et al, Guideline on the management of haemophilia in the fetus and neonate. British Journal of Haematology 2011;154:208–15.