OC 70.4 - Real-world management of delivery in a large cohort of haemophilia carriers: focus on maternal and neonatal outcomes.

Wednesday, July 13, 2022

11:00 AM – 11:15 AM

Location: ExCel Center, S11A

Presentation Format: In-Person

Presenting Author(s)

BP

Berardino Pollio

SSD Medicina Trasfusionale, Dirigente Medico Ematologo
Regina Margherita Children Hospital Azienda Ospedaliero-Universitaria Città della Salute e della Scienza
Torino, Piemonte, Italy

Co-Author(s)

IR

Irene Ricca

SSD Medicina Trasfusionale Materno-Infantile e Traumatologica
AOU Città della Salute e della Scienza di Torino, Presidio OIRM-S. Anna
Torino, Piemonte, Italy
NS

Niccolo' Spano

paediatric resident
Turin University of medicine
Torino, Piemonte, Italy
CL

Claudia Linari

biologist
Città della Salute e della Scienza di Torino
Torino, Piemonte, Italy
UR

Ugo Ramenghi

Professor of pediatric
Turin University of medicine
Torino, Piemonte, Italy
FQ

Federica Quaglino

SSD Medicina Trasfusionale Materno-Infantile e Traumatologica
AOU Città della Salute e della Scienza di Torino, Presidio OIRM-S. Anna
Turin, Piemonte, Italy
RA

Roberto Albiani

SSD Medicina Trasfusionale Materno-Infantile e Traumatologica
AOU Città della Salute e della Scienza di Torino, Presidio OIRM-S. Anna
Turin, Piemonte, Italy

Background: The optimal modality of delivery in hemophilia carriers s still a matter of debate.

Aims: We evaluated the maternal and neonatal outcomes in a real-world large cohort of haemophilia carriers.

Methods: Our work is a single-institution retrospective observational study. Family history of haemorrhagic disease, prenatal diagnosis, planned and effective mode of delivery, maternal and neonatal haemorrhages were collected from clinical records and parental interviews. Statistical analyses were performed using STATA/SE 16.1.

Results: 59 children with mild, moderate, or severe haemophilia born between 1999 and 2020 and 53 carriers were included. Prenatal diagnosis was performed in 11 cases and in 7 cases the diagnosis was defined as “suspected” according to the family history. Sporadic cases were 34, familiar cases were 25. Vaginal delivery was performed in 29 cases of which 2 induced delivery and 1 instrumental delivery with vacuum. C-section was performed in 29 cases, of which 9 emergency c-sections. 2 women were treated with blood transfusion for postpartum haemorrhage following emergency C-section delivery. Children with severe haemophilia were more likely to be born by c-section (p=0,022). 2 cephalohaematomas were diagnosed after vaginal delivery without instruments, while no child was affected by intracranial haemorrhage at the time of birth. 7 minor haemorrhages in sampling sites were found. There was no significant difference in frequency for cephalohaematomas between vaginal delivery and C-section (p=0,491). Treatment with an infusion of FVIII was requested in 3 cases.

Conclusion(s): Natural childbirth in our experience appears safe for both the mother and the fetus in sporadic cases. Although there are no evidence-based recommendations, the elective cesarean section before labor was the preferred modality of delivery in familiar cases. Prenatal diagnosis of haemophilia is a maternal risk factor for cesarean delivery.