In neonates with hemophilia, neither intracranial hemorrhage rate nor rate of other major bleeding events differed based on route of delivery (vaginal vs Cesarean section), according to results published in Haematologica.

Intracranial hemorrhage and other major bleeds present major risks during delivery of neonates with hemophilia, and the optimal mode of delivery for pregnant hemophilia carriers has been a topic of debate.

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Researchers assessed bleeding outcomes in 926 neonates, 786 of whom had severe hemophilia and 140 of whom had moderate hemophilia. Vaginal delivery occurred in 68.3% of births and Cesarean section occurred in 31.6% of births. There were 20 intracranial hemorrhages (2.2%) and 44 other major bleeds (4.8%) overall.

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Following vaginal delivery, intracranial hemorrhage occurred in 2.4% of neonates, and other major bleeds occurred in 4.2% of neonates. Following Cesarean section, intracranial hemorrhage occurred in 1.7% of neonates, and other major bleeds occurred in 5.8% of neonates. The differences between neonates delivered vaginally and neonates delivered by Cesarean section were not significant.

Subgroup analysis indicated the use of instruments in vaginal delivery was a significant risk factor for both intracranial hemorrhage and other major bleeds (relative risk, 4.78-7.39; P <.01). Analyses revealed no other significant differences between vaginal delivery with or without instruments compared with Cesarean section during labor.

The rates of intracranial hemorrhage and other major bleeds were not different between planned vaginal deliveries and planned Cesarean deliveries.

Of children with a family history of hemophilia, 35.8% were born via planned Cesarean section and 27.6% were born via planned vaginal delivery. No differences in rates of intracranial hemorrhage or other major bleeds were found.

These results indicate that both modes of delivery of neonates with moderate to severe hemophilia carry similar risks for intracranial hemorrhage and major bleeds.


Andersson NG, Chalmers EA, Kenet G, et al. Mode of delivery in hemophilia: Vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and major bleeds [published online February 21, 2019]. Haemotologica. doi: 10.3324/haematol.2018.209619.

This article originally appeared on Hematology Advisor