It is well established that the clinical management of pregnant women with congenital bleeding disorders (CBDs) is challenging, as healthcare providers, including obstetricians, hematologists and other specialists must consider potential varying complications, including levels of bleeding risk for both mother and child. There are therefore several intrapartum precautions and fetal restrictions, such as the use of mid-cavity forceps, that are designed and often advised to mitigate bleeding risks associated vaginal delivery in pregnant women with CBDs.
A team of researchers from Ireland sought to better understand the effect of CBD-related restrictions on maternal and neonatal outcomes, including the rate of emergency Cesarean sections. The study was led by Dr. Bridgette Byrne, Royal College of Surgeons in Ireland, Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital in Dublin. Byrne and her team performed a retrospective review of obstetric outcomes within a large group of women with CBDs who had received care at a specialized obstetric/hematologic antenatal clinic over a six-year period.
Included in the review were 76 patients, encompassing 94 pregnancies. Of these, 20 patients were carriers of hemophilia, 28 had low von Willebrand Factor levels or VWD, eight had other coagulation factor deficiencies, and 20 had an unspecified bleeding disorder. Of the 94 pregnancies, 83 (88.3%) had fetal precautions advised, while 11 (11.7%) did not. There was no significant difference between the groups in the numbers of non-labor elective Cesarean section, emergency Cesarean section not in labor, or emergency Cesarean section in labor. Of the 63 patients who went into labor with fetal precautions, six (10%) underwent Cesarean section because of the precautions. Primary postpartum hemorrhage was noted in nine patients (12.2%) overall.
While Byrne and her team acknowledge the study’s limitations, they also note that these findings could be instructive as it relates to planning for labor and delivery.
“This study is not of sufficient size to comment on maternal and fetal safety with different modes of delivery in different CBDs. It does show, however, that 10% of women who labor with fetal precautions in place are delivered by Cesarean section because of these restrictions. This is important information when counselling this group of women about mode of delivery,” concluded the authors.
The study, “The Impact of Fetal Restrictions on Mode of Delivery in Women with Inherited Bleeding Disorders,” was published in the European of Journal Haematology.
Source: Hematology Advisor, July 21, 2020