Bleeding risk the same for vaginal and Caesarean delivery
The incidence of major bleeds and intracranial haemorrhage associated with vaginal delivery and Caesarean section are similar, a new analysis of the PedNet database has shown (Haematologica 2019 Feb 21. doi: 10.3324/haematol.2018.209619).
The study included 926 neonates (786 with severe and 140 with moderate haemophilia) in hospitals in Europe and Israel. About two-thirds were delivered vaginally; children with a family history of haemophilia (n=466) were more likely to be born by Caesarean section (36% vs 28% with no family history).
There were 20 cases of intracranial haemorrhage and 44 other major bleeds. The incidence of intracranial haemorrhage was 2.4% after vaginal delivery and 1.7% after Caesarean section; the incidence of other major bleeds was 4.2% and 5.8% respectively (neither difference was statistically significant). Subgroup analysis showed that vaginal delivery with instruments increased the risk of intracranial haemorrhage and major bleeds by a factor of approximately 5 and 7. There was no difference in risk between planned vaginal delivery and planned Caesarean section.