NORMAL VAGINAL DELIVERY IS TO BE RECOMMENDED FOR HEMOPHILIA CARRIER GRAVIDAE

Every child with severe or moderate haemophilia A or B, born in Sweden during the period 1970-1990, was traced in the national haemophilia r egister, all 117 case records being surveyed for mode of delivery and perinatal complications. Of the 117 deliveries, 13 were by caesarean s ection and the remaining 104 vaginal. Of the 13 caesarean sections, 2 were performed because the woman was a haemophilia carrier, the remain ing 11 (5 emergency, 6 elective) for other reasons. Neonatal complicat ions were: subgaleal or cephalic haematoma (n = 12), intracranial haem orrhage (n = 4), umbilical bleeding (n = 4), haematuria (n = 1), retro -orbital bleeding (n = 1) and abnormal bleeding after surgery, injecti on or venepuncture (n = 28). Of the 12 infants with subgalear/cephalic haematoma, 10 were delivered by vacuum extraction. Seven more infants were delivered by vacuum extraction and another 1 1 were born without abnormal bleedings after laborious (> 24 h) delivery. Of the 4 childr en with intracranial haemorrhage, all were sporadic cases of haemophil ia, 1 was a premature birth by caesarean section in the 27th week, 1 w as delivered by vacuum extraction and the remaining 2 vaginally. In th ese 4 cases there were no sequelae or only minor ones. We conclude tha t the risk of serious bleeding in conjunction with normal vaginal deli very is small, but that vacuum extraction should be avoided when deliv ering offspring of haemophilia carriers.