Current practices regarding newborn intracranial haemorrhage and obstetrical care and mode of delivery of pregnant haemophilia carriers: a survey of obstetricians, neonatologists and haematologists in the United States, on behalf of the National Hemophilia Foundation's Medical and Scientific Advisory Council

We undertook this survey to determine institutional practices of obstetrici ans, neonatologists and haematologists regarding care of pregnant haemophil ia carriers and newborns with haemophilia and intracranial haemorrhage (ICH ). Our purpose was also to determine whether institutions had written guide lines to manage such patients. Questionnaires were sent to 1000 obstetricia ns and through the Haemophilia Treatment Centres (HTC) to 180 paediatric ha ematologists and 180 neonatologists, each representing an institution. Twenty-three per cent of obstetricians, 22% of neonatologists and 16% of pa ediatric haematologists returned completed surveys. Over 94% of the respond ents had no written guidelines for management of pregnant haemophilia carri ers or their newborns or for neurologic assessment of newborns. For known h aemophilia carriers, 57% of the obstetricians routinely preferred vaginal d elivery and 11% preferred caesarean section. Availability of perinatal serv ices influenced prenatal management (P < 0.05). In term newborns with docum ented ICH, only 23% of neonatologists would evaluate for haemophilia, where as in pre-term newborns with ICH, this number dropped even further to 3%. F or all newborns with haemophilia, 40% preferred routine administration of c lotting factor concentrates (CFC) immediately following birth to offset the trauma of delivery and 89% of paediatric haematologists favoured early pro phylaxis with CFC. Guidelines are needed for management of pregnant haemophilia carriers as we ll as newborns with haemophilia. Physicians need to be made aware that ICH may be a presenting sign of haemophilia in both term as well as pre-term ne wborns, so that appropriate therapy can be instituted early in the event of a bleed.