Abstract Number: PB1123
Meeting: ISTH 2020 Congress
Background: Women who are carriers of haemophilia along with their offspring face a significant haemostatic challenge during the peripartum period.
Aims: Review obstetric management and pregnancy outcomes in carriers of haemophilia.
Methods: Retrospective cohort analysis of data collected from multi-disciplinary (MDT) clinic and electronic maternity notes of carriers of haemophilia, registered at the Katharine Dormandy Haemophilia and Thrombosis Centre and delivered at Royal Free Hospital.
Results: 53 carriers of haemophilia (45 A and 8 B) were identified; 17 mild, 8 moderate and 28 severe cases. Obstetric care was provided in 65 pregnancies resulting in 42 male and 23 female live-births.
Fetal gender was established in all cases by free-fetal DNA from maternal blood in the first trimester.
Invasive prenatal diagnosis (PND) was taken up by 14%. There were five affected male fetuses diagnosed and one was terminated subsequently.
Third-trimester Factor VIII and IX levels increased by 2.4 and 1.5 times, respectively (ranges: FVIII= 45-251, FIX= 53-171 iU/DL).
78% received intrapartum haemostatic cover with Tranexamic Acid (TXA). Three cases received Factor IX concentrate and another one given DDAVP in addition to TXA. Regional analgesia/anaesthesia was administered in 66% of cases.
There were no cases of fetal scalp-electrode application, fetal blood sampling or ventouse delivery.
76% of male fetuses delivered by elective LSCS; one was complicated by a non-life-threatening subdural haematoma in an affected male fetus. 22% of female fetuses delivered by LSCS, all but one were emergencies due to failure to progress or fetal distress. There were no adverse haemostatic sequale in the female neonates. Mean birth-weight was 3287g.
There were two cases of postpartum haemorrhage; both were primary due to perineal trauma and uterine angle extension at LSCS.
Conclusions: Carriers of haemophilia require special MDT obstetric care. Management guidelines should be available and observed. Antenatal knowledge of fetal gender is essential in formulating birth plans.
To cite this abstract in AMA style:Turan O, Pollard D, Abdul-Kadir R. The Obstetric Experience of Carriers of Haemophilia [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-obstetric-experience-of-carriers-of-haemophilia/. Accessed September 24, 2023.
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