Labour and delivery
Planning for childbirth depends on the needs of the mother and her potentially affected child.
It is difficult to measure clotting factor levels during labour, so this should be done in the last trimester of pregnancy. If factor levels are low, treatment may be given during labour to reduce the risk of excessive bleeding during and after childbirth. Clotting factor levels may also determine whether a woman can receive local anesthesia (an epidural).
There is an increased risk of head bleeding in affected male babies, especially if the labour and delivery have been prolonged or complicated. Carriers may give birth vaginally, but prolonged labour should be avoided and delivery should occur in the least traumatic way possible. Invasive monitoring techniques such as fetal scalp electrodes and fetal blood sampling should be avoided whenever possible. Delivery by vacuum extraction (Ventouse) and forceps should also be avoided.
As soon as the baby is delivered, a sample of blood from the umbilical cord should be collected to measure clotting factor levels. Injections into the baby’s muscle tissue and other surgical procedures, such as circumcision, should be avoided until the results of these blood tests are known.Postpartum care
After delivery, a carrier’s circulating clotting factor goes back down to her pre-pregnancy level and the chance of bleeding is at its highest.
Postpartum hemorrhage (PPH) is a major cause of maternal death and disability, especially in some parts of the world. Therefore carriers of haemophilia, particularly symptomatic carriers and women with haemophilia, should be cared for in an obstetric unit with close collaboration with the haemophilia team.
Certain precautions can be taken to reduce the risk of PPH: medications that keep the womb contracted can be given, and the placenta should be delivered by controlled traction of the umbilical cord. This is called "active management" for placenta delivery and has been shown to significantly reduce the risk of PPH.
Carriers are at risk of PPH for up to six weeks after childbirth and should be advised to see their doctor immediately if bleeding is excessive during this period. Treatment may be recommended as a preventative measure, especially in carriers with low clotting factor levels.