title: Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers.
abstract: BACKGROUND
  Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial.
  
  
  OBJECTIVE
  To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders.
  
  
  METHODS
  We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews.Date of last search of the Group's Trials Registers: 13 January 2015.
  
  
  METHODS
  Randomised controlled trials and all types of controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review.
  
  
  METHODS
  No trials matching the selection criteria were eligible for inclusion
  
  
  RESULTS
  No results from randomized controlled trials were found.
  
  
  CONCLUSIONS
  The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.
authors.affiliation: Department of Obstetrics and Gynecology, Melaka Manipal Medical College, Bukit Baru, Jalan Batu, Hampar, Melaka, Malaysia, 75150.
authors.forename: Laxminarayan
authors.initials: L
authors.lastname: Karanth
authors.forename: Sachchithanantham
authors.initials: S
authors.lastname: Kanagasabai
authors.forename: Adinegara B L
authors.initials: AB
authors.lastname: Abas
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000235:genetics; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005333:Fetus; D006579:Heterozygote; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000235:genetics