title: Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta-analysis of the literature.
abstract: OBJECTIVE
  Cranial bleeding at birth can result in significant neurological morbidity in newborns with haemophilia. The optimum mode of delivery (MOD) of a potentially affected foetus remains controversial.
  
  
  OBJECTIVE
  The aim of this review is to ascertain overall incidence of cranial bleeding in newborns with haemophilia compared to the general population and the impact of MOD on rates of intracranial haemorrhage (ICH).
  
  
  METHODS
  An EMBASE/MEDLINE search using key terms revealed the relevant studies. Studies included report the incidence of cranial bleeding by MOD within a newborn population. The heterogenicity across studies was assessed using Cochrane's Q test and I(2) statistic and studies were assigned appropriate weight based on a fixed-effect model. Odds ratio (OR) is the primary effect measure.
  
  
  RESULTS
  Newborns with haemophilia are 44 times (95% CI: 34.7-57.1, P < 0.01) more likely to experience symptomatic ICH, and 8 times (95% CI: 5.38-12.6, P < 0.01) more likely to experience extracranial haemorrhage at birth, compared to the general population. In newborns with haemophilia the OR of experiencing ICH are 4.4 (95% CI: 1.46-13.7, P = 0.008) following an assisted vaginal delivery (AVD) and 0.34 (95% CI: 0.14-0.83, P = 0.018) following caesarean section (CS), compared to vaginal delivery.
  
  
  CONCLUSIONS
  Cranial bleeding occurs with a significantly higher frequency in newborns with haemophilia compared to the general population. In newborns with haemophilia, delivery by a CS is associated with the lowest risk of ICH. AVD significantly increases the risk of ICH and should be avoided.
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Davies
authors.affiliation: Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Foundation Trust, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Kadir
mesh_terms: D036861:Delivery, Obstetric; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000150:complications*
keywords: cranial bleeding; haemophilia; intracranial haemorrhage; mode of delivery; newborns