title: Mode of delivery and risk of intracranial haemorrhage in newborns with severe haemophilia A: a multicentre study in Gulf region.
abstract: BACKGROUND
  The optimum mode of delivery in a known carrier of a haemophilia A is still an issue of debate.
  
  
  OBJECTIVE
  This study was conducted to report a multicentre experience in Gulf Cooperation Council (GCC) on the incidence of intracranial haemorrhage (ICH) in newborns with severe haemophilia A delivered by different modalities.
  
  
  METHODS
  We have conducted a retrospective/prospective multicentre cohort study including a total of seven hospitals distributed in four GCC countries between 1998 and Jan 2015. A total of 163 patient with severe haemophilia A (factor VIII <1%) were enrolled in this study, age ranged between 2 weeks to 18 years.
  
  
  RESULTS
  Most of the patients were born by spontaneous vaginal delivery (SVD) (131, 80.4%), whereas 26 patients (16%) were born by CS and only six patients were born by instrumental delivery (3.7%), five of them by vacuum and one was delivered using forceps. Five out of 163 patients developed ICH during the first 2 weeks of life (3.1%). Two of them were born by SVD (2/131; 1.5%) and two were born by instrumental delivery (2/6; 33.3%). Only one patient among those who were born by caesarean section developed ICH (1/26; 3.8%). Assisted vaginal delivery was associated with a significant risk of ICH, in comparison to SVD and CS (P = 0.0093).
  
  
  CONCLUSIONS
  Normal vaginal delivery is still considered a safe journey through the birth canal for haemophilic newborns particularly in this area of the world. Larger prospective studies might be needed to define an evidence-based optimal mode of delivery for the haemophilia carrier expecting an affected child.
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.|Division of Hematology, Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: H F
authors.initials: HF
authors.lastname: Nazir
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: T
authors.initials: T
authors.lastname: Al Lawati
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: I
authors.initials: I
authors.lastname: Beshlawi
authors.affiliation: Department of Pediatrics, Mubarak Alkabeer Hospital, Kuwait, Kuwait.
authors.forename: S
authors.initials: S
authors.lastname: AlSharidah
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.|Division of Hematology, Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: M
authors.initials: M
authors.lastname: Elshinawy
authors.affiliation: Pediatric Hematology Department, Children Hospital, King Saud Medical City, Riyadh, Saudi Arabia.
authors.forename: F
authors.initials: F
authors.lastname: Alkasim
authors.affiliation: Department of Pediatrics, Tawam Hospital, Alain, UAE.
authors.forename: M F
authors.initials: MF
authors.lastname: Khanani
authors.affiliation: Hereditary Blood Disorders Center, King Abdullah Medical City, Madinah, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Tarawa
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: T
authors.initials: T
authors.lastname: Al Subhi
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: A
authors.initials: A
authors.lastname: Alrawas
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: W
authors.initials: W
authors.lastname: Al Riyami
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: S
authors.initials: S
authors.lastname: Al Kindi
authors.affiliation: Radiology Department, Diwan Medical Complex, Muscat, Oman.
authors.forename: K
authors.initials: K
authors.lastname: Al Saadi
authors.affiliation: Department of Haematology & Transfusion Medicine, Royal Hospital, Muscat, Oman.
authors.forename: S
authors.initials: S
authors.lastname: Al-Lamki
authors.affiliation: Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.|Division of Hematology, Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Y
authors.initials: Y
authors.lastname: Wali
mesh_terms: D000293:Adolescent; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000453:epidemiology*; D008297:Male; D008877:Middle East / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk
keywords: Gulf region; haemophilia A; intracranial haemorrhage; mode of delivery