Neonatal intracranial hemorrhage (ICH) is life threatening and can be associated with significant morbidity. It is estimated that 4% of infants with hemophilia will experience an ICH at the time of delivery. This estimate includes all modes of delivery and infants born to mothers with known and unknown carrier status. ICH prevalence is approximately 40 fold higher in neonates with hemophilia as compared to those without. Mode of delivery has been identified as a potential modifiable risk factor to prevent neonatal ICH. It is clear that complicated vaginal deliveries (i.e. use of vacuum or high forceps) are associated with higher rates of neonatal bleeding and should be avoided. Uncertainty remains regarding the use of elective caesarean versus spontaneous vaginal delivery. Caesarean delivery may not completely eliminate the risk of neonatal ICH and could increase the rate of maternal complications. Alternatively, caesarean delivery is currently recommended in other clinical situations where there is theoretically less benefit.

Dr. Rezan Adbul-Kadir, a practicing obstetrician/gynecologist, will discuss the obstetrical point of view for delivery considerations in this unique clinical situation.

Dr. Char Witmer, a practicing pediatric hematologist, will discuss the hematologic considerations for the delivery and care of a neonate who may have hemophilia.