Mother and baby outcomes following normal delivery and caesarean (c-section) delivery in women with bleeding disorders and carriers

Review question

We looked at the evidence on mother and baby outcomes following natural vaginal delivery and caesarean (c-section) section in women with bleeding disorders and carriers. This is an uptate of a previously published review.

Background

We wanted to review the safest way to deliver babies in women with bleeding disorders and carriers and assess problems that may occur during delivery for the mother and baby with either method of delivery.

Search date

The evidence is current to: 16 February 2017.

Key results

We did not find any randomised controlled trials to analyse the safest way (either natural vaginal delivery or c-section) to deliver babies and problems encountered during delivery to mothers and babies in this population. Given the rarity of the disorders and the challenge of performing trials in pregnancy, it is unlikely that randomised controlled trials will be carried out in the future. Therefore, clinicians will need to make decisions regarding treatment using lower level evidence.

Authors' 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.

Read the full 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. This is an update of a previously published review.

Objectives: 

To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders.

Search strategy: 

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: 16 February 2017.

Selection criteria: 

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.

Data collection and analysis: 

No trials matching the selection criteria were eligible for inclusion

Main results: 

No results from randomised controlled trials were found.

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