Haemophilia A in Pregnancy

00:52 Intro - very important topic

02:00 Case Study: Haem/Obstetrics clinic, Family Hx Severe Haemophilia A, 12wks pregnant

04:15 Clotting changes in pregnancy

• Increased: FVII, FVIII, FX, VWF, Fibrinogen
• Decreased: FXIII   Protein S, Antithrombin 
• Stable: FIX

07:57 New born to 6 months clotting:

• FVIII (8) similar to adult
• FIX (9) lower and rises after 6 months

09:30 GUEST STARRING

Dr. William Jones MRCP FRCA St6 Anaesthetics SpR with a special interest in Obstetrics

10:25 Will speaks about Delivery, Instrumentations,  Anaesthetics/Analgesia aspects of Obstetrics.

13:28 David asks about big needles, bleeding risks and Will explains Spinal vs Epidural

15:40 Three Stages of Labour (briefly, very briefly) ***

‘Haematologists advise active management of the third stage’ means:

Management of process of delivering the placenta ie.

• Uterotonic - Syntometrine IM- helps reduce bleeding and get placenta out
• Placental traction
• ?Cord clamping

Thanks Will.

17:40 All the nuggets you'll need **avoiding a traumatic ICH to a baby boy**

1/ Pre-conception: baseline factor levels, family Hx (genetic mutations), discussion of treatments and risks  

2/ Antenatal: 

• Male identification (IVF, fetal free DNA testing in maternal blood from 9 wks)
• Offer CVS (11-14 wks, miscarriage risk) or Amniocentesis (15-20 wks, pre-term delivery risk)
• Faetal anomaly scan @ 20wks
• Check FVIII/FIX at booking, pre-procedure, 28wks and 34 wks
• MDT (haematologist, anaesthetist, obstetrician, nenonatolgist, lab) 
• haemophilia centre, 24hr access to haenostasis lab
• Clear delivery plan by 37 weeks

3/ Labour/deliver

• Avoid instrumentation
• Risk of bleeding: Forceps > Ventouse > Vaginal > C Section (high mortality for mother)
• FVIII >50 IU/dL : TXA
• FVIII <50 IU/dL: TXA + DDAVP (avoid in pre-eclampsia)
• Neuro-axial anaesthesia needs FVII > 80 IU/dL
• Avoid faetal blood sampling, fetal scalp electrodes, ventouse, forceps, external cephalic version

4/ Post partum

• Uncomplicated: maintain FVIII >50 for three days
• Complicated/C-Section: maintain FVIII >50 for five days
• Continue TXA till minimal Lochia 
• If FVIII >50 needs VTEp
• Newborn: PT/APTT, FVIII and FIX (cord blood),
• Newborn: Routine screen for bleed with USS, Give factor if ANY suspicion of ICH- don't wait for a scan. CT/MRI head.
• Newborn: if ICH, maintain FVIII approx 80-100 for first 3 days, then above 50 for 2 weeks and will need prophylaxis going forwards. ?Vitamin K. SC vaccinations not IM. Give parent info. 

40:15 David attempts the case study

44:20 How to write the delivery plan:

A Practical Guide to the Management of the Fetus and Newborn With Hemophilia - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Suggested-Contents-of-the-Written-Delivery-Plana_tbl2_328606634 [accessed 10 Jan 2026]

47:20 Summary 

'Basics to Brilliance: Haematology Podcast' has been accredited for CPD credit by the Royal College of Pathologists UK.

Medical professionals and clinical scientists holding career-grade positions, who are registered with any of the Royal Colleges for CPD, will be eligible to earn 1 credit for every hour of learning.

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