CO38 | Management of pregnancy, delivery, and postpartum in Italian carriers and women with hemophilia A and B

S. Linari¹, B. Pollio², A. Ferretti³, M. Napolitano⁴, E. Grandone⁵, S. Siboni⁶, Ab. Aru⁷, E. Bertoni⁸, C. Biasoli⁹, I. Cantori¹⁰, P. Di Gregorio¹¹, G. Lassandro¹², G. Sottilotta¹³, A. Strangio¹⁴, Mr. Villa¹⁵, A. Rocino¹⁶, G. Castaman¹ | ¹Center for Bleeding Disorders and Coagulation, Careggi University Hospital, Firenze; ²Regional Reference Center for Inherited Bleeding and Thrombotic Disorders, Transfusion Medicine, Regina Margherita Children Hospital, Turin; ³Center for Hemorrhagic and Thrombotic Diseases, IRCCS A. Gemelli University Hospital Foundation, Roma; ⁴Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo; ⁵Thrombosis and Hemostasis Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo; ⁶Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan; ⁷Pediatric Onco-Hematology Center, Microcitemico Hospital Cagliari; ⁸Pediatric Oncohematology and Bone Marrow Transplant “BMT” Unit, Children’s Hospital, Spedali Civili, Brescia; ⁹Hemophilia and Transfusion Center, Bufalini Hospital, Cesena; ¹⁰Hemophilia Center, Department of Transfusion Medicine, Hospital of Macerata; ¹¹Transfusion Medicine Department, SS. Annunziata Hospital, Chieti; ¹²B. Trambusti General and Specialised Pediatrics Unit, Giovanni XXIII Hospital, University of Bari; ¹³Hemophilia Center, Grande Ospedale Metropolitano, Reggio Calabria; ¹⁴Center for Hemorrhagic and Thrombotic Disorders, Pugliese Ciaccio Hospital, Catanzaro; ¹⁵Hemophilia and Thrombosis Center, Haematology Unit, Ospedale del Mare Hospital, Naples; ¹⁶Past President of the Italian Association of Hemophilia Centers, Italy

Background and Aims: Pregnancy management of carriers/women with hemophilia has four main objectives: preconception and prenatal care, reduction of maternal bleeding, choice of mode of delivery to reduce fetal/neonatal bleeding, and postpartum care. The optimal factor VIII/IX level at the time of delivery and the mode of delivery to reduce maternal and fetal complications are still debated. The aim of this study is to share real-world clinical management in Italian hemophilia treatment centers.

Methods: In March-April 2023, members of the Italian Association of Hemophilia Centers «AICE» were invited to participate in an online survey to collect information on management of pregnancy, delivery, and postpartum in carriers/women with hemophilia.

Results: Thirty-three Centers completed the survey. Plasma FVIII/FIX levels are systematically evaluated in the third trimester and a threshold level greater than 50% is considered necessary for safe delivery and neuraxial analgesia. Overall, the hematologic counseling provided for the mode of delivery is according to obstetric indication in 73% of Centers. In women who will give birth to a known affected male fetus, 55% rely on obstetric indication, while 24% suggest spontaneous delivery and 21% planned cesarean section. Excluding those which follow obstetric indication, natural delivery and planned cesarean section are recommended respectively by 40% and 60% when prenatal diagnosis is available or by 20% and 80% when not available. All Centers agree to avoid instrumental delivery in affected male fetus or when prenatal diagnosis has not been made.

Conclusions: Multidisciplinary pregnancy management is recommended, and the choice of delivery mode is usually guided by the maximum possible protection for the newborn.