The birth of a newborn is an emotional event for any parent. The happiness of a family depends on the health of the children. But, when a child is born with a disorder, the stigma not only affects the individual but also the family, peers, acquaintances, and society itself. Rare bleeding disorders like Haemophilia is one such condition, and haemophilic newborns present risk factors and patterns of bleeding that are challenging and life threatening.

The dawn of potentially curative strategies for Haemophilia, advances in gene diagnosis, and the availability of safer clotting factor concentrates for treatment and prophylaxis makes it imperative that newborns with Haemophilia be appropriately diagnosed and managed. This can avoid the crippling consequences of Haemophilia and avail them a better quality of life. The knowledge of the carrier status prior to pregnancy can also help in choosing the available conception options and it may help in minimising bleeding risks during pregnancy for both the carrier mother and affected baby.

One optimal method to increase awareness is genetic counselling. Although genetic analysis has both practical and ethical considerations, it remains the ideal method of carrier identification, and carriers of Haemophilia should be informed about genetic risks, suitable reproductive options, and methods of prenatal testing. They must be recommended an appropriate plan to manage prepartum, partum, and neonatal care. Prenatal counselling, foetal sexing, and foetal DNA analysis allow couples to opt for or against the pregnancy. It can be performed either by ultrasound (US) examination or by testing circulating cell-free DNA from maternal blood for Y-chromosome-specific sequences.

The optimum mode of delivery in such patients is also a debated issue, and the risks and benefits for both vaginal delivery (VD) and caesarean section (CS) are argued. However, the possible precautions to avoid traumatic delivery should be practiced under a multidisciplinary team.

One of the most challenging conditions among haemorrhagic newborns is intracranial haemorrhage (ICH). It can occur regardless of the mode of delivery or the severity of Haemophilia. Instrumental delivery was found to be the single one risk factor for head bleeding in haemophilic babies. The knowledge of the mother’s carrier status or, optimally, the Haemophilia status of the baby (severe ICH in babies with weight less than 1500 grams), and early screening can help to avoid the risk factors for ICH.

Considering that factor replacement for newborns with inherited bleeding disorders is a debated issue, it is a personal choice in the absence of any guidelines. Some clinicians are inclined towards early prophylactic measures in neonates with risks while some believe in aggressive management and choose to administer prophylactic treatment after a traumatic or prolonged labour to babies strongly suspected or confirmed as having Haemophilia.

The overall perinatal management of Haemophilia should include the following measures:

  1. Pregnant Haemophilia carriers along with their high-risk babies should have access to Haemophilia centres in conjunction with multidisciplinary services
  2. Haemophilia carriers should be informed about genetic risks, available reproductive options, and methods of prenatal testing, and should be provided with an appropriate management plan for prepartum, postpartum, and neonatal care
  3. Bleeding risk assessment for carrier mothers should be performed in advance of the expected date of delivery
  4. The use of instruments such as vacuum devices, forceps and foetal scalp monitors should be avoided during the vaginal delivery of Haemophilia carriers
  5. The evaluation of bleeding disorders among infants with ICH and severe bleeding episodes, term or preterm, should be performed as early as possible
  6. Management education for all specialties involved, including obstetricians, paediatricians, haematologists, neonatologists, and general practitioners to ensure safe delivery for the carrier mother, and suitable diagnosis and management for the haemophilic baby