Feedback00:52 Intro - very important topic02:00 Case Study: Haem/Obstetrics clinic, Family Hx Severe Haemophilia A, 12wks pregnant04:15 Clotting changes in pregnancyIncreased: FVII, FVIII, FX, VWF, FibrinogenDecreased: FXIII Protein S, Antithrombin Stable: FIX07:57 New born to 6 months clotting:FVIII (8) similar to adultFIX (9) lower and rises after 6 months09:30 GUEST STARRINGDr. William Jones MRCP FRCA St6 Anaesthetics SpR with a special interest in Obstetrics10:25 Will speaks about Delivery, Instrumentations, Anaesthetics/Analgesia aspects of Obstetrics.13:28 David asks about big needles, bleeding risks and Will explains Spinal vs Epidural15:40 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 outPlacental traction?Cord clampingThanks 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 @ 20wksCheck FVIII/FIX at booking, pre-procedure, 28wks and 34 wksMDT (haematologist, anaesthetist, obstetrician, nenonatolgist, lab) haemophilia centre, 24hr access to haenostasis labClear delivery plan by 37 weeks3/ Labour/deliverAvoid instrumentationRisk of bleeding: Forceps > Ventouse > Vaginal > C Section (high mortality for mother)FVIII >50 IU/dL : TXAFVIII <50 IU/dL: TXA + DDAVP (avoid in pre-eclampsia)Neuro-axial anaesthesia needs FVII > 80 IU/dLAvoid faetal blood sampling, fetal scalp electrodes, ventouse, forceps, external cephalic version4/ Post partumUncomplicated: maintain FVIII >50 for three daysComplicated/C-Section: maintain FVIII >50 for five daysContinue TXA till minimal Lochia If FVIII >50 needs VTEpNewborn: 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 study44:20 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. Email: [email protected] Insta: BasicstoBrilliance X: @basics_2_brill Send us your feedback!

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