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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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