Mode of Birth and Bleeding Outcomes in Pregnancies at Risk of Fetal and Neonatal Alloimmune Thrombocytopenia: A Retrospective Cohort Study

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Abstract
Objective: To assess the impact of vaginal deliveries on the occurrence of intracranial haemorrhage (ICH) in subsequent pregnancies with Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT). Design: Retrospective data collection. Setting: Sanquin Diagnostic Services, the national institute for diagnostic FNAIT‐testing and Leiden University Medical Center, the national referral centre for FNAIT‐management. Population: 73 subsequent pregnancies with FNAIT; 16 high‐risk and 57 standard‐risk. Methods: All women with a confirmed index pregnancy with alloantibodies against human platelet antigens (HPA) and a subsequent HPA‐incompatible pregnancy between March 1992 and February 2026 were included. Main Outcome Measures: Severe bleeding or other bleeding symptoms in neonates, associated with mode of birth. Results: There were 63 index pregnancies and 73 subsequent pregnancies, of which 72 (99%) received weekly intravenous immunoglobulin (IVIG). In the high‐risk group ( n = 16), there were 10 caesarean sections, of which four neonates had a platelet count below 50 × 10 9 /L. Of the six vaginal deliveries, two neonates had a platelet count below 50 × 10 9 /L. There were no bleeding complications. In the standard‐risk group ( n = 57), there were 19 caesarean sections of which eight neonates had a platelet count below 50 × 10 9 /L. One ICH was identified antenatally before IVIG initiation, and three neonates developed petechiae or haematomas. Of 38 vaginal deliveries, 13 neonates had a platelet count below 50 × 10 9 /L and one neonate developed petechiae. Overall (standard‐ or high‐risk), no ICH was detected in neonates delivered vaginally ( n = 44). Conclusion: No ICH was observed in HPA‐alloimmunised women who had a vaginal delivery and antenatally treated with IVIG.

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