MIAMI – Obstetricians may be lacking adequate information on the proper management of pregnancies affected by epidermolysis bullosa, findings from a survey suggested.
Of 195 Australian obstetricians who responded to the survey, 111 (57%) said information on epidermolysis bullosa (EB) is needed in prenatal clinics, Dr. Lizbeth Intong reported at the annual meeting of the American Academy of Dermatology.
Of the 195 (7%) respondents, 14 had encountered a pregnancy affected by EB; only 6 (43%) of the 14 said they conducted a literature search for information on the disease to help in their patient management, and only 4 (29%) comanaged their EB patients with a dermatologist, said Dr. Intong, a dermatologist at St. George Hospital in Sydney.
Mothers who had given birth to babies with EB, and mothers with EB who had given birth were also surveyed as part of the study. A total of 58 mothers who had babies with EB responded, and they had a total of 130 babies, including 67 (52%) born with EB.
Most babies were born by normal vaginal delivery, with a 5:1 ratio of normal vaginal deliveries to cesarean sections; the more severe the EB type, the more blistering was seen at birth.
Forty-one mothers with EB also responded to the survey. These mothers gave birth to a total of 104 babies, including 50 (48%) born with EB, mostly by normal vaginal delivery. In this group there was a 4:1 ratio of normal vaginal deliveries to C-sections.
Two of the mothers with EB reported that their condition worsened during pregnancy, and two said it improved; EB-related problems that were reported included blistering at the site of the adhesive tape used during an epidural and nipple blistering during breastfeeding, which led to a switch from breastfeeding to bottle feeding “There is an obvious need for information about EB in [prenatal] clinics,” Dr. Intong said, adding that based on the survey results, she now advises that normal vaginal delivery (no forceps or vacuum assistance) is generally safe, that C-section should be considered in severe cases to reduce birth trauma, that nonadhesive tapes and dressings be used on mothers with EB, and that mothers with EB receive counseling about proper care during breastfeeding, such as the use of nipple shields to help prevent blistering.
Dr. Intong said she had no conflicts of interest to disclose.