Effective measures for the secondary prevention of hemophilia include avoidance of invasive fetal monitoring of a hemophilic fetus, avoidance of operative vaginal delivery, administration of vitamin K injection with care, availability of the factor concentrate at the time of delivery, infusion of factor VIII or IX concentrate at least once weekly for ≥ 45 weeks per year, and the use of e-Diaries to improve record keeping of hemophilia patients’ home treatment and bleeding episodes.

Effective measures for the secondary prevention of hemophilia include:

• Avoidance of invasive fetal monitoring of a hemophilic fetus^[1]
• Operative vaginal delivery should be avoided due to the risk of intracranial and extracranial hemorrhage.^[1][2]
• Vitamin K injection, via the intramuscular or subcutaneous route, should be given with a 27 gauge (or smaller) needle, and followed by the application of direct pressure for approximately 5 minutes^[1][3]
• The World Federation of Hemophilia recommends that vaccines be administered subcutaneously to patients with hemophilia^[1][4]
• An appropriately sized vial of the chosen factor concentrate should be available at the time of delivery and the staff present should be well skilled in the reconstitution and administration of the concentrate^[1]
• Cryoprecipitate, and fresh frozen plasma should not be used in newborns unless the appropriate factor concentrate is available^[1]
• Desmopressin should also be not used in newborns due to the risk of developing hyponatremia^[5][6]
• Infusion of factor VIII or IX concentrate at least once weekly for ≥ 45 weeks per year^{[7][8][9][10]}
• Emicizumab, a bispecific monoclonal antibody bridging factor IXa and Xa, can be used to replace the function of missing factor VIIIa^[11]
• Invasive orthopedic interventions to control recurrent hemarthrosis and to prevent the loss of joint function^[12][13]
• Recombinant factor VIII Fc fusion protein is associated with improved bleeding rates and lower weekly factor consumption compared to the conventional recombinant factor VIII ^[14]
• The use of e-Diaries improves record keeping of hemophilia patients’ home treatment and bleeding episodes^[15]