Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest Study.

Hugon-Rodin, Justine; Carrière, Camille; Claeyssens, Ségolène; Trillot, Nathalie; Drillaud, Nicolas; Biron-Andreani, Christine; Lavenu-Bombled, Cécile; Wieland, Anna; Flaujac, Claire; Stieltjes, Natalie; Lebreton, Aurélien; Brungs, Thomas; Hegglin, Andrea; Fiore, Mathieu; Desconclois, Céline; Gay, Valérie; Tardy-Poncet, Brigitte; Beurrier, Philippe; Barbay, Virginie; Chamouni, Pierre; ... (2023). Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest Study. Journal of thrombosis and haemostasis, 21(8), pp. 2126-2136. Wiley-Blackwell 10.1016/j.jtha.2023.04.035

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BACKGROUND

Women with hereditary fibrinogen disorders (HFDs) seem to be at increased risk of adverse obstetrical outcomes, but epidemiologic data are limited Patients/methods: We conducted a retrospective and prospective international study to determine the prevalence of pregnancy complications, the modalities and management of delivery, and the postpartum events.

RESULTS

A total of 425 pregnancies were investigated from 159 women (49 hypofibrinogenemia, 95 dysfibrinogenemia, 15 hypodysfibrinogenemia). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) in a late miscarriage and 4 (0.9%) in an intrauterine fetal death. Prevalence of live birth was similar among the types of HFD (p=0.31). Obstetrical complications were observed in 54 (17.3%) of live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most 56deliveries were spontaneous (218, 74.1%) with a vaginal non-instrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, while 71 (16.6%) and 129 (44.9%) were under general or no anesthesia, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) of pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were more at risk of bleeding during the pregnancy (p=0.04).

CONCLUSIONS

Compared to European epidemiologic data, we did not observe a greater frequency of miscarriage while retroplacental hematoma, postpartum hemorrhage and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on management of pregnancy in HFDs.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory

UniBE Contributor:

Wieland-Greguare-Sander, Anna

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1538-7836

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Pubmed Import

Date Deposited:

15 May 2023 12:12

Last Modified:

21 Jul 2023 00:14

Publisher DOI:

10.1016/j.jtha.2023.04.035

PubMed ID:

37172732

Uncontrolled Keywords:

Hypofibrinogenemia delivery dysfibrinogenemia miscarriage pregnancy

BORIS DOI:

10.48350/182538

URI:

https://boris.unibe.ch/id/eprint/182538

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