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Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study.
Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study.
- Source :
-
Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2023 Aug; Vol. 21 (8), pp. 2126-2136. Date of Electronic Publication: 2023 May 11. - Publication Year :
- 2023
-
Abstract
- Background: Women with hereditary fibrinogen disorders (HFDs) seem to be at an increased risk of adverse obstetrical outcomes, but epidemiologic data are limited.<br />Objectives: We aimed to determine the prevalence of pregnancy complications; the modalities and management of delivery; and the postpartum events in women with hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia.<br />Methods: We conducted a retrospective and prospective multicentric international study.<br />Results: A total of 425 pregnancies were investigated from 159 women (49, 95, and 15 cases of hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia, respectively). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) resulted in a late miscarriage, and 4 (0.9%) resulted in an intrauterine fetal death. The prevalence of live birth was similar among the types of HFDs (P = .31). Obstetrical complications were observed in 54 (17.3%) live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most deliveries were spontaneous (218, 74.1%) with a vaginal noninstrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, whereas general or no anesthesia was performed in 71 (16.6%) and 129 (44.9%) pregnancies, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were at an increased risk of bleeding during the pregnancy (P = .04).<br />Conclusion: Compared with 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 the management of pregnancy in HFDs.<br />Competing Interests: Declaration of competing interests A.C. reports grants and fees paid to his institution from CSL Behring, Octapharma, Sobi, LFB, Takeda, and Novo Nordisk. A.L. reports grants and fees from Octapharma and LFB. C.L.B reports receiving grants and fees from LFB, Octapharma, CSL Behring, and Novo Nordisk. M.F. reports grants and fees from LFB. All other authors have no competing interests to disclose.<br /> (Copyright © 2023 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Female
Humans
Pregnancy
Abortion, Spontaneous etiology
Fibrinogen
Gastrointestinal Hemorrhage
Hematoma complications
Prospective Studies
Retrospective Studies
Afibrinogenemia complications
Afibrinogenemia epidemiology
Hemostatics
Postpartum Hemorrhage epidemiology
Postpartum Hemorrhage etiology
Thrombosis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1538-7836
- Volume :
- 21
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of thrombosis and haemostasis : JTH
- Publication Type :
- Academic Journal
- Accession number :
- 37172732
- Full Text :
- https://doi.org/10.1016/j.jtha.2023.04.035