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. 2024 Jul;103(7):1339-1347.
doi: 10.1111/aogs.14828. Epub 2024 Mar 22.

Management and outcomes of women with low fibrinogen concentration during pregnancy or immediately postpartum: A UK national population-based cohort study

Caroline Diguisto  1   2 , Elfreda Baker  1 , Simon Stanworth  3   4 , Peter W Collins  5 , Rachel E Collis  6 , Marian Knight  1
Affiliations

Management and outcomes of women with low fibrinogen concentration during pregnancy or immediately postpartum: A UK national population-based cohort study

Caroline Diguisto et al. Acta Obstet Gynecol Scand. 2024 Jul.

Abstract

Introduction: Pregnant women with a fibrinogen level <2 g/L represent a high-risk group that is associated with severe postpartum hemorrhage and other complications. Women who would qualify for fibrinogen therapy are not yet identified.

Material and methods: A population-based cross-sectional study was conducted using the UK Obstetric Surveillance System between November 2017 and October 2018 in any UK hospital with a consultant-led maternity unit. Any woman pregnant or immediately postpartum with a fibrinogen <2 g/L was included. Our aims were to determine the incidence of fibrinogen <2 g/L in pregnancy, and to describe its causes, management and outcomes.

Results: Over the study period 124 women with fibrinogen <2 g/L were identified (1.7 per 10 000 maternities; 95% confidence interval 1.4-2.0 per 10 000 maternities). Less than 5% of cases of low fibrinogen were due to preexisting inherited dysfibrinogenemia or hypofibrinogenemia. Sixty percent of cases were due to postpartum hemorrhage caused by placental abruption, atony, or trauma. Amniotic fluid embolism and placental causes other than abruption (previa, accreta, retention) were associated with the highest estimated blood loss (median 4400 mL) and lowest levels of fibrinogen. Mortality was high with two maternal deaths due to massive postpartum hemorrhage, 27 stillbirths, and two neonatal deaths.

Conclusions: Fibrinogen <2 g/L often, but not exclusively, affected women with postpartum hemorrhage due to placental abruption, atony, or trauma. Other more rare and catastrophic obstetrical events such as amniotic fluid embolism and placenta accreta also led to low levels of fibrinogen. Maternal and perinatal mortality was extremely high in our cohort.

Keywords: fibrinogen; hemorrhage; placenta; postpartum; pregnancy.

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Conflict of interest statement

Peter W Collins has received research support from CSL Behring, Werfen, and Haemonectics, and paid consultancy from CSL Behring, Werfen, and Haemonectics. The other authors do not have any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the population. TOP, termination of pregnancy.
See this image and copyright information in PMC

References

    1. Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323‐e333. - PubMed
    1. de Lloyd L, Bovington R, Kaye A, et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth. 2011;20:135‐141. - PubMed
    1. Mavrides E, Allard S, Chandraharan E, The Royal College of Obstetricians and Gynaecologists . Prevention and management of postpartum haemorrhage: green‐top guideline no. 52. BJOG. 2017;124:e106‐e149. - PubMed
    1. Sentilhes L, Vayssière C, Deneux‐Tharaux C, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol. 2016;198:12‐21. - PubMed
    1. Collins PW, Cannings‐John R, Bruynseels D, et al. Viscoelastometric‐guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double‐blind randomized controlled trial. Br J Anaesth. 2017;119:411‐421. - PubMed