Obstetrical and postpartum complications in women with hereditary fibrinogen disorders: A systematic literature review

Authors: Valiton, V., Hugon-Rodin, J., Fontana, P., Neerman-Arbez, M., and Casini, A.

Published: Haemophilia; 2019;25,5:747-754.

Affiliations: Faculty of Medicine, University of Geneva, Geneva, Switzerland ; Unite de Gynecologie Endocrinienne, Hopital Port-Royal, Universite Paris Descartes, Equipe EPOPE, Inserm, Paris, France ; Division of angiology and hemostasis, University Hospitals of Geneva, Geneva, Switzerland ; Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; Division of angiology and hemostasis, University Hospitals of Geneva, Geneva, Switzerland.

Abstract: INTRODUCTION: Hereditary fibrinogen disorders (HFD) are rare quantitative or qualitative fibrinogen anomalies, including afibrinogenaemia (A), hypofibrinogenaemia (H), dysfibrinogenaemia (D) and hypodysfibrinogenaemia (HD). As fibrinogen plays an essential role in pregnancy, we addressed the issue of obstetrical and postpartum complications in women with HFD. METHODS: A systematic literature review, restricted to English manuscripts, was conducted according to the PRISMA guidelines. We searched through the MEDLINE database for English articles, published from January 1985 until November 2018, focusing on pregnancy in A, H, D and HD. A total of 198 articles were identified, 15 articles were added from other sources. Overall, 213 articles were screened and 54 were included in the final analysis. RESULTS: A total of 188 pregnancies from 70 women were analysed. About half of pregnancies resulted in miscarriage; more specifically in 15 (42.9%), 36 (46.8%), 27 (42.9%) and 4 (30.8%) of A, H, D and HD patients, respectively. Preterm complications were also frequent (33.5%). Metrorrhagia, mainly in the first trimester, was observed in 21.7% of the pregnancies. Placenta abruption was reported in 5 (14.3%), 4 (5.2%), 5 (7.9%) and 1 (7.7%) of A, H, D and HD, respectively. A total of 24 (12.7%) deliveries were complicated by postpartum thrombotic events (3.2%) or postpartum haemorrhage (9.6%). A fibrinogen replacement therapy was introduced in 30% of pregnancies, as prophylaxis (81.1%) or on demand (18.9%). CONCLUSION: These results suggest that women with HFD are at high risk of obstetrical and postpartum complications. Prospective international registries may allow identifying more precisely the incidence of obstetrical and postpartum adverse outcomes and their management.