OC 75.2 - Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest Study

Wednesday, June 28, 2023

10:30 – 10:45 ET

Room: 510

Session Available As: On-Demand

Co-Author(s)

Justine Hugon-Rodin, MD PhD (she/her/hers)

Gynecology department, Gynaecological Endocrinology Unit, Hospital Saint Joseph, Paris Division of Gynecology, University Hospitals of Geneve, Geneva, Switzerland
Paris, Ile-de-France, France
CC

Camille Carrière

MD
Gynecology Department, Bigorre Hospital Center, Tarbes, France
Paris, Ile-de-France, France
NT

Nathalie Trillot

MD
Lille University, CHU, Department of Haematology and Clinical Haemostasis Unit, Lille, France
Lille, Nord-Pas-de-Calais, France
ND

Nicolas Drillaud

MD
CRC-MHC, CHU Hôtel-Dieu
Nantes, Pays de la Loire, France
CB

Christine Biron

MD
Haemophilia Treatment Centre, University Hospital, Montpellier, France
Montpellier, Languedoc-Roussillon, France
VB

Virginie Barbay

MD
Haemophilia Treatment Centre, University Hospital, Rouen, France
Rouen, Haute-Normandie, France
PC

Pierre Chamouni

MD
Haemophilia Treatment Centre, University Hospital, Rouen, France
Rouen, Haute-Normandie, France
CL

Cécile Lavenu Bombled

MD
Service d’hématologie biologique, Centre de Ressources et Compétences Maladies Constitutionnelles rares, CHU Bicêtre, AP-HP, Université Paris-Saclay et UMR S1176 INSERM, Le Kremlin-Bicêtre, France
Paris, Ile-de-France, France
AL

Aurélien Lebreton

MD
Service d’hématologie, CHU Clermont-Ferrand, Hôpital Estaing
Clermont Ferrand, Auvergne, France
AW

Anna Wieland

MD
Department of Hematology and Central Hematology Laboratory, Bern University Hospital, University of Bern, Switzerland
Bern, Bern, Switzerland
MM

Mouhamed D Moussa

MD
Pôle d’Anesthésie-Réanimation, CHU Lille, F59000, Lille, France.
Lille, Nord-Pas-de-Calais, France
TB

Thomas Brungs

MD
Haemostasis and Thrombosis Unit, CHR Orleans, Orleans, France
Orléans, Pays de la Loire, France
Brigitte Tardy, MD PhD

PH
Université Jean Monnet Saint-Étienne, CHU Saint-Étienne, Centre de traitement de l'hémophilie, Mines Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 SAINT-ÉTIENNE, FRANCE
St Etienne, Rhone-Alpes, France
CD

Céline Desconclois

MD
Biological Hematology, Antoine Béclère Hospital, AP-HP, Paris-Saclay University, Clamart, France
Clamart, Ile-de-France, France
PB

Philippe Beurrier

MD
Hemophilia Treatment Center, Vascular and Coagulation Clinic, University Hospital Angers, France
Angers, Pays de la Loire, France
VG

Valérie Gay

md
Hemophilia Treatment Center, Hospital, Chambéry, France
Chambery, Rhone-Alpes, France
SC

Ségolène Clasyssens

MD
Haemophilia Treatment Centre, University Hospital, Toulouse, France
Toulouse, Aquitaine, France
ED

Emmanuel De Maistre

MD
Hématologie Biologique, CHU, Dijon
Dijon, Bourgogne, France
Tomas Simurda, MD, PhD.

physician
National Centre of Hemostasis and Thrombosis, Department of Hematology and Transfusiology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin and University Hospital in Martin, Slovakia
Martin, Zilina, Slovakia

Presenting Author(s)

Alessandro Casini, MD

MD
Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
Geneva, Geneve, Switzerland

Background: Women with hereditary fibrinogen disorders (HFD) seem to be at increased risk of adverse obstetrical outcomes, but epidemiological data are limited.

Aims: To determine the prevalence of pregnancy complications, the management of delivery, the variation of fibrinogen levels and the post-partum events in women with HFD

Methods: We conducted a retrospective and prospective international study of women with hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia and at least one previous pregnancy. Women were enrolled in 19 Hemophilias Center in France, Slovakia and Switzerland.

Results: A total of 425 pregnancies were investigated from 159 patients (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, regardless of the type of fibrinogen disorder (p=0.989). Obstetrical complications were observed in 54 (17.3%) of live birth pregnancies, including retroplacental hematoma (4.1%), vaginal bleeding (3.5%) and thrombosis (1%). Most of women had a spontaneous labor (74.1%) with a vaginal non-instrumental delivery (63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, while 71 (16.6%) and 129 (44.9%) were performed under general or no anesthesia, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Post-partum hemorrhages were observed in 61 (19.9%) of pregnancies. Post-partum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were more at risk of bleeding during the pregnancy (p=0.016).

Conclusion(s): We did not observe a greater risk of miscarriage compared to the general population but found a significant risk of retroplacental hematoma as well as of post-partum haemorrhage and thrombosis. Most women did not received analgesia at the delivery due to the underlying fibrinogen disorder. Our findings highlight the urgent need for international guidance on management of pregnancy in HFD

Learning Objectives:

Upon completion, participants will be able to estimate the prevalence of live birth in women with hereditary hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia.
Upon completion, participants will be able to estimate the prevalence of retropacental, post-partum hemorrhage and thrombosis in women with hereditary hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia.
Upon completion, participants will be able to disucss strategies on delivery management, including analgesia, in women with hereditary hypofibrinogenemia, dysfibrinogenemia and hypodysfibrinogenemia