National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, center Olympe de Gouges, CHRU de Tours, Université de Tours, Tours, France.
Acta Obstet Gynecol Scand. 2024 Jul;103(7):1339-1347. doi: 10.1111/aogs.14828. Epub 2024 Mar 22.
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.
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.
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.
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.
纤维蛋白原水平<2g/L 的孕妇属于高危人群，与严重产后出血和其他并发症相关。目前尚未确定哪些女性需要纤维蛋白原治疗。
本研究采用基于人群的横断面研究，于 2017 年 11 月至 2018 年 10 月期间在英国任何一家有顾问领导的产科单位的医院使用英国产科监测系统开展。研究纳入纤维蛋白原<2g/L 的任何妊娠或产后即刻的孕妇。本研究的目的是确定妊娠期间纤维蛋白原<2g/L 的发生率，并描述其病因、处理和结局。
在研究期间，共发现 124 例纤维蛋白原<2g/L 的患者（每 10000 例分娩 1.7 例；95%置信区间 1.4-2.0 例/10000 例分娩）。不到 5%的低纤维蛋白原病例是由预先存在的遗传性纤维蛋白原血症或低纤维蛋白原血症引起的。60%的病例是由胎盘早剥、宫缩乏力或创伤引起的产后出血引起的。羊水栓塞和除胎盘早剥以外的胎盘原因（前置胎盘、胎盘粘连、胎盘滞留）与估计出血量最大（中位数 4400ml）和纤维蛋白原水平最低相关。死亡率很高，有两名产妇因产后大出血死亡，27 例死胎和 2 例新生儿死亡。
纤维蛋白原<2g/L 通常但并非仅在因胎盘早剥、宫缩乏力或创伤导致产后出血的女性中出现。羊水栓塞和胎盘植入等其他更罕见和灾难性的产科事件也会导致纤维蛋白原水平降低。本队列的孕产妇和围产儿死亡率极高。
