Pregnancy and post-partum
Fibrinogen and
post-partum haemorrhage
Because hypofibrinogenemia is a major and early part of post-partum
haemorrhage-associated coagulopathy, fibrinogen supplementation appears
to be one of the most promising targets for this haemostatic intervention
Anne-Sophie Ducloy-
Bouthors
Anne-Sophie Baptiste
Pole anesthésie-
réanimation, maternité
Jeanne de Flandre,
academic hospital,
avenue Oscar Lambret,
Lille, France
Cyril Huissoud
Pole Obstétrique et
Gynécologie Hôpital
Croix Rousse Hospices
Civils 103 Grande Rue
de la Croix-Rousse, Lyon,
France
Post-partum haemorrhage (PPH) is the leading
cause of maternal mortality and morbidity in
Europe and worldwide. 1,2 PPH following vaginal
delivery is due to uterine atony, retained placental
products and placental abnormal implantation,
genital-tract trauma and systemic medical
disorders. A large proportion of women who
develop PPH do not have previous identifiable
risk factors; so all women must be considered at
risk. Antenatal screening is important to detect
high risk parturients using the 4T rule: Tone,
Tissue, Trauma, and Thrombin. 3 Acquired
coagulopathy (hypofibrinogenemia and
hyperfibrinolysis) appears early in the course of
PPH, worsening its prognosis by increasing the
bleeding volume. 4,5 The diagnosis and treatment
of the acquired coagulopathy is a part of the PPH
15
HHE 2018 | hospitalhealthcare.com
management protocol in parallel with
uterotonics, obstetrical procedures and
transfusion. 3
Hypofibrinogenemia is a risk marker
of PPH severity
Fibrinogen is a central substrate for clot
formation. It is the main thrombin substrate
leading, through fibrin monomers and their
polymerisation, to fibrin clot formation.
Fibrinogen is also the target of plasmin in excess.
Fibrinogenolysis has been identified as a major
component in PPH, trauma, and massive
haemorrhage-induced coagulopathy. 6–8 Charbit
et al demonstrated, in 128 women with PPH
requiring prostaglandin administration, that
plasma fibrinogen concentration at enrolment