Prenatal and peripartum management of congenital afibrinogenaemia

We experienced three cases and four successful deliveries with congenital afibrinogenaemia and propose the following guidelines for the prenatal and peripartum management: (i) genital bleeding usually begins at 5 weeks' gestation and spontaneous abortion always occurs at 6–8 weeks' gestation without fibrinogen infusion; (ii) the fibrinogen level must be at least 0·60 g/l and, if possible, higher than 1·0 g/l during the pregnancy; (iii) the necessary amounts of fibrinogen increase as the pregnancy progresses and the preterm labour occurs; (iv) the fibrinogen level under the continuous infusion of fibrinogen during labour must be at least 1·5 g/l and, if possible, higher than 2·0 g/l to prevent placental abruption; (v) the puerperium is usually uneventful with a reduced dose of fibrinogen infusion.