Gynaecological and obstetrical problems in women with different bleeding disorders

Abstract

The aim of this case-control study was to analyse the prevalence of gynaecological, obstetrical and other more general bleeding symptoms in 114 women affected by various inherited bleeding disorders, who were compared with 114 apparently healthy women. Retrospective information were collected by means of two specific questionnaires, one on gynaecological and obstetrical bleeding symptoms, with special focus on the presence of menorrhagia as defined by a pictorial blood loss assessment chart (PBAC); and the other on general bleeding symptoms, whose severity was graded by means of the bleeding score (BS). Compared to normal women, the whole group of women with inherited bleeding disorders had a higher prevalence of excessive bleeding at menarche (25% vs. 5%, P < 0.0001) and menorrhagia (59% vs. 46%, P = 0.06). Affected women also had a higher frequency than controls of general bleeding symptoms that scored as severe by a BS > or = 12 (49% vs. 0%, P < 0.0001). In affected women, the BS increased according to the severity of the haemostasis defect. In conclusions, the BS and the PBAC are simple tools to evaluate the severity of general bleeding symptoms and menorrhagia in women with inherited bleeding disorders. These instruments may help to identify those women for whom a therapeutic intervention is warranted.

Postpartum Hemorrhage in Women with Von Willebrand Disease – A Retrospective Observational Study

“…The incidence of primary PPH was 44% in our study group, thus higher than what has been described in the previous studies where similar methods of data collection were used, and similar to the reported incidence in studies investigating PPH by patient recall [2, 18, 20, 22–24, 38]. …”

“…Studies using interviews and questionnaires for data collection have reported a primary PPH incidence of 31–59% [2, 18, 20, 22, 23], whereas the incidence was 15–34% in studies using an objective measure of blood loss (>500 ml) and medical records for data collection [2, 24, 38, 39]. However, comparing the results between these studies is problematic, as the study groups may differ regarding severity of VWD, hemostatic drug treatment and obstetric care.…”

“…Studies have shown a significantly increased incidence of PPH in women with VWD compared to healthy controls [18–24], despite the fact that FVIII and VWF increase during pregnancy [25]. Experts have suggested that if plasma FVIII is at least 30–40% of normal levels, then bleeding after delivery is unlikely [26].…”

Ciąża, poród i połóg u nosicielki hemofilii

“…a porodem, obserwuje się w przypadku 2-5% wszystkich ciąż [11]. Częstość występowania APH wśród nosicielek hemofilii oraz w populacji ogólnej jest porównywalna [12,14]. W większości przypadków APH to następstwo patologii łożyska -występowania łożyska przodującego lub jego przedwczesnego odklejenia.…”

Peripartum Haemorrhage: Haemostatic Aspects of the New German PPH Guideline

“…Due to increasing factor concentrations with developing pregnancy, patients with von Willebrand disease (type I) or haemophilia (only A, as factor IX does not increase) do not have an elevated bleeding risk during pregnancy compared to healthy ones. Nevertheless, this risk is greatly augmented in the postpartum period [17,23,24].…”