Assessment of obstetric and gynaecological problems in females with bleeding disorders

Shruti Ashok Panchbudhe; Ashwini Sudhir Desai

doi:10.18203/2320-1770.ijrcog20211139

Authors

Shruti Ashok Panchbudhe Department of Obstetrics and Gynaecology, Seth G.S. Medical College, Mumbai, Maharashtra, India
Ashwini Sudhir Desai Department of Obstetrics and Gynaecology, Seth G.S. Medical College, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20211139

Keywords:

Antiphospholipid antibody syndrome, Idiopathic thrombocytopenic purpura, Recurrent pregnancy loss, Von-Willebrand’s disease

Abstract

Background: Inherited bleeding disorders are not common but they are lifelong. Their effects on women are far greater than previously realised. Many clinicians are not familiar with these disorders but may encounter such women under acute conditions. Objectives were to study various obstetric and gynaecological problems in females with bleeding disorders and to assess the type of management given for these disorders.

Methods: This was a prospective observational study carried out at Department of Obstetrics and Gynaecology at a tertiary care hospital in which 30 women of known bleeding disorder were studied and various obstetric and gynaecological problems including menorrhagia, metrorrhagia, dysmenorrhoea, mid-cycle pain, conception, haemorrhagic ovarian cyst, etc. were identified and studied in them.

Results: 30 patients of known bleeding disorder who were found to have obstetric and gynaecological problem were studied. Idiopathic thrombocytopenic purpura constituted the major bleeding disorder (23%), followed by von Willebrand’s disease (17%) in our study. 21 patients had gynaecological problem and the most common gynaecological problem was menorrhagia (62%), followed by hemoperitoneum (10%), mid cycle pain (10%), persistent haemorrhagic cyst (7%), dysmenorrhea (7%) and endometriosis (4%). 20 patients had obstetric problems of which postpartum haemorrhage (59%) was a major problem followed by recurrent pregnancy loss (33%) and infertility (8%). The study concluded that both obstetric and gynaecological problems are common in patients of bleeding disorders and occur in distribution 66.66% and 70% respectively.

Conclusions: The study conducted shows that obstetric and gynaecological problems are very common in patients of bleeding disorders and thus optimal management of these problems requires a multidisciplinary team of approach.

Metrics

Metrics Loading ...

References

Roberts HR, Escobar MA. Other clotting factor deficiencies. In: Hoffman R, Benz EJ Jr, Shattil SJ, Cohen HJ, Silberstein LE, McGlave P, eds. Hematology: Basic Principles and Practice. 4th edn. NYC: Churchill Livingstone; 2005.

Barr RD, Sek J, Horsman J, Furlong W, Saleh M, Pai M, et al. Health status and health-related quality of life associated with von Willebrand’s Disease. Am J Hematol. 2003;73:108-14.

Kouides PA, Burkart P, Phatak PD, Porter J, Peacock L, Braggins C, et al. The substantial impact of von Willebrand’s disease on menstruation. Update Obstet Gynecol. 1998;5:153-4.

Kadir RA, Sabin CA, Pollard D, Lee CA, Economides DL. Quality of life during menstruation in patients with inherited bleeding disorders. Haemophila 1998;4:836-41.

Shankar M, Chi C, Kadir RA. Review of quality of life: menorrhagia in women with or without inherited bleeding disorders. Haemophilia. 2008;14(1):15-20.

Barr RD, Sek J, Horsman J, Furlong W, Saleh M, Pai M, et al. Health status and health-related quality of life associated with von Willebrand’s disease. Am J Hematol. 2003;73(2):108.

ACOG. Management of anovulatory bleeding. American College of Obstetricians and Gynaecologists: Washington DC: 2000:1-12.

Siboni SM, Calo L, Santagostino E, Mancuso ME, Gianniello F, Federici AB, et al. Gynaecological and Obstetrical problems in women affected with inherited bleeding disorders J Thromb Haemost. 2007;5(2): O-W-021.

Payne JH, Maclean RM, Hampton KK, Baxter AJ, Makris M. Haemoperitoneum associated with ovulation in women with bleeding disorders: the case for conservative management and the role of the contraceptive pill. Haemophilia. 2007;13(1):93-7.

Bremme KA. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol. 2003;16(2):153-68.

Lee CA, Chi C, Pavord SR, Bolton‐Maggs PH, Pollard D, Hinchcliffe‐Wood A, et al. The obstetric and gynaecological management of women with inherited bleeding disorders- review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors’ Organization. Haemophilia. 2006;12(4):301-36.

Empson M, Lessere M, Creig J, Scott J. Recurrent pregnancy loss with antiphospholipid antibody or lupus anticoagulant. Chochrane Database Syst Rev. 2005;2:CD002859.

Rai R, Cohen H, Dave M, Regan L. Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriages associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;314:253-7.