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Obstetrical and gynaecological bleeding: a common presenting symptom.
1Department of Obstetrics and Gynaecology, The Royal Free Hospital London, England, UK.
Clinical and Laboratory Haematology
|March 17, 2001
Summary
Undiagnosed bleeding disorders like von Willebrand disease are common causes of heavy menstrual bleeding (menorrhagia) and postpartum hemorrhage in women. Early screening for these conditions is crucial, especially with early-onset menorrhagia.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Medical Diagnostics
Background:
- Excessive hemorrhage is a frequent obstetric and gynecologic complaint.
- While often linked to known pathologies, unexpected bleeding can signal underlying coagulation defects, most commonly von Willebrand disease (vWD).
- Menorrhagia may be the sole indicator of an inherited bleeding disorder.
Purpose of the Study:
- To investigate the prevalence of inherited bleeding disorders in women presenting with menorrhagia.
- To assess the risk of postpartum hemorrhage in women with known bleeding disorders.
- To highlight the importance of considering bleeding disorders in unexplained postpartum and postoperative hemorrhage.
Main Methods:
- Screening of 150 women with menorrhagia for bleeding disorders.
- Analysis of postpartum hemorrhage incidence in carriers of hemophilia, vWD, and Factor XI (FXI) deficiency.
- Review of cases with unexplained postpartum and postoperative hemorrhage.
Main Results:
- Von Willebrand disease was diagnosed in 13% of women with menorrhagia; other hereditary disorders were found in 4%.
- Menorrhagia starting at menarche predicted inherited bleeding disorders in a significant percentage of patients.
- High rates of postpartum hemorrhage were observed in women with hemophilia, vWD, and FXI deficiency.
Conclusions:
- Testing for bleeding disorders is recommended for women with menorrhagia, particularly those with early onset and no clear pelvic pathology.
- Women with inherited bleeding disorders face a substantially increased risk of postpartum hemorrhage.
- Clinicians should consider bleeding disorders in unexplained postpartum/postoperative hemorrhage and collaborate with hemophilia centers for optimal management.