Management of Hemoperitoneum Secondary to Bleeding Disorders in Low-Middle-Income Countries

Area of Science:

• Reproductive Medicine
• Hematology
• Surgical Complications

Background:

• Bleeding disorders (BD) in women are under-addressed, particularly in resource-limited settings.
• Ovulation poses a risk of life-threatening hemorrhage for women with BD.
• Management of bleeding complications varies from conservative approaches to surgery.

Purpose of the Study:

• To describe women with various BD who developed hemoperitoneum.
• To analyze management strategies and outcomes for hemoperitoneum in women with BD.
• To provide insights into managing this potentially fatal complication in the absence of established guidelines.

Main Methods:

• A case series review of 5 women of reproductive age with BD and hemoperitoneum.
• Analysis of patient demographics, clinical presentation, diagnostics, and management.
• Evaluation of outcomes, including the role of blood products, antifibrinolytics, and surgery.

Main Results:

• Four out of five women responded favorably to conservative management, avoiding surgery.
• One patient with Glanzmann's thrombasthenia (GT) expired due to massive hemoperitoneum from a delayed surgical bleed.
• Conservative management showed efficacy in the majority of cases.

Conclusions:

• Hemoperitoneum in women with BD can be effectively managed conservatively.
• Surgical interventions require caution, especially in Glanzmann's thrombasthenia, due to bleeding risks.
• This case series offers valuable insights for managing hemoperitoneum in BD where guidelines are lacking.