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Dkeidek A, Mattinson R, Grover SR. Bleeding disorders: Are gynaecologists testing women at risk? Haemophilia 2021; 27:e534-e536. [PMID: 33645859 DOI: 10.1111/hae.14283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Amira Dkeidek
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Vic, Australia.,Obstetrics & Gynaecology, Mercy Hospital for Women, Heidelberg, Vic, Australia
| | - Roisin Mattinson
- Obstetrics & Gynaecology, Mercy Hospital for Women, Heidelberg, Vic, Australia
| | - Sonia R Grover
- Department of Gynaecology, Royal Children's Hospital, Melbourne, Vic, Australia.,Obstetrics & Gynaecology, Mercy Hospital for Women, Heidelberg, Vic, Australia.,University of Melbourne, Melbourne, Vic, Australia
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2
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Veen CSB, van der Reijken IS, Jansen AJG, Schipaanboord CWA, Visser W, de Maat MPM, Leebeek FWG, Duvekot JJ, Kruip MJHA. Severe postpartum haemorrhage as first presenting symptom of an inherited bleeding disorder. Haemophilia 2019; 25:1051-1058. [PMID: 31583797 DOI: 10.1111/hae.13846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/11/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Postpartum haemorrhage (PPH) is the major cause of maternal death worldwide. Haemostatic abnormalities are independently associated with a significantly increased risk for severe PPH. In this study, the value of haemostatic evaluation in women with severe PPH was explored. AIM To investigate the occurrence of previously unknown inherited bleeding disorders in women with severe PPH. METHODS Women with severe PPH (blood loss of ≥2000 mL) between 2011 and 2017, referred to the haematology outpatient clinic for haemostatic evaluation, were retrospectively included. A bleeding disorder was diagnosed based on (inter)national guidelines, or when having a clear bleeding phenotype, not fulfilling any diagnostic criteria or laboratory abnormalities, this being classified as Bleeding of Unknown Cause (BUC). Logistic regression was used to model the association between diagnosis and obstetrical causes and risk factors for PPH. RESULTS In total, 85 women with PPH were included. In 23% (n = 16), a mild bleeding disorder was diagnosed, including low von Willebrand factor (Low VWF 8/16), platelet function disorders (PFD 5/16), BUC (2/16) and von Willebrand disease type 1 (1/16). No significant associations were found between obstetrical causes or risk factors for PPH and the presence of a bleeding disorder. CONCLUSION In 23% of women with severe PPH, a mild bleeding disorder was diagnosed, independent of obstetrical causes or risk factors for PPH. This implies that severe PPH can be the first clinical symptom of an inherited bleeding disorder. Therefore, to optimize clinical management, haemostatic evaluation after severe PPH is recommended.
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Affiliation(s)
- Caroline S B Veen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Irene S van der Reijken
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A J Gerard Jansen
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Willy Visser
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Vascular Medicine, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics & Gynaecology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marieke J H A Kruip
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
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3
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Rasmussen CK, Hansen ES, Al-Mashadi Dahl S, Ernst E, Dueholm M. The effect of transcervical endometrial resection on clinical symptoms related to intrinsic adenomyosis and junctional zone changes. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100029. [PMID: 31404400 PMCID: PMC6687372 DOI: 10.1016/j.eurox.2019.100029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/20/2019] [Accepted: 04/14/2019] [Indexed: 01/16/2023] Open
Abstract
Objectives To assess the effect of transcervical endometrial resection on clinical symptoms related to histopathological findings of the junctional zone. Study design This prospective study took place at a university hospital. Premenopausal women suffering from abnormal uterine bleeding and/or pelvic pain and scheduled for transcervical endometrial resection were enrolled (n = 112). Histopathological findings of the endomyometrial biopsies were categorized as follows: Adenomyosis of the inner myometrium (intrinsic adenomyosis): ≥ 2 mm myometrial invasion without contact to the basal endometrium, serrated junctional zone: > 3 mm myometrial invasion with contact to the basal endometrium and linear junctional zone: No or marginal myometrial invasion (≤ 3 mm) with contact to the basal endometrium. All study participants received a baseline and two follow-up questionnaires (6 and 18 months after surgery) regarding symptom severity, health-related quality of life and pelvic pain. Data regarding reintervention surgery was obtained from the National Database Patoweb. The rate of reintervention surgery and the improvement in symptom severity, health-related quality of life and pelvic pain were correlated to histopathological findings. Results Twenty-four patients had intrinsic adenomyosis, 31 had serrated junctional zone and 57 had linear junctional zone. Fifteen patients (13%) underwent reintervention surgery; three (20%) within 6 months, nine (60%) between 6–18 months and three (20%) > 18 months after transcervical endometrial resection. Reintervention surgery was more common in women with intrinsic adenomyosis compared to women without (33% (95% CI: 16–55) vs 8% (95% CI: 3–16)) (p-value: < .05). Nine patients (38%) with intrinsic adenomyosis were asymptomatic based on low symptom severity score, high health-related quality of life and no pelvic pain at 18 months follow-up. Patients with linear junctional zone had a higher improvement in symptom severity and health-related quality of life than patients with intrinsic adenomyosis or serrated junctional zone at 6 months follow-up after surgery (p-value < .05). However, there was no significant difference in pelvic pain reduction. Conclusion The effect of transcervical endometrial resection may depend upon the degree of junctional zone changes, and patients with intrinsic adenomyosis are more likely to undergo reintervention surgery than patients with either linear or serrated junctional zone. However, intrinsic adenomyosis may also be successfully treated with endometrial resection.
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Affiliation(s)
| | - Estrid S Hansen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Sham Al-Mashadi Dahl
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Ernst
- Department of Obstetrics & Gynecology, Horsens Regional Hospital, Horsens, Denmark
| | - Margit Dueholm
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
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4
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Winikoff R, Scully MF, Robinson KS. Women and inherited bleeding disorders - A review with a focus on key challenges for 2019. Transfus Apher Sci 2019; 58:613-622. [PMID: 31582329 DOI: 10.1016/j.transci.2019.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The area of women and inherited bleeding disorders has undergone quick expansion in recent years. More patients are being identified and expertise to diagnose and manage these patients is now essential for practising physicians. Programs to help educate and empower patients and caregivers are now in place. Common inherited bleeding disorders affecting women include von Willebrand disease (VWD), inherited platelet disorders, and rare inherited bleeding disorders such as factor VII (FVII) deficiency and factor XI (FXI) deficiency. Specific clinical tools have been developed to help clinicians and patients screen for the presence of these bleeding disorders in both adult and pediatric populations. Affected women can experience heavy menstrual bleeding and resulting iron deficiency anemia, postpartum hemorrhage, and hemorrhagic ovarian cysts which need to be properly managed. Excessive bleeding can adversely affect quality of life in these women. Front line therapy for bleeding in mild cases focuses on the use of non-specific hemostatic agents such as DDAVP ®, tranexamic acid and hormonal agents but specific factor replacement and/or blood products may be required in more severe cases, in severe bleeding or as second line treatment when bleeding is not responsive to first line agents. Iron status should be optimised in these women especially in pregnancy and use of an electronic app can now help clinicians achieve this. These patients should ideally be managed by a multidisciplinary team whenever possible even remotely. Although clinical research has closed some knowledge gaps regarding the diagnosis and management of these women, there remains significant variation in practise and lack of evidence-based guidelines still exists in many spheres of clinical care in which caregivers must rely on expert opinion. Ongoing efforts in education and research will continue to improve care for these women and restore quality of life for them.
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Affiliation(s)
- R Winikoff
- Division of Hematology-Oncology, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| | - M F Scully
- Department of Medicine, Memorial University of Newfoundland Medical School, NL, Canada.
| | - K S Robinson
- Division of Hematology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Department of Medicine, Halifax, NS, Canada.
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Allotey J, Aroyo-Manzano D, Lopez P, Viale L, Zamora J, Thangaratinam S. Global variation in pregnancy complications in women with epilepsy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2017; 215:12-19. [DOI: 10.1016/j.ejogrb.2017.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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Raisi Dehkordi Z, Hosseini Baharanchi FS, Bekhradi R. Effect of lavender inhalation on the symptoms of primary dysmenorrhea and the amount of menstrual bleeding: A randomized clinical trial. Complement Ther Med 2014; 22:212-9. [PMID: 24731891 DOI: 10.1016/j.ctim.2013.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore the effect of Lavandula angustifolia (lavender) inhalation on the symptoms of dysmenorrhea and the amount of menstrual bleeding in female students with primary dysmenorrhea. DESIGN This study is an experimental clinical trial. The subjects were 96 female students residing in dormitory at Tehran University of Medical Sciences in 2011 and suffering from level two or three dysmenorrhea according to the verbal multi-dimensional scoring system. The inclusion criteria were as: being single, suffering from primary dysmenorrhea, having no genital organs disorder, having no systemic disease, having regular menstrual cycles, using no contraceptives, etc. The follow-up time was 4 menstrual cycles. INTERVENTIONS The subjects were randomized into two groups: experimental (n=48) who inhaled lavender based on sesame oil, and placebo (n=48) who inhaled sesame oil only. MAIN OUTCOME MEASURES The severity of dysmenorrhea symptoms was measured through a questionnaire, and the amount of menstrual bleeding was measured by sanitary towel usage. METHODS Ordinal logistic regression and generalized estimating equation (GEE) were used to analyze the data. RESULTS The symptoms of dysmenorrhea were significantly lowered in the lavender group compared to the placebo group (p<0.001). The amount of menstrual bleeding in the lavender group was reduced in comparison to the placebo group but the difference was not statistically significant (p=0.25). No significant difference was observed for blood clot among the students (p=0.666). CONCLUSIONS This study showed that lavender inhalation was effective in alleviating dysmenorrhea symptoms, suggesting that it could be applied by midwives in a safe manner because of no side effects, simplicity and cost-effectiveness for all patients.
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Affiliation(s)
- Ziba Raisi Dehkordi
- Department of Midwifery, School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Fatemeh Sadat Hosseini Baharanchi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; Department of Mathematics & Statistics, Eyvanakey Institute of Higher Education, Semnan, Iran
| | - Reza Bekhradi
- Research Development Unit, Barij Essence Pharmaceutical Company, Kashan, Iran
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Abstract
Acquired hemophilia is a rare disorder with an estimated annual incidence of 0.2-1 cases per million individuals. The etiology of the disorder remains obscure, although approximately half of all cases are associated with other underlying conditions. In acquired hemophilia, the severe hemorrhagic diathesis is caused by the development of autoantibodies directed against a clotting factor, most commonly factor VIII. These autoantibodies inhibit normal coagulation and lead to bleeding complications, which can be life-threatening in a high percentage of cases. Prompt diagnosis and appropriate management of the disorder enable effective control; the short- and long-term aims of therapy are to terminate the acute bleed and eliminate or reduce the inhibitor, respectively. Immune tolerance therapy has been shown to successfully eradicate or suppress inhibitors in patients with congenital hemophilia A and may be applicable to patients with acquired hemophilia. Here we present preliminary data on the use of immune tolerance therapy in patients with acquired hemophilia and discuss possible treatment strategies.
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Affiliation(s)
- Mario von Depka
- Department of Hematology, Haemostasis and Oncology, Hannover Medical School, Germany.
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8
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The Effects of Menorrhagia on Women's Quality of Life: A Case-Control Study. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:918179. [PMID: 23970973 PMCID: PMC3734607 DOI: 10.1155/2013/918179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/13/2013] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this study is to identify menstruation characteristics of the women and the effects of menorrhagia on women's quality of life. Methods. The study was designed as a descriptive, case-control one. Results. Of the women in the case group, 10.9% stated that their menstrual bleeding was severe and very severe before complaints while 73.2% described bleeding as severe or very severe after complaints. Among those who complained about menorrhagia, 46.7% pointed that they used hygienic products that are more protective than regular sanitary pads. Women also stated that their clothes, bed linens, and furniture got dirty parallel to the severity of the bleeding. In all subscales of SF-36 scale, quality of life of the women in the menorrhagia group was significantly lower than the ones in the control group (P < 0.05). Conclusion. Menorrhagia has negative effects on women's quality of life. Therefore, quality of life of the women consulting the clinics with menorrhagia complaint should be investigated and effective approaches should be designed.
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Fraser IS, Zeun S, Parke S, Wilke B, Junge W, Serrani M. Improving the Objective Quality of Large-Scale Clinical Trials for Women With Heavy Menstrual Bleeding. Reprod Sci 2013; 20:745-54. [DOI: 10.1177/1933719113477492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ian S. Fraser
- University of Sydney and Sydney Centre for Reproductive Health Research, Family Planning NSW, Sydney, New South Wales, Australia
| | | | | | - Baerbel Wilke
- Laboratorium für Klinische Forschung, Schwentinental, Germany
| | - Wolfgang Junge
- Laboratorium für Klinische Forschung, Schwentinental, Germany
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10
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Fraser IS, Parke S, Mellinger U, Machlitt A, Serrani M, Jensen J. Effective treatment of heavy and/or prolonged menstrual bleeding without organic cause: pooled analysis of two multinational, randomised, double-blind, placebo-controlled trials of oestradiol valerate and dienogest. EUR J CONTRACEP REPR 2011; 16:258-69. [PMID: 21774563 PMCID: PMC3154543 DOI: 10.3109/13625187.2011.591456] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives To evaluate the efficacy of oestradiol valerate/dienogest (E2V/DNG) for the treatment of heavy and/or prolonged menstrual bleeding without organic pathology based on the analysis of data from two identically designed double-blind, randomised studies. Methods Women aged ≥ 18 years with heavy and/or prolonged menstrual bleeding were randomised to E2V/DNG (n = 269) or placebo (n = 152) for 196 days. Objective changes in menstrual blood loss (MBL) volume were assessed using the alkaline haematin method. Results After six months of treatment, median MBL decreased by 88% with E2V/DNG compared with 24% with placebo. The greatest reduction was achieved at the first withdrawal bleed after treatment initiation and it was sustained with no loss of effect throughout treatment. Conclusion E2V/DNG was more effective than placebo in reducing MBL in women with heavy and/or prolonged menstrual bleeding without organic pathology. The reduction was largely achieved as early as the first withdrawal bleed, with further gradual improvement throughout treatment.
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Affiliation(s)
- Ian S Fraser
- University of Sydney, Sydney, New South Wales, Australia
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11
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Przkora R, Euliano TY, Roussos-Ross K, Zumberg M, Robicsek SA. Labor and delivery in a patient with hemophilia B. Int J Obstet Anesth 2011; 20:250-3. [PMID: 21641201 DOI: 10.1016/j.ijoa.2011.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 04/04/2011] [Accepted: 04/05/2011] [Indexed: 11/26/2022]
Abstract
Hemophilia B is a rare X-linked disorder that may cause dramatic bleeding. Women account for only 3.2% of those clinically affected. The X-linked inheritance frequently delays the diagnosis in women and may expose the patient to an increased risk of adverse events. There is limited experience with these patients during labor and delivery. A 28-year-old primiparous woman with hemophilia B (bleeding phenotype) delivered a male infant by an unplanned cesarean delivery under general anesthesia following treatment with factor IX and normalization of her coagulation parameters, guided by thromboelastography. Postpartum vaginal bleeding required transfusion of two units of packed red blood cells. Factor IX supplementation continued for one week. Once diagnosed with hemophilia B, a multidisciplinary approach and advanced antenatal planning can increase the likelihood of a safe delivery. Neuraxial approaches and cesarean delivery are recommended only after normalization of the coagulation profile. The male fetus of a hemophilia A or B patient requires special attention. Operative vaginal delivery and invasive fetal monitoring should be avoided. Thromboelastography is an excellent technique to assess parturients with bleeding disorders or peripartum hemorrhage and may be underused.
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Affiliation(s)
- R Przkora
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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12
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Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- J Turner Vosseller
- Section of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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13
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Menstrual disturbances in puberty. Best Pract Res Clin Obstet Gynaecol 2010; 24:157-71. [DOI: 10.1016/j.bpobgyn.2009.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 09/29/2009] [Accepted: 11/10/2009] [Indexed: 11/23/2022]
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15
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Abstract
Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.
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Affiliation(s)
- M Walfish
- SUNY Downstate Medical Center, 450 Clarkson Ave., Box 6, Brooklyn, NY 11203, USA.
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17
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Franchini M, Lippi G, Franchi M. The use of recombinant activated factor VII in obstetric and gynaecological haemorrhage. BJOG 2006; 114:8-15. [PMID: 17233855 DOI: 10.1111/j.1471-0528.2006.01156.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recombinant activated factor VII (rFVIIa) was originally developed for the treatment of bleeding in patients with haemophilia A or B and inhibitors. Over the past ten years, it has been successfully used to prevent or control bleeding in several other nonhaemophilic bleeding conditions. Among the newer 'off-label' clinical applications of rFVIIa, there is increasing evidence of its effectiveness in treating obstetric and gynaecological bleeding unresponsive to conventional therapy. The existing literature on the use of rFVIIa in obstetrics and gynaecology is summarised in this review. Although supported by few and uncontrolled studies, on the whole, the published data suggest a potential role of rFVIIa in the management of obstetric and gynaecological intractable bleeding. However, further evidence is needed to improve the assessment of its optimal dose, effectiveness and safety in such conditions.
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Affiliation(s)
- M Franchini
- Servizio di Immunoematologia e Trasfusione-Centro Emofilia, Ospedale Policlinico Azienda Ospedaliera di Verona, Verona, Italy.
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18
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Abstract
The development of factor VIII autoantibodies is a rare but severe complication of pregnancy. Although the natural history of postpartum acquired hemophilia A is usually benign, with a high percentage of spontaneous remissions and a low mortality, its quick recognition is important to control bleeding episodes. Based on an analysis of the literature, this review presents the current knowledge on the pathogenesis, diagnosis, epidemiology, natural history, clinical manifestations, and therapeutic management of postpartum acquired hemophilia A.
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Affiliation(s)
- Massimo Franchini
- Servizio di Immunoematologia e Trasfusione, Centro Emofilia, Azienda Ospedaliera di Verona, Verona, Italy.
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19
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Salomon O, Steinberg DM, Pshithizki M, Zalel Y, Lerner A, Rosenberg N, Achiron R. The influence of prothrombotic polymorphisms and obstetrical and medical variables on the length of secondary postpartum hemorrhage. J Womens Health (Larchmt) 2005; 14:306-10. [PMID: 15916503 DOI: 10.1089/jwh.2005.14.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if the presence of prothrombotic polymorphisms, such as factor V G1691A (factor V Leiden) or factor II G20210A, affect the length of secondary postpartum bleeding. METHODS We conducted a prospective and blind study that enrolled primiparous healthy women following singleton pregnancy. Whole blood was taken for determining the presence of factor V G1691A or prothrombin G20210A by PCR and specific restriction enzymes. RESULTS We enrolled 638 women, of whom 524 had vaginal delivery, 34 had planned cesarean delivery, and 80 had emergency cesarean delivery. Seventy-nine of 524 women with vaginal delivery required vacuum, 19 women needed forceps, and 2 women required both vacuum and forceps. Seventy parturients had prothrombotic polymorphisms: 31 were heterozygote to factor V G1691A, 34 were heterozygote to prothrombin G20210A, and 1 was homozygote for the mutation. Another 4 women had both mutations. Women who gave birth by planned cesarean deliveries bled 4.9 days longer on average than women who gave birth vaginally or had emergency cesarean delivery (p = 0.03), after adjustment for length of pregnancy. The weight of the newborn and the length of the pregnancy affected the duration of bleeding. The presence of prothrombotic polymorphisms did not affect the duration of postpartum bleeding. CONCLUSIONS The duration of secondary postpartum hemorrhage is related to length of pregnancy, neonate weight, and planned cesarean delivery but is not affected by the presence of factor V G1691A or prothrombin G20210A mutation in the primiparous women.
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Affiliation(s)
- Ophira Salomon
- Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Aviv University, Israel.
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20
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Yang MY, Ragni MV. Clinical manifestations and management of labor and delivery in women with factor IX deficiency. Haemophilia 2005; 10:483-90. [PMID: 15357775 DOI: 10.1111/j.1365-2516.2004.00946.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Haemophilia is uncommon in females and little is known about the clinical manifestations and postpartum management of women with this disorder. Clinical characteristics of postpartum bleeding were evaluated in women with factor IX deficiency (FIX:C < 0.20 U mL(-1)), including two with haemophilia B and three carriers of haemophilia B, undergoing labour and delivery. Data were collected prospectively during routine outpatient comprehensive haemophilia care at the haemophilia Center of Western Pennsylvania and during inpatient management. Four of five women experienced postpartum bleeding, during six of 16 deliveries: the median haemoglobin was 10.7 g% and two required blood transfusion. Postpartum bleeding was significantly more common among those receiving fewer than 4 days of FIX replacement: six of 13 (46.1%) receiving fewer three or fewer days bled vs. none of three (0%) receiving six or more days treatment [P < 01 (Wilcoxon)]. Postpartum bleeding was not related to the route of delivery (P = 0.525), vaginal vs. Caesarean, nor the FIX level (P = 0.371; FIX > 0.05 U mL(-1) vs. < or =0.05 U mL(-1)). Compared with females with von Willebrand disease or FXI deficiency, females with FIX deficiency were more likely to experience postpartum bleeding (P = 0.008) and anaemia (P = 0.045); and they were less likely to experience menorrhagia (P = 0.065), but the latter did not reach significance. Postpartum bleeding is common in women with haemophilia B or carriers of haemophilia B, and treatment with factor replacement for at least 4 days of postpartum may prevent bleeding following delivery in such women.
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Affiliation(s)
- M Y Yang
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh School of Medicine, and The Hemophilia Center of Western Pennsylvania, Pittsburgh, PA 15213, USA
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Abstract
AbstractMild bleeding disorders are a common reason for a referral to a hematologist and these conditions can be challenging to evaluate. Recent research has highlighted that some bleeding symptoms are quite common in the general population and that there is clinical variability in symptom expression among individuals with defined bleeding problems. Moreover, bleeding risks for many bleeding disorders are unknown. This article reviews symptoms and problems that can be considered suspicious of a mild form of bleeding disorder and the diagnostic investigations useful to evaluate these problems. A stepwise approach is presented for the diagnostic evaluation, to allow detection of common and rare coagulation and fibrinolytic defects, and adequate assessments of potential von Willebrand factor and platelet problems. Some common problems in the diagnosis and management of mild bleeding problems are reviewed, including the common failure to establish a diagnosis with testing. An approach is proposed for translation of knowledge to patients who are challenged by mild bleeding problems.
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Affiliation(s)
- Catherine P M Hayward
- McMaster University, Health Sciences Center, 1200 Main St., West, Room 2N31, Hamilton, Ontario L8N 3Z5, Canada.
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Winikoff R, Amesse C, James A, Lee C, Pollard D. The role of haemophilia treatment centres in providing services to women with bleeding disorders. Haemophilia 2004; 10 Suppl 4:196-204. [PMID: 15479398 DOI: 10.1111/j.1365-2516.2004.01001.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R Winikoff
- Hemophilia Treatment Center, Sainte-Justine Hospital, Montreal, Quebec H3T 1C5, Canada.
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Saxena R, Gupta M, Gupta PK, Kashyap R, Choudhry VP, Bhargava M. Inherited bleeding disorders in Indian women with menorrhagia. Haemophilia 2003; 9:193-6. [PMID: 12614371 DOI: 10.1046/j.1365-2516.2003.00720.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to define the prevalence of haemostatic defects in women presenting with menorrhagia in our region, the coagulation data on women bleeders investigated in the Department of Haematology, AIIMS, were analysed. A total of 337 of the 2200 menorrhagic women investigated were characterized to have an inherited bleeding disorder; 221 of these 337 women presented with menorrhagia alone while 116 also had other associated bleeding manifestations as prolonged bleeding from injury site, ecchymotic patches in the skin, epistaxis, haematomas, haemarthroses and major bleeds like intracerebral bleeding. The tests performed included bleeding time (BT), platelet count, prothrombin time (PT), prothrombin consumption index (PCI), activated partial thromboplastin time (APTT), PF3 release with adenosine diphosphate (ADP) at 0 and 20 min, total PF3 assay and platelet Aggregation studies with collagen, ADP, adrenaline, arachidonic acid and ristocetin. Coagulation factor assays, von Willebrand antigen estimation, ristocetin cofactor assay and electron microscopy were performed wherever necessary. Inherited platelet dysfunction was seen in 283 (83.9%) of the patients. Amongst these, isolated PF3 availability defect was seen in 163 (48.4%) cases. Glanzman's thrombasthenia was seen in 30 (8.9%) patients, Storage pool disease in eight (2.4%) patients, arachidonic acid pathway defect in five (1.5%) patients and Bernard-Soulier Syndrome in six (1.8%) patients. In 71 (21.1%) patients, the platelet function defect could not be classified into any specific subtypes. Inherited defects of coagulation were observed in 54 (16%) of the cases. Amongst these, von Willebrand disease (vWD) was the most frequent being seen in 40 (11.9%) of the cases. Factor XIII deficiency was seen in one (0.3%), factor X deficiency in four (1.2%), factor VII deficiency in one (0.3%) and factor XII deficiency in one (0.3%) of the patients. It is concluded that although hereditary platelet function defects constitute a large majority of women bleeders in India but among the coagulation defects, vWD is the commonest as reported from the caucasian population. It is thus suggested that in women presenting with menorrhagia, screening tests for haemostasis especially for vWD and inherited platelet function defects must be performed.
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Affiliation(s)
- R Saxena
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Problems associated with menstruation affect 75% of adolescent females and are a leading reason for visits to physicians. This chapter begins with a review of the timing and characteristics of normal menstruation during adolescence. It then discusses the evaluation and management of adolescents with amenorrhoea, dysmenorrhoea and abnormal uterine bleeding. An approach to adolescent amenorrhoea is presented that utilizes primary versus secondary amenorrhoea, delayed versus normal pubertal development, and the presence or absence of hyperandrogenism as nodal points for decision making. The differential diagnosis of dysmenorrhoea and the management of primary dysmenorrhoea and endometriosis are reviewed. The section on abnormal uterine bleeding contrasts anovulatory dysfunctional uterine bleeding (DUB) with bleeding secondary to problems of pregnancy, uterine pathology, exogenous hormone use and systemic bleeding disorders.
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Affiliation(s)
- Gail B Slap
- Division of Adolescent Medicine (ML-4000), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, 45229, USA.
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