Obstetrical and gynaecological bleeding: A common presenting symptom

R. A. Kadir, L. M. Aledort

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Excessive haemorrhage is one of the commonest symptom when women present to obstetricians and gynaecologists. In the majority of cases the cause is related to the primary obstetric and gynaecological pathology and is easily identified. However, less commonly, the bleeding is unexpected and due to an undiagnosed underlying coagulation defect, the commonest of which is von Willebrand (vWD) disease. Menorrhagia is a common, and may be the only, clinical manifestation of an inherited bleeding disorder. Screening 150 women with menorrhagia, vWD was diagnosed in 13% of patients and other hereditary haemorrhagic disorders in another 4%. Menorrhagia with onset at the menarche was predictive of an inherited bleeding disorder in 65% of vWD and 67% of FXI deficient patients. Therefore, testing for bleeding disorders should be considered in women with menorrhagia especially those with early onset and no obvious pelvic pathology. Childbirth and puerperium present a special risk for excessive haemorrhage. The risk of postpartum haemorrhage is very high in women with inherited bleeding disorders. In our centre, the incidence of primary and secondary postpartum haemorrhage was 22% and 11% in carriers of haemophilia 18.5% and 20% in vWD and 16% and 24% in FXI deficient women, respectively. Acquired haemophilia can be an unusual cause of severe and unexpected postpartum haemorrhage with a very high mortality rate. Unexplained postpartum and postoperative haemorrhage that does not respond to general measures should alert clinicians to the possibility of bleeding disorders as a causative factor. In addition, increased awareness among obstetricians and gynaecologists of these less common causes and close collaboration with the local haemophilia centre and availability of management guidelines are essential for optimal outcome.

Original languageEnglish
Pages (from-to)12-16
Number of pages5
JournalClinical and Laboratory Haematology, Supplement
Volume22
Issue number1
DOIs
StatePublished - 2000
Externally publishedYes

Keywords

  • Acquired haemophilia
  • Carriers of haemophilia
  • Factor XI deficiency
  • Menorrhagia
  • Postpartum haemorrhage
  • Von Willebrand disease

Fingerprint

Dive into the research topics of 'Obstetrical and gynaecological bleeding: A common presenting symptom'. Together they form a unique fingerprint.

Cite this