Frequency of Various Bleeding Disorders Among Gynecological and Obstetric Patients Presenting with Bleeding

Abstract

Introduction: Bleeding issues specific to women and adolescent females are common across the world. These issues can present either due to gynecological causes or obstetric one; however these can result in significant morbidity and work up needs to be done to rule out any underlying bleeding diathesis. Aims & Objectives: To determine frequency of various bleeding disorders among gynecological and obstetric patients presenting with bleeding. Place and duration of study: It is a cross sectional study which was conducted in the Hematology Department, Services Institute of Medical Sciences, Lahore. The duration of study was 6 months i.e from 21st Oct, 2018 to 30th April, 2019. Material & Methods: Females with age range of 15 to 50 years irrespective of pregnancy presenting as menorrhagia, metrorrhagia or obstetrical bleeding were included. Results: In the present study there were total 140 cases with mean age of 30.14±9.59 years. There were 98 (70%) cases that were pregnant. There were 35 (25%) cases presented with PPH (Post Partum Hemorrhage), 42 (30%) with IPH (Intra Partum Hemorrhage), 49 (35%) with menorrhagia and 14 (10%) with metrorrhagia. HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet count) syndrome was seen in 13 (9.29%) cases, DIC (Disseminated Intravascular Coagulation) in 2 (1.43%), gestational thrombocytopenia in 7 (5%), while factor deficiency in 34 (24.29%) cases; and 84 (60%) of cases revealed none of the bleeding disorder. Out of total 34 cases of factor deficiencies, vWD was the most common, seen in 20 (58.82%) cases. There was none of the cases seen having deficiency of factor II, VII, VIII, XI, XII. HELLP syndrome was seen in 11 (84.62%) of the cases with age group 15 to 32 years and similarly both cases of DIC were seen in same age group; but the difference in both the age groups regarding these bleeding disorders was not statistically significant with p= 0.38. There was no significant difference in terms of pregnancy; however, both cases of DIC were seen in pregnancy with insignificant p value of 0.51. HELLP syndrome was more seen in IPH affecting 5 (38.40%), factor deficiency in menorrhagia affecting 13 (38.2%) with p value of 0.61. vWD and factor V Leiden presented in 44.4% cases each with PPH, and vWD affected 87.5% of cases in IPH without any significant difference with p= 0.42. Conclusion: Bleeding disorders are not uncommon in gynecological and obstetric conditions. Factor deficiency were the most common causes and amongst these vWD was the most deficient factor. There was no significant association with any confounding variable; however, DIC was only seen in obstetrical conditions. Key words: Bleeding, menorrhagia, HELLP, DIC, IPH, PPH