ANALISI DEI PROBLEMI GINECOLOGICI ED OSTETRICI NELLE DONNE CON COAGULOPATIA A DIATESI EMORRAGICA ATTRAVERSO IL REGISTRO INTERNAZIONALE (WRBDD).
Tesi di Dottorato
Data di Pubblicazione:
2012
Citazione:
ANALISI DEI PROBLEMI GINECOLOGICI ED OSTETRICI NELLE DONNE CON COAGULOPATIA A DIATESI EMORRAGICA ATTRAVERSO IL REGISTRO INTERNAZIONALE (WRBDD) / L. Calo' ; tutor: F. Payvandi ; coordinatore: P. Cattaneo. Università degli Studi di Milano, 2012 Feb 13. 23. ciclo, Anno Accademico 2010.
Abstract:
SUMMARY
Patients affected by bleeding disorders present a wide spectrum of clinical symptoms that vary from mild or moderate bleeding tendency to significant episodes. Women with inherited bleeding disorders are particularly disadvantaged since in addition to suffering from general bleeding symptoms they are also at risk of bleeding complications from regular haemostatic challenges during menstruation, pregnancy and childbirth. Moreover, such disorders pose important problems for affected women due to their reduced quality of life caused by limitations in activities and work, and alteration of their reproductive life. These latter problems include excessive menstrual bleeding or menorrhagia, miscarriage, bleeding complications during pregnancy and after delivery and their related complications such as acute or chronic anaemia.
Moreover, reliable information on clinical management are scarce, only a few available long term prospective studies of large cohorts provide evidence-based guideline about diagnosis and treatment.
To this end, the University of Milan has created a working group on menorrhagia and other gynecological problems in women with rare bleeding disorders (WRBD: http://www.wrbd.org/network.htm) involving worldwide renewed centers besides the Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre of Milan. A prospective study recruiting women with confirmed diagnosis of von Willebrand disease (VWD), rare coagulation disorders (RBDs: rare bleeding disorders) and platelet disorders was designed. Women without evidence of coagulation disorders constituted the control group.
The aim of this project was to retrospectively and prospectively collect a large cohort of women to:
- evaluate the prevalence of gynaecological problems (menarche, ovulation bleeding, menorrhagia, bleeding during pregnancy and postpartum bleeding)
- evaluate the association between menstrual loss and clinical severity (other bleeding symptoms)
- evaluate the association between clinical severity and phenotype results
- to collect and analyse data on concomitant gynaecological abnormalities, complications of menorrhagia (anaemia), requirement of gynaecological intervention and to evaluate the occurrence of abortion, miscarriage and other pregnancy complications.
A specifically tailored questionnaire was used to collect data, along with the Bleeding Score (BS) quesstionnaire, capable of translating the hemorrhagic history of the subject in a numerical coefficient, and the pictorial blood assessment chart (PBAC), graphical tool that scores the intensity of menstrual flow, thus defining the severity of menorrhagia. The collected data have been then entered into a database specifically created to obtain a complete and extensive amount of information which will ultimately be able to extrapolate the clinical information necessary for the intended purposes.
After the first year, 231 patients were enrolled in the study: 113 (48.9%) patients were affected with VWD, 38 (16.5%) with RBDs and 80 (34%) were controls for a total of 214 pregnancies.
Our data showed that menorrhagia was a specific symptom of women with VWD, while the profuse menarche and intermittent and heavy menstrual bleeding seemed to be a symptom of women with RBDs. However, the intra-abdominal bleeding and the vaginal bleeding near ovulation seem not to be specifically related to the presence of hemorrhagic disease, confirming currently available data from the literature. Similarly, hemorrhagic complications during surgery do not seem to have a higher incidence in the presence of VWD or RBDs compared with controls, but we consider that these data needs to be further analyzed after further enlargement of the sample size in order to discriminate the population in two gr
Tipologia IRIS:
Tesi di dottorato
Keywords:
bleeding score ; database ; diatesi emorragica ; emorragia post partum ; emnorragia ; PBAC ; registro internazionale WRBDD
Elenco autori:
L. Calo'
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