Haemorrhagic problems in obstetrics and gynaecology in patients with congenital coagulopathies

Article Abstract:

Congenital coagulopathies are disorders of blood clotting mechanisms, and include von Willebrand's disease, hemophilia A and hemophilia B (also referred to as Christmas disease). von Willebrand's disease affects 3 to 4 persons per 100,000 people in the United Kingdom, and is the most common congenital coagulopathy among women. This disorder is characterized by easy bruising, nosebleeds, bleeding from the mouth and digestive tract, prolonged bleeding after surgery, injuries, and childbirth, and heavy menstrual bleeding. von Willebrand's disease can be detected by decreases in the levels of factor VIII:vWF, which is involved in blood clot formation. Hemophilia A and Christmas disease are less common than von Willebrand's disease, and are characterized by low levels of the blood coagulation factors VIIIc and IX, normal bleeding times, deep tissue bleeds, bleeding into the joints, and prolonged bleeding after surgery. Studies show that factor VIII:vWF increases during pregnancy; this may protect women with congenital coagulopathies from excessive bleeding associated with delivery. Obstetric and gynecologic complications were assessed in 8 women with von Willebrand's disease, 18 women who carry the gene for hemophilia A, and 5 carriers of Christmas Disease. Bleeding after childbirth; the formation of hematomas (masses of blood within tissues) associated with episiotomy; and menorrhagia (heavy menstrual bleeding) occurred in women with von Willebrand's disease. These bleeding complications were treated with the drugs danazol, tranexamic acid, and oral contraceptives. In one woman severe bleeding occurred after curettage, the scraping of the inside of the uterus. Pelvic pain and pain during intercourse were associated with hematomas in two cases. Bleeding and the formation of hematomas occurred in women with hemophilia A and Christmas disease. These findings show that women with congenital coagulopathies have specific bleeding-related complications, which should be managed in close association with a hemophilia center. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Blood clotting disorders, Blood coagulation disorders, Hemorrhage, Hemophilia, Pregnancy, Complications of, Pregnancy complications, Hematologic diseases, Von Willebrand's disease, Blood diseases in pregnancy

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A maternal death caused by AIDS. case report

Article Abstract:

The case report is presented of a 26-year-old woman who developed breathing difficulties, fever, and a cough in the tenth week of pregnancy. On examination, the patient tested positive for human immunodeficiency virus (HIV), associated with AIDS, and was diagnosed with Pneumocystis carinii pneumonia. In spite of drug treatment and other intervention, the patient's condition worsened and she died on the 24th day of hospitalization. This represents the first maternal death in Britain associated with HIV infection. Because the patient was a political refugee who had arrived in England only shortly before she fell ill, her HIV antibody status was unknown, and some time elapsed in the hospital before the test results were available. Other research indicates that pregnant women who are infected with HIV need prophylactic medication to guard against pneumocystosis. The medication for treating this disease with the fewest effects to the fetus appears to be oral Septrin. The possibility that pregnancy may accelerate the rate of progress of HIV infection has been raised; if it does, offering voluntary termination to infected women may be considered. Physicians in Britain need to be aware of the problems that can affect HIV-infected women who become pregnant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, AIDS (Disease), AIDS (Disease) in pregnancy

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