IMPACT OF HEREDITARY COAGULATION DISORDERS IN FERTILE AGE WOMEN – A RELEVANT SOURCE OF MORBIDITTY?

Problem Statement

Coagulation disorders are potential causes of abnormal uterine bleeding (AUB), integrating the PALM-COEIN acronym. Their chronicity carries out relevant morbidity throughout women’s reproductive age.

Methods

Retrospective study of women with coagulopathy followed longitudinally in our centre, with one pregnancy and delivery in the last two years (n=25).

Results

The most prevalent coagulopathy was Congenital Thrombocytopenia (n=8), followed by Von Willebrand Disease (vWD) (n=7), Idiopathic Thrombocytopenic Purpura (n=5) and Hemophilia A carriers (n=4). Mean age at diagnosis was 21 years. Sixty-four percent of the women suffered from menorrhagia (maximum of 20 days of bleeding). From the latter, two had history of acute abnormal uterine bleeding, one requiring hospitalisation. At diagnosis, 68% of the women presented with mucocutaneous bleeding signs; 12% had history of iron-deficiency anemia, either requiring iron oral supplementation (n=2) or red blood cell transfusion (n=1). Control of AUB was achieved through combined hormonal contraception in 36% of the cases, placement of levonorgestrel intra-uterine device (n=3) and insertion of etonogestrel subcutaneous implant (n=2).

At current pregnancy, an average of 10 years elapsed since diagnosis. Fourty-eight percent of the women were multipara. From the latter, two had history of bleeding complications in previous gestation. In the actual pregnancy, two women with vWD required intra-partum factor administration. Two postpartum bleeding cases were registered: one primary, with resolution after misoprostol administration; one secondary, with a hemoperitoneum diagnosis at 96 hours post-partum, requiring an exploratory laparotomy. Twenty-four of the women presented with postpartum anemia with need for intravenous iron administration, 8% required red blood cell transfusion.

Conclusion

Abnormal uterine bleeding owing to coagulopathy leads to long-term repercussions in fertile age women, interfering with quality of life in affected women since the time of menarche, as well as increasing the odds for adverse obstetric outcomes.