D. L. Economides

Frequency of inherited bleeding disorders in women with menorrhagia

BACKGROUND Although menorrhagia is a common gynaecological symptom, a specific cause is identified in less than 50% of affected women. We investigated the frequency of inherited bleeding disorders in women with menorrhagia. METHODS Women referred for investigation of menorrhagia whose pelvis was normal on clinical examination and who had an estimated menstrual blood loss of more than 80 mL were studied. A detailed menstrual history and history about other bleeding symptoms was taken. The activated partial thromboplastin time, factor VIII activity, von-Willebrand-factor antigen and activity, and factor XI (FXI) were measured in all patients; further tests were done when results were at or outside the limits of the assays. FINDINGS 150 women were screened. An inherited bleeding disorder was diagnosed in 26 (17%) patients: the disorders were von Willebrands disease of mild (15) or moderate severity (three), mild FXI deficiency (four), mild von Willebrands disease and FXI deficiency (one), combined von Willebrands disease, FXI deficiency, and factor X deficiency (one), carriage of haemophilia-A gene (one), and platelet dysfunction (one). The frequency of von Willebrands disease and FXI deficiency were 13% (95% CI 7.9-18.8%) and 4% (1.5-8.5%), respectively. Menorrhagia since menarche was noted in 11 (8.9%) of 123 women without a bleeding disorder compared with 13 (65%) of 20 women with von Willebrands disease (p=0.001) and four (66.7%) of six women with FXI deficiency (p<0.001). INTERPRETATION Inherited bleeding disorders are found in a substantial proportion of women with menorrhagia and a normal pelvis examination. We suggest that such patients should be investigated for these disorders-especially von Willebrands disease-before invasive procedures are done.

Pregnancy in women with von Willebrand's disease or factor XI deficiency

Objective To assess the obstetric outcome in women with von Willebrands disease or factor XI deficiency.

von Willebrand disease in women with menorrhagia: a systematic review

Objective  To determine the prevalence of von Willebrand disease in women presenting with menorrhagia.

The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population.

Objective To determine the value of early pregnancy sonography in detecting fetal abnormalities in an unselected obstetric population.

The use of levonorgestrel‐releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders

Background  The levonorgestrel‐releasing intrauterine system (LNG‐IUS) is used commonly by gynaecologists as a contraceptive and to treat menorrhagia. However, its efficacy has not been examined in women with inherited bleeding disorders.

The obstetric experience of carriers of haemophilia

Objective To review the obstetric problems, pregnancy outcome and management of carriers of haemophilia.

First trimester ultrasonographic diagnosis of fetal structural abnormalities in a low risk population

Objectives Ultrasonographic screening between 12+01 and 13+6 weeks for fetal structural abnormalities using transab dominal sonography and, where necessary, transvaginal sonography in a low risk population.

Assessment of fetal anatomy at 12 to 13 weeks of gestation by transabdominal and transvaginal sonography

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First trimester sonographic detection of chromosomal abnormalities in an unselected population

Objective To investigate the role of first trimester sonography in detecting chromosomal abnormalities in an unselected obstetric population.

Psychological outcome in women undergoing termination of pregnancy for ultrasound‐detected fetal anomaly in the first and second trimesters: a pilot study

To ascertain and compare psychological morbidity following first‐ and second‐trimester termination for fetal anomaly.