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

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 insignificant 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 patientspresenting with bleeding. Place and duration of study: It is a cross sectional study which was conducted inthe Hematology Department, Services Institute of Medical Sciences, Lahore. The duration of study was 6months i.e from 21st Oct, 2018 to 30th April, 2019. Material & Methods: Females with age range of 15 to 50years irrespective of pregnancy presenting as menorrhagia, metrorrhagia or obstetrical bleeding wereincluded. Results: In the present study there were total 140 cases with mean age of 30.14±9.59 years. Therewere 98 (70%) cases that were pregnant. There were 35 (25%) cases presented with PPH (Post PartumHemorrhage), 42 (30%) with IPH (Intra Partum Hemorrhage), 49 (35%) with menorrhagia and 14 (10%) withmetrorrhagia. 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 in7 (5%), while factor deficiency in 34 (24.29%) cases; and 84 (60%) of cases revealed none of the bleedingdisorder. 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 wasseen in 11 (84.62%) of the cases with age group 15 to 32 years and similarly both cases of DIC were seen insame age group; but the difference in both the age groups regarding these bleeding disorders was notstatistically 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 moreseen 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 IPHwithout any significant difference with p= 0.42. Conclusion: Bleeding disorders are not uncommon ingynecological and obstetric conditions. Factor deficiency were the most common causes and amongst thesevWD 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