Background: Inherited bleeding disorders are not common but they are lifelong. Their effects on women are far greater than previously realised. Many clinicians are not familiar with these disorders but may encounter such women under acute conditions. Objectives were to study various obstetric and gynaecological problems in females with bleeding disorders and to assess the type of management given for these disorders.Methods: This was a prospective observational study carried out at Department of Obstetrics and Gynaecology at a tertiary care hospital in which 30 women of known bleeding disorder were studied and various obstetric and gynaecological problems including menorrhagia, metrorrhagia, dysmenorrhoea, mid-cycle pain, conception, haemorrhagic ovarian cyst, etc. were identified and studied in them.Results: 30 patients of known bleeding disorder who were found to have obstetric and gynaecological problem were studied. Idiopathic thrombocytopenic purpura constituted the major bleeding disorder (23%), followed by von Willebrand’s disease (17%) in our study. 21 patients had gynaecological problem and the most common gynaecological problem was menorrhagia (62%), followed by hemoperitoneum (10%), mid cycle pain (10%), persistent haemorrhagic cyst (7%), dysmenorrhea (7%) and endometriosis (4%). 20 patients had obstetric problems of which postpartum haemorrhage (59%) was a major problem followed by recurrent pregnancy loss (33%) and infertility (8%). The study concluded that both obstetric and gynaecological problems are common in patients of bleeding disorders and occur in distribution 66.66% and 70% respectively.Conclusions: The study conducted shows that obstetric and gynaecological problems are very common in patients of bleeding disorders and thus optimal management of these problems requires a multidisciplinary team of approach.
Morbidly adherent placenta is a serious and a catastrophic pregnancy complication. In this condition, the placenta penetrates deeply inside the uterine walls and is not separated after delivery of the baby. Reporting herewith a case of a primigravida who had undergone Emergency lower segment Caesarean section at a private hospital for severe pregnancy induced hypertension with IUGR and then was referred to Tertiary Care hospital with placenta left in-situ due to non-separation of the placenta at the time of caesarean section. Conservative management was given using Methotrexate which is an anti-metabolite alternatively with Leucovorin (Folinic acid) and followed up with serial ultrasonography with Doppler for placental size and volume and beta-HCG levels which showed a decreasing trend respectively.
Rhesus-D alloimmunization is characterized by production of antibodies as a result of immune response generated in an individual due to exposure to alloantibodies from different individual. Here we are reporting a case of successful obstetric and perinatal outcome of twin pregnancy with Rh-incompatibility along with other atypical antibodies leading to fetal and neonatal anemia in both the twins. Antenatal management consisted of serial obstetric Doppler to look for Middle cerebral artery blood flow and Peak systolic velocity to detect fetal anemia followed by Intra Uterine transfusion of packed red cells through umbilical vein to treat the same for both the twins. In the presence of multiple atypical antibodies in the maternal serum no compatible blood was available for transfusion for either the mother or the neonates after delivery so NICU management consisted initially of transfusion of intravenous immunoglobulin’s along with steroids to prevent auto and alloantibody reactions but in view of dropping hemoglobin in both twins least incompatible blood was given to both the twins.
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