Gynaecological and obstetric bleeding in moderate and severe von Willebrand disease

Eva M. de Wee; H. Marieke Knol; Eveline P. Mauser-Bunschoten; Johanna G. van der Bom; Jeroen C. J. Eikenboom; Karin Fijnvandraat; Arja de Goede-Bolder; Britta Laros-van Gorkom; Paula F. Ypma; Sonja Zweegman; Karina Meijer; Frank W. G. Leebeek; for the WiN study group

doi:10.1160/TH11-03-0180

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(05): 885-892
DOI: 10.1160/TH11-03-0180

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Gynaecological and obstetric bleeding in moderate and severe von Willebrand disease

Eva M. de Wee

¹Hematology, Erasmus University Medical Center Rotterdam, Netherlands

,

H. Marieke Knol

²Hematology, University Medical Center Groningen, Netherlands

³Gynaecology, University Medical Center Groningen, Netherlands

,

Eveline P. Mauser-Bunschoten

⁴Van Creveldkliniek and Hematology, University Medical Center Utrecht, Netherlands

,

Johanna G. van der Bom

⁵Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Netherlands

⁶Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands

,

Jeroen C. J. Eikenboom

⁵Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Netherlands

⁷Thrombosis and Hemostasis, Leiden University Medical Center, Netherlands

,

Karin Fijnvandraat

⁸Pediatric Hematology, Emma Children’s hospital AMC, Amsterdam, Netherlands

,

Arja de Goede-Bolder

⁹Pediatrics, Erasmus MC, Sophia Children’s hospital, Rotterdam, Netherlands

,

Britta Laros-van Gorkom

¹⁰Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

,

Paula F. Ypma

¹¹Hematology, HagaZiekenhuis, The Hague, Netherlands

,

Sonja Zweegman

¹²Hematology, VU University Medical Center, Amsterdam, Netherlands

,

Karina Meijer

²Hematology, University Medical Center Groningen, Netherlands

,

Frank W. G. Leebeek

¹Hematology, Erasmus University Medical Center Rotterdam, Netherlands

,

for the WiN study group

› Author Affiliations

Abstract

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Summary

A nation-wide cross-sectional study was initiated to assess gynaecological and obstetrical symptoms in an unselected cohort of women with moderate and severe von Willebrand disease (VWD) in the Netherlands. A total of 423 women aged ≥16 years were included. Bleeding severity was measured using the Tosetto Bleeding Score (BS). Menorrhagia, defined as occurrence of ≥2 menorrhagia symptoms, was reported by 81%. Of all VWD women, 78% received any kind of treatment for menorrhagia and 20% underwent a hysterectomy predominantly because of severe menstrual bleeding. Over half of the women reported more blood loss than can be expected with a normal delivery. In 52% of reported pregnancy losses curettage was needed because of bleeding. Mean number of live births was 1.9, which is comparable with the general Dutch population. In conclusion, women with moderate or severe VWD frequently have menorrhagia in need of treatment, and 20% of the VWD women underwent a hysterectomy. Bleeding complications occurred in over 50% of the women after childbirth or pregnancy loss. Progeny seems not to be affected in women with moderate or severe VWD.

Keywords

Bleeding - menorrhagia - postpartum haemorrhage - von Willebrand disease - hysterectomy

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References

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