Women who have completed their childbearing, particularly those who have

failed medical management or endometrial Lumacaftor ic50 ablation, are candidates for hysterectomy. Because menorrhagia is often the primary symptom that women with bleeding disorders experience, hysterectomy does offer the possibility for significant improvement in quality of life and is a safer procedure than it was decades ago. Thirty-six years ago when Silwer et al. published the results of a comparison of the complications of hysterectomy in 18 women with VWD vs. 50 controls, 50% of the women with VWD received transfusion, but so did 30% of the controls [17]. In a recent study of United States hospital discharge data, only 7% of women with VWD received transfusions compared to 2% of controls [41]. Furthermore, in the last 20 years, the availability of recombinant or plasma-derived/virally inactivated clotting factor concentrates has reduced the chance of viral transmission with factor replacement. There are few data on management

of acute, severe menorrhagia, particularly in the adolescent or woman with a bleeding disorder. In November, 2009, a consensus conference sponsored by CSL Behring selleck compound was convened specifically to address this issue. A full report will be published in the future, but there was consensus that balloon tamponade, hormonal therapy (oestrogen) and antifibrinolytic treatment should be instituted while replacing clotting factor or platelets as indicated. It is recognized that normal pregnancy is accompanied by increased concentrations of various clotting factors. Despite improved haemostasis, however, women with bleeding disorders often do not achieve the same levels of clotting factors as other women and, therefore, are at an increased risk of bleeding complications with pregnancy. In the last 20 years, there have been several case reports and case series documenting the profoundly increased risk of miscarriage and placental

abruption resulting in foetal loss or premature delivery in women with deficiency of fibrinogen [42–51], or factor XIII [52–55] but whether there is an increased risk of miscarriage in women with other bleeding disorders is not clear [18]. Clotting factor replacement is used to reduce the risk of miscarriage, foetal loss and premature 上海皓元 delivery in women with deficiency of fibrinogen [43–45,47–51] and factor XIII [52–55], but whether any therapy is necessary or available to prevent miscarriage or foetal loss in women with other bleeding disorders has not been reported. Despite the primary role of uterine contractility in controlling postpartum blood loss, women with bleeding disorders are at an increased risk of postpartum haemorrhage. There are multiple case series documenting the incidence of postpartum haemorrhage in women with bleeding disorders [18] and four case-control studies comparing women with VWD and controls.