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Abdomenul acut în ginecologie. Hemoragia în ginecologie Asist. univ. dr. Bogdan Doroftei Thursday, December 30, 2010

Abdomenul Acut Si Hemoragia in Ginecologie

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  • Abdomenul acut n ginecologie. Hemoragia n

    ginecologieAsist. univ. dr. Bogdan Doroftei

    Thursday, December 30, 2010

  • Abdomenul acut

    Durerea acut: este intens, caracterizat prin instalare brusc, creterea rapid n intensitate i durata scurtDurerea ciclic - dismenoreea este asociat cu ciclul menstrualDurerea pelvin cronic este durerea cu durat mai mare de 6 luni

    Thursday, December 30, 2010

  • Durerea acut

    Instalarea rapid a durerii este sugestiv pentru peforaia unui organ cavitar sau pentru un proces ischemicDurerea colicativ sunt asociate cu contracia muscular sau obstrucia unui viscer cavitar, precum intestinul sau uterulDurerea perceput la nivelul ntregului abdomen sugereaz o reacie generalizat la prezena unui fluid iritant n interiorul cavitii peritoneale

    Thursday, December 30, 2010

  • etiologia durerii acute

    Periombilical

    Apendicita - forma de debut Obstrucia intestinului subire Gastroenterita Ischemia de mezenter Ruptura unui anevrism aortic abdominal Disecia unui anevrism aortic abdominal

    Thursday, December 30, 2010

  • Flancul drept: Apendicita Colon iritabil Tumorile ovariene Torsiunea de ovar Sarcina ectopic Boala inflamatorie pelvin Abcesul tubo-ovarian Pielonefrita Abcesul perinefritic Urolitiaza Procese neoplazice gastro-intestinale Diverticulite situate pe colonul ascendent Ileocolita Gastroenterita Hernia

    etiologia durerii acute

    Thursday, December 30, 2010

  • Suprapubic

    Colonul iritabil Tumorile ovariene Torsiunea de ovar Sarcina ectopic Boala inflamatorie pelvin Abcesul tubo-ovarian Ovarian tumor Dismenoreea Diverticulita Cistita Nefrolitiaza

    etiologia durerii acute

    Thursday, December 30, 2010

  • etiologia durerii acuteFlancul stng abdominal

    Colon iritabil Tumora de ovar Torsiunea de ovar Sarcina ectopic Boala inflamatorie pelvin Abcesul tubo-ovarian Pielonefrita Abcesul perinefritic Nefrolitiaza Diverticul sigmoidian Ileocolit Gastroenterit Hernia Tumori neoplazice gastrointestinale

    Thursday, December 30, 2010

  • Difuze

    GastroenetritaOcluzia intestinalPeritonitaIschemia de mezenterColon iritabilCetoacidoza diabeticPorfiria UremiaHipercalcemia Sickle cell crisis Vasculite Intoxicaia cu metale greleSevrajul dup consumul de opiacee Febra familial mediteranean Angioedemul ereditar

    etiologia durerii acute

    Thursday, December 30, 2010

  • Diagnostic

    1. Istoric

    2. Examenul fizic

    Semne vitale

    Examenul abdomenului

    Examenul pelvin

    3. Teste de laborator

    4. Radioimagistica

    5. Laparoscopia exploratorie

    Thursday, December 30, 2010

  • Istoricdebutul dureriicircumstanele apariiei dureriiCaracterul durerii: colicativ, difuz, simptomatologia asociatCondiii ginecologice anterioare: APF si APPDisuria, hematuria, polakiuria orienteaz diagnosticul spre etiologia urinarAmenoreea, scurgerile vaginale, dispareunia. hemoragiile vaginale orienteaz spre cauze ginecologiceVrsturile: imp ca moment al apariiei: n abdomenul acut chirurgical apar DUP instalarea durerii ca mecanism reflex determinat de iritarea vagului. Se nsoeste de greaDac vrsturile apar nainte de instalarea durerii e mai puin probabil s fie o cauz de abdomen acut chirurgical

    Thursday, December 30, 2010

  • Examenul fizic Semne vitale:

    expresia feei transpiraii paloare gradul de agitaietemperatur: subfebrilitate - apendicit, diverticulit

    febr: BIP, Peritonit, pielonefritpuls cu dif >30b/min. intre poz ortostatic si decubit - hipovolemietensiune arterial dif > 20 mmHg intre poz ortostatic si decubit la un interval de 1 min. - hipopvolemieAtenie la boli neurologice sau medicaie hipotensoare care pot duce la confuzie n stabilirea diagnosticului

    Thursday, December 30, 2010

  • examenul abdomenului Inspecia abdomenului: c icatr ic i anter ioare laparotomie/laparoscopie - risc de ocluzie intestinal / hernie la nivelul inciziei, aderene. Cianoz cutanat periombilical - SEU

    Distensia abdominal mai frecvent n ocluzia intestinal, perforaia unui organ abdominal sau ascit Ascultaia abdomenului - zgomote specifice n ocluzia intestinal.

    Palparea abdomenului pe fiecare cadran cu accentuare pe zona indicat de pacient Iritaia peritoneal - aprare muscular sau abdomen de lemn datorit reflexului de aprare involuntar i a spasmului muchilor abdominali.

    Thursday, December 30, 2010

  • Examinarea ginecologic

    Secreia vaginal purulent - BIPHemoragia vaginal - complicaiile sarcinii, traumatisme n aria genital, tumori benigne sau maligne ale ovarului, uterului (col) vaginului.

    Sarcina, adenomioza, leiomiomul uterin sunt responsabile de creterea n volum a uterului i de modificarea consistenei acestuia.Mobilizarea cervixului urmat de durere se ntlnete mai frecvent n sindromul de iritaie peritoneal ( BIP, apendicit, diverticulit, hemoragie intraabdominal).

    Mase anexiale dureroase reflect sarcina ectopic sau abces tubo-ovarian, chist ovarian torsionat, rupt sau hemoragie intrachistic. ATENIE! Se poate confunda cu abces apendicular sau diverticul. Tueul rectal- informaii suplimentare despre sursa i mrimea unor eventuale mase anexiale sau posibilitatea unei patologii colo-rectale

    Thursday, December 30, 2010

  • Teste de laborator

    hemoleucograma complet cu determinarea Hb, Ht, Leucocite, formula leucocitarVSH -nespecific, adesea este singurul test anormal n BIP subacutSumar urinTest sarcinCuldocenteza

    Thursday, December 30, 2010

  • imagistic

    Eco pelvin transabdominal/ endovaginalRx abd pe gol/ subst de contrastCT /RMN

    Thursday, December 30, 2010

  • Laparoscopia diagnostic

    Contraindicaii: Tumori pelvine > 10 cmperitonitileusocluzie intestinalcicatrice median postlaparotomie ( peritonite, ocluzii intestinale, procese neoplazice)oc hipovolemic

    Thursday, December 30, 2010

  • Ruperea sau pierderea coninutului unui chist ovarianchistul folicular este cel mai frecvent implicatmittelschmertz chist de corp luteal hemoragicteratomul chistic - dermoidchistadenoameleendometriomul

    Thursday, December 30, 2010

  • un chist ovarian care NU torsioneaz, dar care crete rapid n dimensiuni, se infecteaz sau pierde din coninut nu determin durere acutchist luteinic rupt - simptomatologie ca n sarcina ectopic - hemoperitoneu, durere instalat brusc, sincopendometriomul sau chistul dermoid nu va fi nsoit de hemoperitoneu, cantitatea de snge fiind mai micsensibilitate abdominal semnificativ asociat cu sensibilitate de rebound datorat iritaiei peritonealeabdomen moderat destinsformaiune pelvin dac nu este complet ruptverific Ht/culdocentez

    Ruperea sau pierderea coninutului unui chist ovarian -

    Thursday, December 30, 2010

  • test de sarcin - negativhemoleucogram modificatculdocentez pozitivecografie: pune n eviden formaiunea, lichid in DouglasHt
  • hemoperitoneu - tratament chirurgical laparoscopic sau clasicCuldocenteza: snge proaspt - corp luteal; snge cu aspect chocolatiu - endometriom; lichid uleios, sebaceu - chist dermoid; lichid purulent - BIP sau abces tubo-ovarianAntibioticeAntiinflamatorii

    Ruperea sau pierderea coninutului unui chist ovarian -

    Thursday, December 30, 2010

  • Torsiunea de ovarinstalarea rapid a durerii pelvine acuteteratomul chistic benign cel mai frecvent se poate torsionadurere sever i constantinstalarea durerii coincide cu ridicarea unor greuti, a unui efort fizic deosebit sau contact sexualse nsoete de grea, vrsaturi, anxietateabdomen sensibil la palpare palparea - prezena unei mase pelvine marifebr, leucocitoz

    Thursday, December 30, 2010

  • Torsiunea de ovar

    Chistectomie dac esutul nu este infarctizatOvariectomie dac este infarctizat

    Thursday, December 30, 2010

  • Chistectomie

    Thursday, December 30, 2010

  • Thursday, December 30, 2010

  • Thursday, December 30, 2010

  • ovariectomie

    Clamping the meso-ovarium

    Thursday, December 30, 2010

  • Pedicle ligation.

    Thursday, December 30, 2010

  • Chistecomia laparoscopica

    Ovarian incision.

    Thursday, December 30, 2010

  • Cyst dissection.

    Thursday, December 30, 2010

  • Cyst wall removal.

    Thursday, December 30, 2010

  • Thursday, December 30, 2010

  • Thursday, December 30, 2010

  • Salpingo-ooforita acutaNeisseria gonorrhea i Chlamydia trachomatisAvortul septic, endometrita, colonizare ascendentinstalare acut a durerii ce crete n intensitate cu micareafebrsecreie vaginal purulentvrsturisensibilitate abdominalsensibilitatea la mobilizarea coluluisensibilitate anexial bilateralVSH mrit, leucocitozCuldocentez - lichid purulent, fetidtest pozitiv la antigene Chlamydiene din col

    Thursday, December 30, 2010

  • Criterii de spitalizare:abces tubo-ovarian suspectprezena unui DIU, diagnostic incertgrea/ vrsturi ce mpiedic tratament per ossemne peritoneale lipsa ameliorrii dup 48 ore tratament cu antibiotice

    Salpingo-ooforita acuta

    Thursday, December 30, 2010

  • Abcesul tubo-ovarianmai frecvent bilateraledurer i febr persistent mai mult de 7 zileabcesul tubo-ovarian rupt - URGEN - oc endotoxinic gram negativ cu potenial letalmase bilaterale fixe, ferme, intens dureroasepot fi fixate la fundul de sac ecografic se stabilete diagnosticultratament cu asociere de antibiotice ivabces rupt- peritonit - tahicardie, sensibilitate n toate cele 4 cadrane, hipotensiunea i oliguria

    Thursday, December 30, 2010

  • Leiomiomul uterin degenerat sau torsionat

    Thursday, December 30, 2010

  • Endometrioza

    Thursday, December 30, 2010

  • Sindromul de Hiperstimulare ovarian

    n urma procedurilor de FIVDurere abdominal Grea, vrsturi, stare alterat, dispneeAscit, hidrotorax, hidropericardoligurie, hemoconcentraietromboze venoase profunde

    Thursday, December 30, 2010

  • Sindromul de Hiperstimulare ovarian

    Thursday, December 30, 2010

  • Hemoragia n ginecologie

    Menorrhagia is defined as prolonged or heavy cyclic menstruation. Objectively, menses lasting longer than 7 days or exceeding 80 mL of blood loss

    Metrorrhagia describes intermenstrual bleeding.

    Frequently women may complain of both patterns, menometrorrhagia

    Some women, there is diminished flow or shortening of menses, hypomenorrhea.

    Normal menstruation typically occurs every 28 days 7 days. Cycles with intervals longer than 35 days describe a state of oligomenorrhea.

    Withdrawal bleeding refers to the predictable bleeding that often results from abrupt progestin cessation.

    Thursday, December 30, 2010

  • Differential Diagnosis of Abnormal BleedingDysfunctional uterine bleeding

    Anovulatory

    Perimenarchealimmature hypothalamic-pituitary-ovarian axis

    Perimenopausalinsensitive ovarian follicles

    Endocrinopathiessee systemic causes

    Drugshypothalamic depressants, steroids

    Ovulatory

    Organic lesions

    Pregnancy-associated causesimplantation spotting, abortion, ectopic pregnancy, gestational trophoblastic disease, postabortal or postpartum infection

    Anatomic uterine lesions

    Neoplasmleiomyoma, polyp, endometrial hyperplasia, cancer

    Atrophic endometrium

    Infectionsexually transmitted disease, tuberculosis

    Mechanical causesintrauterine device, perforation

    Arteriovenous malformation

    Partial outflow obstructioncongenital mllerian defect, Asherman syndrome Thursday, December 30, 2010

  • Anatomic nonuterine lesions Ovarian lesionshormonally functional neoplasm

    Fallopian tube lesionssalpingitis, cancer Cervical and vaginal lesionscancer, polyp, infection, atrophic vaginitis, foreign body, trauma

    Systemic abnormalitiesExogenous hormone administrationsex steroids, corticosteroids

    CoagulopathiesHepatic failure

    Chronic renal failureEndocrinopathieshypothyroidism, hyperthyroidism, adrenal disorders, diabetes mellitus,

    hypothalamic-pituitary disorders, polycystic ovarian syndrome, obesity

    Thursday, December 30, 2010

  • Simptomatologia

    Menorrhagia and Metrorrhagia

    Postcoital Bleeding endocervical polyps, cervicitis, and less commonly, endometrial polyps. In the cases of cervicitis, Chlamydia trachomatis is a frequent cause. Bax and associates (2002) found that the relative risk of chlamydial infection in women with postcoital bleeding was 2.6 times higher than that of a control group without bleeding. From cervical or other genital tract neoplasia.

    Pelvic Pain Dysmenorrhea frequently develops concurrently with abnormal bleeding caused by leiomyomas polyps, adenomyosis, infections, and pregnancy complications. Because of the role of prostaglandins in both menorrhagia and dysmenorrhea, it seems logical that painful cramping would commonly accompany abnormal bleeding

    Thursday, December 30, 2010

  • Diagnostic

    Diagnostic algorithm to identify endometrial pathology in patients with abnormal uterine bleeding. D&C = dilatation and curettage; EMB = endometrial biopsy; SIS = saline-infusion sonography; TVS = transvaginal sonography.aEndometrium bilayer thickness measurements are used for postmenopausal women.bSIS or hysteroscopy per physician preference.cAdequate diagnosis and clinical management should follow.

    Thursday, December 30, 2010

  • Diagnostic algorithm to identify endometrial pathology in patients with abnormal uterine bleeding and with risk factors for endometrial cancer.D&C = dilatation and curettage; EMB = endometrial biopsy; SIS = saline-infusion sonography; TVS = transvaginal sonography.aTVS or EMB per physician preference.bEndometrium bilayer >5 mm (in postmenopausal women) or obvious pathology seen.cSIS or hysteroscopy per physician preference.dAdequate diagnosis and clinical management should follow.

    Thursday, December 30, 2010

  • Laboratory Evaluation

    HEMATOLOGIC AND -HCG TESTING

    hemogram

    urine or serum levels of human chorionic gonadotropin (-hCG)

    Screening for coagulation disorders should be considered in women with menorrhagia and no other obvious causes. This is particularly true for adolescents with menorrhagia. Evaluation typically includes partial thromboplastin time, prothrombin time, bleeding time, platelet count, and may include special testing for von Willebrand disease (von Willebrand Disease).

    INFECTIONScervicitis commonly causes intermenstrual or postcoital spotting (Chlamydia trachomatis and Neisseria gonorrhoeae). Cervicitis secondary to herpes simplex virus (HSV) infection may also cause bleeding (Paavonen, 1988).

    Thursday, December 30, 2010

  • CYTOLOGIC EXAMINATION

    Both cervical and endometrial cancers can cause abnormal bleeding and evidence for these tumors can often be found with Pap smear screening. The most frequent abnormal cytologic results involve squamous cell pathology and may reflect cervicitis, intraepithelial neoplasia, or cancer. Less commonly, atypical glandular or endometrial cells may be found.

    ENDOMETRIAL BIOPSY

    sampling and histologic evaluation of the endometrium in women with abnormal bleeding may disclose infection or neoplastic lesions such as endometrial hyperplasia, cancer, polyps, or gestational trophoblastic neoplasia

    Laboratory Evaluation

    Thursday, December 30, 2010

  • During biopsy, the Pipelle is first directed to the uterine fundus (A). The stylette of the Pipelle is retracted to create suction within the cylinder. (B). The Pipelle is then drawn to the internal cervical os and advanced back to the fundus. The Pipelle is gently spun during its advancement and retraction to allow thorough sampling of all endometrial surfaces.

    Thursday, December 30, 2010

  • Transvaginal sonography

    With its improved resolution, this technology is chosen by many instead of endometrial biopsy as a first-line tool to assess abnormal bleeding. If abnormal bleeding stems from myometrial pathology such as leiomyomas or adenomyosis, sonography offers anatomic information regarding the myometrium that is not afforded by hysteroscopy or endometrial biopsy. In addition, transvaginal sonography (TVS) compared with these other two offers greater patient comfort and comparable detection of endometrial hyperplasia and cancer.

    Thursday, December 30, 2010

  • Endometrial thickness

    Thursday, December 30, 2010

  • SALINE-INFUSION SONOGRAPHY

    Thursday, December 30, 2010

  • SALINE-INFUSION SONOGRAPHY

    Saline-infusion sonography ( S I S ) h a s a l s o b e e n c o m p a r e d w i t h hysteroscopy to detect uter ine cav i tary foca l lesions. De Kroon and co-workers (2003) performed a meta-analysis of 24 studies and reported SIS to e q u a l t h e d i a g n o s t i c accuracy of hysteroscopy. Importantly, neither hysteroscopy nor SIS can reliably discriminate between benign and malignant focal lesions.

    Thursday, December 30, 2010

  • Endometrial polyps h a d o n l y o n e a rt e r i a l s u p p l y, whereas submucosal l e i o m y o m a s generally received b l o o d fl o w f r o m s e v e r a l v e s s e l s ar is ing from the inner myometrium

    TRANSVAGINAL COLOR DOPPLER SONOGRAPHY

    Thursday, December 30, 2010

  • Hysteroscopy

    Thursday, December 30, 2010

  • Hysteroscopy

    A: A submucous myoma prolapses through the cervix and is grasped with the tenaculum. B: The base of the myoma has been clamped, and a ligature has been placed on the pedicle. C: The myoma has been removed and measures approximately 4 cm across.

    Thursday, December 30, 2010

  • endometrial polypoid hyperplasia.

    Hysteroscopy

    Thursday, December 30, 2010

  • An endometrial polyp in a woman who had received tamoxifen treatment for breast cancer. The endometrium has been modified by the tamoxifen treatment.

    Hysteroscopy

    Thursday, December 30, 2010

  • The endometrium shows extensive atrophy, which accounts for abnormal bleeding.

    Hysteroscopy

    Thursday, December 30, 2010

  • Abnormal vascular pattern and vegetations associated with adenocarcinoma endometrium arising from the posterior wall of the uterus.

    Hysteroscopy

    Thursday, December 30, 2010

  • AINSacid mefenamic 500mg x3/zi , 5 zile din prima zi a CMNaproxen 550mg in ziua 1 a CM apoi 275mg/ziIbufrofen 500mg/zi la menstruaieFlurbiprofen 100 mg x2 /zi 5 zile ncepnd cu ziua 1 a CM

    Meclofenamate 100mg x3 /zi 3 zile ncepnd cu ziua 1 a CM

    tratamentul medical al menoragiilor

    Thursday, December 30, 2010

  • tratamentul medical al menoragiilor

    Contraceptive orale 1cp/zi din ziua 1 a CM, timp de 21 zileacid tranexamic 1g x 4/zi timp de 5 zile din prima zi a CM Androgeni - Danazol 100mg sau 200mg/zi sau GestrinonaGnRH agonist 3,75mg/luna im doza depot, maxim 6 luniNorethindrone 5mg x 3 /zi din ziua 5-a pn n ziua 26 a CM ( HUD ovulatorie) sau 5mg x 2 /zi din ziua 15-a a CM pn n ziua 26 a CM (HUD anovulatorii)Mirena - DIU cu levonorgestrel Estrogen n doze mari pt a controla HUD acut - Premarin 2,5mg x4/zi pn la oprirea hemoragiei, apoi COC

    Thursday, December 30, 2010

  • Tratamentul chirurgical

    Chiuretajul hemostatic i biopsicProceduri de distrucie a endometruluiHisterectomia

    Thursday, December 30, 2010

  • D&C

    Thursday, December 30, 2010

  • D&C

    Thursday, December 30, 2010

  • Thursday, December 30, 2010

  • D&C

    Thursday, December 30, 2010

  • D&C

    Thursday, December 30, 2010

  • Second-Generation Endometrial Ablation Technologies

    Hot liquid balloonsThermaChoice I, II, and IIICavaterm and Cavaterm plusThermablate Hydrothermablation Cryoablation (Her option) Microwave endometrial ablation

    Impedance controlled ablation (NovaSure)

    Thursday, December 30, 2010

  • ThermaChoice III Uterine Balloon Therapy System AND Hysteroscopic termal ablation

    Thursday, December 30, 2010

  • Impedance-controlled electrocoagulation AND Cryoablation

    Thursday, December 30, 2010

  • Absolute Contraindications for Endometrial Ablation

    Genital tract malignancyWomen wishing to preserve their fertilityPregnancyExpectation of amenorrheaAcute pelvic infectionPrior uterine surgeryclassical cesarean delivery, transmural myomectomy.

    Thursday, December 30, 2010

  • Histerectomia

    Thursday, December 30, 2010

  • Histerctomia

    Thursday, December 30, 2010

  • Histerctomia

    Thursday, December 30, 2010

  • Histerctomia

    Thursday, December 30, 2010

  • Histerctomia

    Thursday, December 30, 2010

  • Hemoragia datorat unor procese tumorale

    Leiomiomul (fibromul ) uterinAnomalii ale ductului mullerian - septuri vaginale sau uterine care determin hemoragii intermenstruale prin acumularea i evacuarea ntrziat a sngelui menstrualMalformaii arterio-venoase la nivelul uterinPolip endometrialPolip endocervicalEndometrita cronic

    Thursday, December 30, 2010

  • Insuficiena renal sever- dializ se nsoete de amenoree, infertilitate, hipoestrogenemie. Uneori pot apare menoragii.Tratamentul presupune administraea de doze mari de medroxiprogesteron acetat pt a induce atrofia endometruluiCOC pot fi adminstrate doar dac nu se suspicioneaz HTAInhibitori de sintez ai prostaglandinelor sunt contrainicai deoarece determin spasm arterial renaldac hemoragia nu poate fi controlat se practic histerectomia

    Hemoragia datorat unor boli sistemice

    Thursday, December 30, 2010

  • Insuficiena hepatic60% cazuri la pacientele pt transplant hepaticmetabolismul hepatic interfer cu metabolismul hormonilor sexuali, determinnd hiperestrogenemie - hemoragieInsuficiena hepatic determin i tulburri de coagulare prin deficit de proteine implicate n coagulare, trombocitopenie

    Thursday, December 30, 2010

  • Boli tiroidiene

    Amenoree sau Menometroragie Dozare TSHHipertiroidia se nsoete de hipomenoree/amenoree. 5% din cazuri se asociaz cu menometroragieHipotiroidia - anovulaie, amenoree, HUD cu anovulaie i tulburari ai factorilor de coagulare

    Thursday, December 30, 2010

  • Coagulopatii

    testing for bleeding disorders in: (1) adolescents with severe menorrhagia, (2) women with significant menorrhagia without another identifiable cause, and (3) preoperatively, prior to hysterectomy planned for severe bleeding.

    creening evaluation of bleeding disorders in general has included a prothrombin time (PT), partial thromboplastin time (PTT), platelet count, and bleeding time. More commonly identified coagulopathies include von Willebrand disease (vWD) and other disorders of platelet function. Deficiencies of factor VII and IX (hemophilia A and B) or other factor deficiencies are more rarely involved.

    Thursday, December 30, 2010

  • von Willebrand DiseaseIn women with abnormal bleeding and normal pelvic anatomy, rates of vWD were found to be 13 percent (Shankar, 2004). The disorder is more common in Caucasian than in African-American women (Miller, 2003).

    Patients with vWD commonly complain of menorrhagia, and rates of 60 to 70 percent have been noted (Kadir, 1998, 1999; Lak, 2000). Heavy menstruation begins with menarche in these patients.

    Importantly, vWF levels may be higher during the luteal phase, and thus samples should be obtained prior to day 7 of the menstrual cycle (Kadir, 1999; Lee, 2005).

    Treatments for women with menorrhagia and vWD include desmopressin, plasma concentrates, hormonal contraception, antifibrinolytics, and surgery. Combination oral contraceptive pills have been noted to arrest uterine hemorrhage in 88 percent of women (Foster, 1995). Also, Kingman and co-workers (2004) reported that the LNG-IUS effectively decreased blood loss and induced amenorrhea in 56 percent of women with inherited bleeding disorders. Preliminary success has been found with endometrial ablation for women with vWD-related menorrhagia (El-Nashar, 2007; Rubin, 2004).

    Thursday, December 30, 2010

  • Coagulation factor Deficiencies

    Hemophilia A and B are inherited X-linked deficiencies of factor VIII or IX. Women carriers of the gene, however, can have decreased levels of factor VIII or IX. In some cases, these are low enough to cause mild hemophilia (Mannucci, 2001; Siegel, 2005).

    Deficiencies of other coagulation factors are usually inherited as autosomal recessive traits and are rare. This group includes dysfibrinogenemia, hypofibrinogenemia, prothrombin deficiency, and deficiency of factors V, VII, X, XI, and XIII. Treatment of these disorders is by factor replacement (Mannucci, 2004b).

    Thursday, December 30, 2010

  • Thrombocitopenia

    Trombocitele variaz ca numr pe parcursul ciclului menstrual.

    Cresc dup ovulaie i scad odat cu apariia menstruaiei.La unele femei aceste variaii se nsoesc de hemoragie genital.

    Thursday, December 30, 2010