Gynaecological and obstetrical morbidity in women with type I von Willebrand disease: results of a patient survey.
Type 1 von Willebrand disease (vWD) is generally regarded clinically as 'mild' and the obstetrical-gynaecological features have not been fully described. We administered a patient questionnaire and provider survey of the medical and quality of life aspects of childbirth and menstruation to 99 type 1 vWD patients and compared the patients presently menstruating (n=81) to a cohort of 150 menstruating females in the general population. The following measurements had a statistically higher proportion in the vWD group: number of tampons/towels used for a typical menstrual cycle (P=0. 002); percentage reporting that clothes are stained by menses (P = 0. 001); past or present history of anaemia (P = 0.001); childbirth-related bleeding (P=0.001); and childbirth-related bleeding necessitating RBC transfusion (P=0.002). Quality of life assessment of the impact of menses in both of the above cohorts was measured by a Likert scale using seven quality of life parameters. Compared to the control group, the vWD patients had a significantly higher score, with P-values of < 0.0001 for each parameter. Hormonal interventions for menorrhagia in the vWD patients were < or = 50% effective. Menorrhagia resulted in red blood cell transfusions in 6% of patients, dilatation and curettage in 17% and hysterectomy in 13%. Despite the common connotation of type 1 vWD as clinically 'mild', childbirth and the monthly challenge to haemostasis presented by menstruation result in a substantial degree of morbidity in females with type 1 vWD. These results support the rationale for ongoing international efforts to increase awareness of vWD as a cause for menorrhagia and to improve the quality of life in females with known vWD.
Kouides
P A
PA
Mary M. Gooley Hemophilia Center, Inc., Rochester, NY, USA. peter.kouides@viahealth.org
Phatak
P D
PD
Burkart
P
P
Braggins
C
C
Cox
C
C
Bernstein
Z
Z
Belling
L
L
Holmberg
P
P
MacLaughlin
W
W
Howard
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005831:Genital Diseases, Female / Q000209:etiology / Q000503:physiopathology*; D005836:Genitalia, Female / Q000503:physiopathology*; D006801:Humans; D007743:Labor, Obstetric; D008598:Menstruation; D008875:Middle Aged; D011247:Pregnancy; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014842:von Willebrand Diseases / Q000150:complications / Q000503:physiopathology*