title: [Obstetric and gynecological intervention in women with Bernard-Soulier syndrome: report of two cases].
abstract: Introduction Bernard-Soulier syndrome (BSS) is a rare inherited bleeding disorder characterized by giant platelets thrombocytopenia, prolonged bleeding time, frequent hemorrhages with considerable morbidity. Data on the outcome of pregnancy and gynecological intervention in BSS are rare and there are no general therapeutic recommendations.
  
  
  METHODS
  We report two cases of BSS. In the first case a 29-year-old patient with BSS was admitted in 8 weeks of gestation. The diagnosis of BSS was made on the basis of prolonged bleeding time, giant-platelets thrombocytopenia, and absent ristocetin-induced platelet aggregation. In 38 week of gestation Cesarean section, with platelets transfusion preparation, was performed. Obstetric intervention passed without complication. Postoperative course was complicated with a three-week vaginal bleeding resistant to platelet transfusion. Neonate platelet count was normal. Our second case was a 28-year-old patient with BSS, hospitalized for ovarial tumor surgery. The patient was prepared for the intervention with platelets transfusion. The surgery was uncomplicated, but on the second postoperative day a massive vaginal bleeding, resistant to the platelet transfusion, developed. Bleeding control was achieved with activated recombinant factor VII. Twelve hours the patient developed later hypertensive crisis with epileptic seizure due to subarachnoid hemorrhage. Therapy was continued with platelet transfusion, antihypertensive and antiedema drugs. PH examination of tumor tissue showed hemorrhagic ovarial cyst.
  
  
  CONCLUSIONS
  Obstretic and gynecological intervention in women with BSS may be associated with a life-threatening bleeding thus requiring a multidisciplinary approach with adequate preparation. Because of the limited data in the literature, it is not possible to provide firm management recommendations and each case should be managed individually.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Mitrović
authors.forename: Ivo
authors.initials: I
authors.lastname: Elezović
authors.forename: Predrag
authors.initials: P
authors.lastname: Miljić
authors.forename: Darko
authors.initials: D
authors.lastname: Antić
mesh_terms: D000328:Adult; D001606:Bernard-Soulier Syndrome / Q000097:blood / Q000601:surgery*; D002585:Cesarean Section / Q000009:adverse effects; D015942:Factor VIIa / Q000627:therapeutic use; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D010051:Ovarian Neoplasms / Q000601:surgery*; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000628:therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa