Massive ovarian cyst haemorrhage with haemoperitoneum as a complication of long-term anticoagulation

Corpus luteum hemorrhage with acquired hemophilia A: a case report and literature review

Background

The rupture of the corpus luteum (CL) may occur at all stages of a woman’s reproductive life. Bleeding of the ruptured CL varies from self-limiting hemorrhage to massive hemoperitoneum, causing the shock and subsequent emergency surgery. But hemoperitoneum secondary to ruptured CL is a rare complication and situation for women with bleeding disorders.

Case presentation

We here describe a case of severe CL hemorrhage with factor VIII deficiency. We chose conservative management instead of surgery for the abnormal hemostatic condition. With blood product and factor concentrate support, conservative management was successful in avoiding surgery in the episode of bleeding.

Conclusion

Gynecologist should be alert for the patients with abnormal hemostatic condition. Selective patients presenting with CL hemoperitoneum association with bleeding disorders may undergo conservative management and avoid the risk of surgery.

Descriptive study of the general practitioners' perception of direct oral anticoagulants and the risk of genital bleeding in women of childbearing age

AIM OF THE STUDY AND PATIENTS

Direct oral anticoagulants (DOA) tend to replace antivitamins K (VKA). The incidence of major and minor hemorrhages is higher in women, a difference potentially linked to genital hemorrhages. The objective is to assess the practices and perception of general practitioners of the use of oral anticoagulant therapy in women of childbearing age.

MATERIALS AND METHODS

Descriptive, observational, transversal and monocentric study. An 11-items questionnaire was sent to 900 randomized general practitioners, assessing the type of patient, the type of anticoagulant prescribed, the management of genital bleeding, and the assessment of the quality of life of anticoagulated patients.

RESULTS

DOA were the most prescribed anticoagulants. Genital hemorrhage was the second leading cause of minor hemorrhage. Most doctors (60.6%) believed they were due to VKAs. 25% reported an alteration in the quality of life of patients following these genital hemorrhages and 47.5% addressed this subject in consultation.

CONCLUSION

Our study suggests that, according to the general practitioners interviewed, genital hemorrhage is more frequent on VKA than on DOA in women of reproductive age, which is contradictory with the data in the literature. The probably taboo subject is rarely mentioned in consultation and is responsible for a deterioration in the quality of life in these young patients. No recommendation exists on the management of this type of genital hemorrhage in these women. An algorithm is proposed for their management.

Abnormal Vaginal Bleeding in Women Desiring Contraception Who Are Taking Anticoagulation Therapy

A 30-year-old nulligravid woman is referred to you for heavy menstrual cycles. Although her menstrual cycles were previously light, she was recently diagnosed with an unprovoked lower extremity venous thromboembolism and is taking anticoagulation therapy after a negative thrombophilia workup. She wants help with her vaginal bleeding and desires contraception.

[Complications of presumed benign ovarian tumors]

The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.