Abstract Number: PB1567
Meeting: ISTH 2020 Congress
Background: Women with inherited bleeding disorders have significant gynaecological bleeding. Though many have menorrhagia, some suffer more prominent bleeding causing pelvic haematomas. Discovery of haematomas can be daunting as many are initially thought to be malignancies before being diagnosed as haematoma.
Aims: We report 3 cases of pelvic haematomas at our hospital.
Methods: Retrospective review of patients clinic notes.
Case 1: 47-year-old nulliparous lady, with GT and significant menstrual bleeding. She experienced prolonged menstruation in 2017 with abdominal distension. Imaging showed a heterogenously enhancing solid cystic mass at the posterior wall of uterus measuring 13.5 x 1.0 x 13.3 cm with bilateral obstructive uropathy. She was transferred to us for further management of suspected malignant tumour. Multidisciplinary discussion concluded that it was a haematoma. She underwent ultrasound guided culdocentesis and drained 1liter of infected clots.She received continuous combined OCP (ccOCP), iron supplements and regular tranexamic acid and has been symptom free since.
Case 2: 32 year old, diagnosed with Type 2 vWD when she suffered post partum haemorrhage. in 2018, she developed severe abdominal pain with palpable pelvic mass consistent with a 14 weeks gravid uterus. Ultrasound showed a multiseptated solid-cystic mass measuring 5.4×6.3cm; concluded to be a haematoma and was started on ccOCP. Despite being advised against it, she wants to get pregnant and not compliant to OCPs. She continues to have abdominal pains.
Case 3: 19 year old, nulliparous diagnosed with type 3 vWD at menarche. In 2017 she had severe abdominal pain and ultrasound revealed an ovarian cyst measuring 5.8 x 5.0 cm. She received ccOCP and serial ultrasound reveals slightly smaller cyst at 5.0cm x 5.0 cm.
Conclusions: Pelvic haematoma in women with bleeding disorders is usually due to bleeding during ovulation. The use of continuous combined hormonal therapy ensures anovulation preventing further bleeding into the pelvis.
To cite this abstract in AMA style:Selvaratnam V, Sivapatham L, Ganesalingam M, Sathar J. Pelvic Haematoma in Women with Bleeding Disorders: A Single Center Experience [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/pelvic-haematoma-in-women-with-bleeding-disorders-a-single-center-experience/. Accessed November 30, 2023.
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