Hemostatic defects of menorrhagia. [A prospective clinicohematological study]

To identify patients with menorrhagia due to underlying hemostatic disorder whether primary or secondary. A prospective clinico - hematological case series study. As-Salam, Al-Batool and Ibn Sina Teaching Hospitals over a period of 3 years [January 2000-January 2003]. 500 females with menorrhagia. - Basic hematological procedures, coagulation tests [including prothrombin time [PT], activated partial thromboplastin time [APTT] and skin bleeding time [BT] and bone marrow study in certain cases. Menorrhagic patients were divided into 3 groups: Group I: included 400 females [80%], all had menorrhagea due to local diseases. Group II: included 32 patients [6.4%] who showed evidences of hemostatic defects. There were 12 cases of Idiopathic thrombocytopenic purpura [ITP], 4 cases of leukemia, 1 case of Burkitt lymphoma of the uterus and 2 cases of Glanzmann's thrombasthenia. In addition prolongation of BT and APTT was found in [15.6%], prolongation of APTT alone in 8 cases [25%]. Group III: included 68 patients [13.6%] with no identifiable local or hemostatic pathology. Group II patients were significantly younger than those of group I [P < 0.005]. Hemostatic disorders are important causes of menorrhagia particularly in young females

Diagnosis and management of intrauterine growth retardation

This study included 50 pregnant women suspected to have intra-uterine Growth Retardation [IUGR]. Various clinical methods and investigations were used to determine if IUGR is present and If so, whether there is any etiological factor and to identify the fetus at risk. In 32 patients [64%] there was no obvious cause of IUGR Pre-eclampsia was present in 12 patients [24%] and chronic renal disease was present in 4 patients [8%]. One patient was a heavy smoker. Daily Fetal movements recording showed reduction in 37 patients [74%], out of these only 28 patients delivered small for gestational age babies. Out of these 20 babies had good Apgar score. The symphysis - Fundus measurements were subnormal in all cases [100%], however, only 31 patients [62%] delivered small for gestational age babies. A reactive Cardio-Tocography [C. T. G.] was effective in predicting good birth condition in 45 patients [90%]. Thirty patients [60%] had subnormal growth pattern by ultrasound examination, but 18 patients [34%] delivered small for gestational age babies. The incidence of Caesarian section was relatively high [32%]. There were 3 perinatal deaths, 1 still birth and 2 early neonatal deaths. The diagnosis of IUGR is not easy and often elusive until delivery, but it is important as it is one of the major causes of perinatal death