Relationship between diagnosis and intervention in women with inherited bleeding disorders and menorrhagia.

Menorrhagia is the most common bleeding manifestation in women with inherited bleeding disorders. There is little known about whether the management of menorrhagia is altered in specific bleeding disorders. Optimizing treatment strategies for each specific diagnosis may improve quality of life in these women. This work aimed to look for a potential relationship between the specific diagnosis of an inherited bleeding disorder and the intervention required to control the menorrhagia. A retrospective chart review was performed for all women seen in the Kingston Women and Bleeding Disorders Clinic. Patients were categorized by diagnosis into two groups: Haemophilia carriers and all others. Treatment options were grouped into two categories: Medical or gynecological/surgical. Overall, 85.7% of haemophilia carriers required gynaecological surgical management, whereas only 31.4% of patients with all other diagnoses required gynaecological/surgical management (P = 0.012, Fisher's exact test). Therefore, carriers of Haemophilia were more likely to have a better outcome in treating their menorrhagia with gynaecological or surgical management compared with medical management. This information may 1 day help to guide treatment choice for menorrhagia in women with bleeding disorders.

The duration of labor in adolescents.

STUDY OBJECTIVES: To determine the lengths of the first and second stages of labor in a group of Canadian adolescents; to compare this timeline to the estimates from a general population, and to a heterogeneous group of adolescents from a previous study. DESIGN: Retrospective chart review. SETTING: Kingston General Hospital, Kingston, Ontario, Canada. PARTICIPANTS: This study included women 19 years old and under at the time of delivery, having had spontaneous labor and a term singleton cephalic vaginal delivery between 2000 and 2005. MAIN OUTCOME MEASURES: The primary outcome is the length of the first and second stages of labor. Impact of epidural use will be determined. RESULTS: In adolescents undergoing spontaneous labor at term (n = 177), the median duration of the first stage was 6.8 and 3.2 hours for nulliparous and multiparous teens respectively, compared to 10.0 and 5.9 hours in a mostly adult population. The duration of the second stage, in term spontaneous vaginal deliveries, was 54 minutes for nulliparous and 10 minutes for multiparous adolescents, similar to the teens in Greenberg's 2007 study. Comparatively, median lengths of second stage for the general population were 92 minutes and 20 minutes for nulliparous and multiparous women respectively. Epidural analgesia had a significant influence on lengthening the second stage in adolescents, however second stages in teens were still shorter, when controlling for regional analgesia, than in a general population. CONCLUSIONS: Adolescents do have shorter both first and second stages when compared to a general group. These differences demonstrate the importance of determining a distinct timeline for evaluating the course of labor in teens.