THE REPRODUCTIVE HEALTH OF WOMEN WITH VON-WILLEBRAND DISEASE UNRESPONSIVE TO DDAVP - RESULTS OF AN INTERNATIONAL SURVEY

An international registry was established on the reproductive health o f women with types of von Willebrand disease (vWd) unresponsive to DDA VP. Data was collected on 44 women from 16 treatment centers in nine c ountries. Severe menorrhagia requiring blood product therapy occurred at least once in 80% of the women for whom data was reported. Most of the reported episodes occurred prior to the diagnosis of vWd and/or th e use of oral contraceptive (OC) therapy. OC therapy was clinically ef fective in the treatment of chronic menorrhagia in 22 of 25 (88%) wome n treated. Two of the women, however, were unable to tolerate chronic OC use and a third became refractory to treatment. Hysterectomy was pe rformed in 10 of the 44 women (23%). The reported indication for six o f the procedures was menorrhagia. Seventy percent were performed at tw o treatment centers, suggesting different thresholds for the performan ce of the procedure. There were 69 pregnancies reported in 31 of the 4 4 women. Fifteen of the pregnancies resulted in spontaneous abortions. The incidence of miscarriage was 22% and appeared clustered, with 10 of 15 of the miscarriages occurring in just four of the women.