RESUMEN
Recurrent miscarriage is the loss of two or more consecutive pregnancies and affects 1% of couples trying to conceive. It has proven to be frustrating for both patient and clinician. The majority of investigations and treatments offered remain controversial. However, practice must be evidence based and unproven investigations and treatments should be abandoned. Psychological support is of paramount importance since a significant number of women attending RM clinics have high levels of anxiety or are clinically depressed. Setting up a RM clinic is important to provide a dedicated service to couples with RM so as to avoid unnecessary and potentially harmful treatments, and also to recruit patients in trials that will delineate causes and efficacy of treatments.
Asunto(s)
Aborto Habitual/terapia , Solución de Problemas , Aborto Habitual/etiología , Consejo , Toma de Decisiones , Disentimientos y Disputas , Medicina Basada en la Evidencia , Femenino , Humanos , Guías de Práctica Clínica como Asunto , Embarazo , Calidad de la Atención de Salud , Factores de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the prevalence of von Willebrand disease in women presenting with menorrhagia. DESIGN: Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. SETTING: Hospital outpatient clinics (mainly gynaecological) and population surveys. POPULATION: Women presenting with menorrhagia. METHODS: Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. MAIN OUTCOME MEASURES: Number of women with von Willebrand disease. RESULTS: Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11-15.6%). The prevalence was higher in the European studies-18% (95% CI 15-23%) compared with that in North American studies-10% (95% CI 7.5-13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. CONCLUSIONS: The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.