VTE and anticoagulation in menstruating women

Women of childbearing potential have a high prevalence of venous thromboembolism (VTE) due to high estrogen states, such as pregnancy and the use of estrogen-containing contraceptives. Abnormal uterine bleeding (AUB) affects up to two-thirds of menstruating women on anticoagulation (AC), and can severely impair a woman\u27s quality of life. Rates of heavy menstrual bleeding (HMB) and other forms of AUB including inter-menstrual and postmenopausal bleeding are consistently underreported in the original clinical trials utilizing AC. VTE can occur at any time in a woman\u27s life, and the aim of this review article is to discuss the current landscape of literature on AUB for women on AC, VTE and AC in women of child bearing potential, planning for pregnancy while on AC, VTE during pregnancy, and considerations for VTE risk in postmenopausal women. This survey of the current literature may offer data for providers to consider while making clinical decisions on the duration of and appropriate choice of anticoagulation

Evaluation and Counseling of Candidates

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Ultrasonographic Evaluation of Normal and Pathologic Puerperium

Puerperium represents a period of profound physiological and anatomical changes aimed to return to the pre-pregnancy state. As showed by the almost half maternal deaths reported related to this period, the correct diagnosis and treatment of any complication is of paramount importance. In this scenario, the ultrasonographic evaluation has a key role as first level tool to identify and diagnose any complication and to address the cause of any pathological sign and symptom. Ultrasound evaluation is able to identify or exclude retained products of conception or arteriovenous malformations in case of postpartum hemorrhage. Moreover, ultrasound allows to identify and monitor post-surgical complications after cesarean section, such as postpartum hematomas and/or pelvic abscess. Although the key role of this diagnostic tool, the reported reliability and validity of ultrasounds in the assessment of the different complications is heterogenous, and the limited specificity and sensitivity of different ultrasound appearances need to be taking into account. To address this issue, the knowledge of normal ultrasonographic appearance of genital tract during the physiological puerperal involution is the first step to achieve an accurate distinction between normal and abnormal development of puerperium