{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T15:01:52Z","timestamp":1761490912378},"reference-count":33,"publisher":"American Society of Hematology","issue":"1","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>This is the obstetrician\u2019s view on 3 different clinical scenarios involving bleeding and thrombotic disorders. In the first scenario, an 18 year old with a history of heavy menstrual bleeding since menarche presents with abdominal pain and ultrasound findings suggestive of a hemorrhagic ovarian cyst. The association with an underlying bleeding disorder is recognized. The goals of management, which are controlling hemorrhage and preserving fertility, are stated. Ovarian suppression, the most effective method to prevent recurrent hemorrhagic ovarian cysts, is outlined. Long-term management of heavy menstrual bleeding with hormonal contraception is described. In the second scenario, the same patient returns 5 years later for a preconception visit. The potential risks to an unborn baby with von Willebrand disease (VWD) are addressed. The natural rise in von Willebrand factor (VWF) during pregnancy is discussed, but the fact that women with VWD do not achieve the same VWF levels as women without VWD is emphasized and the implications are presented. In anticipation of pregnancy, the need for nonhormonal management of heavy menstrual bleeding and hemorrhagic ovarian cysts is mentioned. In the third and final scenario, the patient\u2019s cousin with factor V Leiden seeks consultation regarding the risks of thrombosis with in vitro fertilization. The steps of assisted reproductive technology are described. The strategies to prevent venous thromboembolism by preventing ovarian hyperstimulation and reducing the likelihood of multiple gestation are detailed.<\/jats:p>","DOI":"10.1182\/hematology.2019000071","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T15:17:29Z","timestamp":1575645449000},"page":"148-151","update-policy":"http:\/\/dx.doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":1,"title":["Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the obstetrician\u2019s view"],"prefix":"10.1182","volume":"2019","author":[{"given":"Andra H.","family":"James","sequence":"first","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Duke University, Durham, NC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"234","reference":[{"issue":"3","key":"2019120610114677100_B1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1272\/jnms.70.243","article-title":"Ultrasonographic and clinical appearance of hemorrhagic ovarian cyst diagnosed by transvaginal scan","volume":"70","author":"Nemoto","year":"2003","journal-title":"J Nippon Med Sch"},{"issue":"4","key":"2019120610114677100_B2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1365-2516.2005.01108.x","article-title":"More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders","volume":"11","author":"James","year":"2005","journal-title":"Haemophilia"},{"issue":"suppl 5 part 2","key":"2019120610114677100_B3","first-page":"808","article-title":"Combined deficiency of factors II, VII, IX, and X (Borgschulte-Grigsby deficiency) in pregnancy","volume":"97","author":"McMahon","year":"2001","journal-title":"Obstet Gynecol"},{"issue":"2","key":"2019120610114677100_B4","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00404-014-3394-2","article-title":"Conservative management of corpus luteum haemorrhage in patients on anticoagulation: a report of three cases and review of literature","volume":"291","author":"Gupta","year":"2015","journal-title":"Arch Gynecol Obstet"},{"issue":"11","key":"2019120610114677100_B5","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1080\/17512433.2018.1536544","article-title":"Pharmacodynamics of combined estrogen-progestin oral contraceptives 3. Inhibition of ovulation","volume":"11","author":"Bastianelli","year":"2018","journal-title":"Expert Rev Clin Pharmacol"},{"issue":"4","key":"2019120610114677100_B6","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.contraception.2004.06.011","article-title":"Contraceptive efficacy and safety of DMPA-SC","volume":"70","author":"Jain","year":"2004","journal-title":"Contraception"},{"issue":"6","key":"2019120610114677100_B7","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.fertnstert.2014.03.004","article-title":"Pharmacokinetics of two low-dose levonorgestrel-releasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies","volume":"101","author":"Apter","year":"2014","journal-title":"Fertil Steril"},{"issue":"1","key":"2019120610114677100_B8","doi-asserted-by":"crossref","first-page":"12.e1","DOI":"10.1016\/j.ajog.2009.04.024","article-title":"Von Willebrand disease and other bleeding disorders in women: consensus on diagnosis and management from an international expert panel","volume":"201","author":"James","year":"2009","journal-title":"Am J Obstet Gynecol"},{"issue":"10","key":"2019120610114677100_B9","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1093\/humrep\/der224","article-title":"Effective treatment of heavy and\/or prolonged menstrual bleeding with an oral contraceptive containing estradiol valerate and dienogest: a randomized, double-blind phase III trial","volume":"26","author":"Fraser","year":"2011","journal-title":"Hum Reprod"},{"issue":"4","key":"2019120610114677100_B10","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/AOG.0b013e3182118ac3","article-title":"Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial","volume":"117","author":"Jensen","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"4","key":"2019120610114677100_B11","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/S1701-2163(16)34151-2","article-title":"A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia","volume":"31","author":"Endrikat","year":"2009","journal-title":"J Obstet Gynaecol Can"},{"issue":"1","key":"2019120610114677100_B12","first-page":"48","article-title":"Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial [published correction appears in Contraception. 2011;84(1):112]","volume":"83","author":"Shaaban","year":"2011","journal-title":"Contraception"},{"issue":"1","key":"2019120610114677100_B13","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1097\/AOG.0000000000003013","article-title":"ACOG committee opinion no. 762: prepregnancy counseling","volume":"133","author":"ACOG Committee","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"1","key":"2019120610114677100_B14","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/hae.12568","article-title":"Postpartum von Willebrand factor levels in women with and without von Willebrand disease and implications for prophylaxis","volume":"21","author":"James","year":"2015","journal-title":"Haemophilia"},{"issue":"2","key":"2019120610114677100_B15","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/ejh.13250","article-title":"Pregnancy and delivery in women with von Willebrand disease","volume":"103","author":"Castaman","year":"2019","journal-title":"Eur J Haematol"},{"key":"2019120610114677100_B16","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1182\/asheducation-2016.1.236","article-title":"Heavy menstrual bleeding: work-up and management","volume":"2016","author":"James","year":"2016","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"suppl 5","key":"2019120610114677100_B17","first-page":"S136","article-title":"Preimplantation genetic testing: a Practice Committee opinion","volume":"90","author":"The Practice Committee of the Society for Assisted Reproductive Technology; the Practice Committee of American Society for Reproductive Medicine","year":"2008","journal-title":"Fertil Steril"},{"key":"2019120610114677100_B18","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1182\/asheducation-2014.1.379","article-title":"Anticoagulation and in vitro fertilization and ovarian stimulation","volume":"2014","author":"Bates","year":"2014","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"2","key":"2019120610114677100_B19","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.fertnstert.2013.03.037","article-title":"Utilization and success rates of unstimulated in vitro fertilization in the United States: an analysis of the Society for Assisted Reproductive Technology database","volume":"100","author":"Gordon","year":"2013","journal-title":"Fertil Steril"},{"issue":"1-2","key":"2019120610114677100_B20","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.mce.2013.12.009","article-title":"Luteinizing hormone and human chorionic gonadotropin: origins of difference","volume":"383","author":"Choi","year":"2014","journal-title":"Mol Cell Endocrinol"},{"issue":"11","key":"2019120610114677100_B21","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1055\/s-0038-1673402","article-title":"Venous thromboembolism in women undergoing assisted reproductive technologies: data from the RIETE registry","volume":"118","author":"Grandone","year":"2018","journal-title":"Thromb Haemost"},{"issue":"1","key":"2019120610114677100_B22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.fertnstert.2011.10.038","article-title":"Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles","volume":"97","author":"Rova","year":"2012","journal-title":"Fertil Steril"},{"issue":"jan15 3","key":"2019120610114677100_B23","doi-asserted-by":"crossref","first-page":"e8632","DOI":"10.1136\/bmj.e8632","article-title":"Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study","volume":"346","author":"Henriksson","year":"2013","journal-title":"BMJ"},{"issue":"3","key":"2019120610114677100_B24","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/GRF.0b013e31825cfe7b","article-title":"Prevention and treatment of venous thromboembolism in pregnancy","volume":"55","author":"James","year":"2012","journal-title":"Clin Obstet Gynecol"},{"issue":"7","key":"2019120610114677100_B25","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1016\/j.fertnstert.2016.08.048","article-title":"Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline","volume":"106","author":"Practice Committee of the American Society for Reproductive Medicine. Electronic address:","year":"2016","journal-title":"Fertil Steril"},{"key":"2019120610114677100_B26","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/978-1-4939-0659-8_14","article-title":"Ovarian stimulation for IVF: mild approaches","volume":"1154","author":"Hamdine","year":"2014","journal-title":"Methods Mol Biol"},{"issue":"suppl 1","key":"2019120610114677100_B27","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/S0049-3848(17)30070-1","article-title":"Prevention and management of ovarian hyperstimulation syndrome","volume":"151","author":"Nelson","year":"2017","journal-title":"Thromb Res"},{"issue":"7","key":"2019120610114677100_B28","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.1016\/j.fertnstert.2009.01.085","article-title":"Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome","volume":"93","author":"V\u00e1rnagy","year":"2010","journal-title":"Fertil Steril"},{"issue":"5","key":"2019120610114677100_B29","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.fertnstert.2007.08.037","article-title":"Low-dose acetylsalicylic acid plus prednisolone as an adjuvant treatment in IVF: a prospective, randomized study","volume":"90","author":"Revelli","year":"2008","journal-title":"Fertil Steril"},{"issue":"22","key":"2019120610114677100_B30","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1182\/bloodadvances.2018024802","article-title":"American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy","volume":"2","author":"Bates","year":"2018","journal-title":"Blood Adv"},{"issue":"6","key":"2019120610114677100_B31","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1016\/j.fertnstert.2009.06.033","article-title":"Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome","volume":"92","author":"Bellver","year":"2009","journal-title":"Fertil Steril"},{"issue":"11","key":"2019120610114677100_B32","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1007\/s10815-014-0334-9","article-title":"Approaches to oocyte retrieval for advanced reproductive technology cycles planning to utilize in vitro maturation: a review of the many choices to be made","volume":"31","author":"Rose","year":"2014","journal-title":"J Assist Reprod Genet"},{"issue":"2","key":"2019120610114677100_B33","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1148\/radiology.183.2.1561359","article-title":"Effect of needle gauge, level of anticoagulation, and target organ on bleeding associated with aspiration biopsy. Work in progress","volume":"183","author":"Gazelle","year":"1992","journal-title":"Radiology"}],"container-title":["Hematology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2019\/1\/148\/1546122\/hem2019000071c.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/hematology\/article-pdf\/2019\/1\/148\/1546122\/hem2019000071c.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T15:17:51Z","timestamp":1575645471000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/hematology\/article\/2019\/1\/148\/422597\/Casebased-discussion-on-the-implications-of"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,6]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12,6]]}},"URL":"https:\/\/doi.org\/10.1182\/hematology.2019000071","relation":{},"ISSN":["1520-4391","1520-4383"],"issn-type":[{"value":"1520-4391","type":"print"},{"value":"1520-4383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,6]]}}}