Obstetric bleeding: causes and principles of treatment

Unfortunately, obstetric hemorrhages have always been considered one of the main causes of death of women after childbirth. That is why it is important to consider the possibility of complications of pregnancy, so that you can provide competent help.

Obstetric bleeding

Often, during pregnancy, childbirth, as well as in the postpartum period, there may be various kinds of complications. One is obstetric hemorrhage. In gynecology, this term means any bloody strong discharge from the genital tract from conception until the late postpartum period.

According to statistical data, the most frequent bleeding occurs in the second, third trimester and after childbirth. Due to the anatomical and physiological characteristics of women, there may be swift, or massive obstetric hemorrhage. In this case, immediate medical attention is required, since such a condition can be a serious threat to the woman and the child.

Classification of obstetric hemorrhages

A similar problem is classified according to different principles. Obstetric bleeding differs from the causes that provoked it, as well as the volume of lost blood. Among the problems classified according to the first principle, one can distinguish bleeding that occurs:

• In the first half of pregnancy;
• In the second half of pregnancy;
• In the very beginning of childbirth;
• In the middle of the generic process;
• In the final stage;
• after childbirth;
• A few days after delivery.

In addition, you can classify obstetric hemorrhages by the volume of lost blood. They are subdivided into such types as:

• Acute loss of blood;
• A syndrome of massive loss of blood;
• Hemorrhagic shock.

Depending on the existing violations and the period in which they occur, a method of treatment is selected.

Bleeding in the first trimester of pregnancy

The main causes of bleeding in the first months of pregnancy are:

• Miscarriages;
• Bladder skidding;
• Cervical pregnancy;
• Pathology of the cervix.

In miscarriages in women, the main symptoms are intense pain syndrome and severe blood loss. When there is a threat of miscarriage, bloody discharge is insignificant, and pain is absent or has a dull blunt character. Spontaneous abortion may be complete or incomplete. From this, the need and the way of rendering medical assistance largely depends.

In addition, bleeding can occur with a problem such as a bladder drift. This pathology is characterized by the fact that the villi of the chorion are transformed into vesicles containing estrogen. At risk are women with inflammations of the genitals, as well as hormonal disorders. Treatment in this case is quite complicated and depends in many respects on the degree of lesion of the uterine cavity.

The nasal pregnancy is interrupted mainly up to 12 weeks. The risk group includes women with inflammatory diseases, pathologies of the cervix, as well as menstrual cycle disorders. Important is the excessive mobility of a fertilized egg not in the uterine cavity, but in the cervical canal. Bleeding in this case is quite abundant, as the structure of large vessels of the uterus is disrupted.

Polyps of the cervical canal can also cause bleeding, but they are minor. With a large proliferation of polyps, bleeding can increase, so it is important to provide timely care for obstetric hemorrhages.

Malignant tumors of the uterus are rare during pregnancy, as this disease is typical for women over 40 years of age. Treatment is performed after childbirth. If the period is short, then a complete removal of the uterus is indicated. In addition, bleeding may be associated with an ectopic pregnancy. As a result of the location of the embryo in the tubes, there may be a rupture of the uterus.

Bleeding in the second half of pregnancy

There may also be bleeding in the second and third trimester of pregnancy. Their main reasons are:

• Placenta previa;
• Placental abruption;
• Ruptured uterus.

The risk group includes women who have previously undergone inflammatory diseases, with malformations of the uterus, as well as hypoplasia of the genitals. Violations mainly occur if the placenta is located directly on the front wall of the uterus. In the second half of pregnancy, the main causes of bleeding may include rupture of the walls of the uterus as a result of the presence of scars after surgery, a cesarean section or the presence of a bubble drift. When the uterus ruptures, as a rule, the situation ends lethal. In addition to bleeding, there are also quite strong painful sensations.

Postpartum hemorrhages

Obstetric bleeding is often observed at delivery and in the early postpartum period. Many women immediately begin to panic, because they do not realize how long such a state will last, and what exactly is considered the norm, and what concerns pathologies. Bleeding during childbirth occurs mainly because of:

• Rupture of the cervix;
• Rupture of the uterus;
• PONPP (premature detachment of a normally located placenta).

Because of rupture of the cervix, there can be very heavy bleeding. This happens because the gap can reach the vaginal vault or even touch the lower wall of the uterus. At risk are women with impaired labor, a large fetus, as well as using certain medications. Rupture of the cervix can be manifested in the form of intense bloody discharge. This is mainly the case in women with rapid childbirth. The doctor makes the final diagnosis when examining the birth canal.

In the first stage of labor, PONRP may occur, which is characterized by severe pain in the uterus, which do not coincide with contractions. In this case, the uterus does not relax or does not relax well enough, and large bloody clots also appear. This condition is mainly diagnosed in women with discoordination of labor, with the administration of some medications, the presence of hypertension. They can have a very fast delivery.

When the uterus ruptures, the doctor can diagnose insufficiently strong contractions, while the woman is troubled by intense pain. In this case, very strong bloody discharge from the vagina appears, and fetal hypoxia is also possible. When these signs appear, a caesarean section is performed.

There may be obstetric haemorrhages in the postpartum period, arising for reasons such as:

• Complex delivery;
• A large fruit;
• Multiple fertility;
• Polyhydramnios.

There may be bleeding in the late postpartum period, which is why, before discharge, the doctor conducts a thorough examination of the woman in childbirth for ruptures and other disorders, and also gives recommendations on the duration and characteristics of the postpartum period. Normally enough strong bloody discharge is observed for several days after childbirth, until the damaged tissue of the mucous uterus does not heal. Severe postpartum haemorrhage refers to very dangerous complications, which can lead to the death of the mother in childbirth. The severity of bleeding depends largely on the amount of blood lost. This condition requires immediate resuscitation.

Causes of obstetric hemorrhages

Before the treatment, it is necessary to establish which causes provoked such a violation. Quite often obstetric hemorrhages are observed. The help in this case appears depending on provoking factors which in each period of pregnancy and patrimonial activity differ. Large blood loss can be very dangerous for the woman and for the fetus. In the first half of pregnancy bleeding occurs due to ectopic fertilization or miscarriage. In the second or third trimester, bleeding can occur due to premature retreatment of the placenta.

Special attention should be paid to bleeding after the completion of labor. At this time there may be problems associated with the fact that:

• Villi placenta grow into the uterus;
• Separate placental sites remain in the uterine cavity;
• Traumatized birth canal.

Bleeding, which occurs in the postpartum period, may be associated with a decreased tone of the uterus. In this case, it does not shrink, which means that the blood does not stop. Also, there may be a problem in poor blood clotting.

Symptoms of obstetric hemorrhages

Bleeding can be internal, external or combined. External bleeding is observed with placental abruption and cervical dilatation. PONRP with the formation of a hematoma is characterized by internal bleeding. Combined bleeding can occur with a lateral placental abruption with a slight opening of the cervical canal.

Emergency care for obstetric hemorrhages should be provided when the first signs, such as:

• Bloody discharge from the vagina, regardless of their volume and nature;
• Pain in the uterus;
• Dizziness, skin pallor, weakness, fainting;
• Pressure reduction;
• Change in the heart rhythm of the fetus.

Manifestations of postpartum hemorrhage are caused by the amount and intensity of blood loss. If the uterus does not respond to therapeutic manipulation, then the bleeding in this case is very strong and can be undulating. Periods it fades away under the action of drugs. In addition, a woman has excessive pallor of the skin, tachycardia, hypotension.

The volume of blood loss up to 0.5% of the mass of the parturient is considered physiologically acceptable, and with the increase of this volume there are dangerous changes in the body, so it is important to eliminate the problem in a timely manner. In the postpartum period, a woman should be alerted by too strong and prolonged lochia with large clots, as well as traumatic pains in the lower abdomen.

Conducting diagnostics

The algorithm for the treatment of obstetric hemorrhages is made only after complex diagnostics. The diagnosis begins with a patient's interview to determine the duration of bleeding and its nature. Then the doctor starts to collect anamnesis to find out what were the diseases, how the pregnancy and childbirth took place.

At the same time, a woman is examined, pulse, blood pressure is measured, the uterus is inspected. At the same time, a gynecological examination with the help of mirrors is needed, a feeling of the uterus for determining the muscle tension. As an additional study, ultrasound is performed to determine if there is a placental abruption, how the umbilical cord is located, and whether the uterine integrity is not compromised. It is important to build an algorithm very clearly. Obstetrical bleeding is very dangerous for a woman and a child, therefore immediate assistance is required.

First Aid

Mandatory emergency care is required for obstetric hemorrhages, since this condition can be critical and provokes many different complications. In the presence of bleeding a woman must be placed in a hospital for observation and treatment. Transportation should only be done in a prone position. In the case of miscarriage and significant blood loss, emergency care implies the elimination of hemorrhagic shock. The drugs are administered intravenously until the patient enters the hospital. With complete miscarriage, funds are introduced to help reduce the uterus, intravenously.

If obstetric hemorrhage is observed, the emergency protocol for ectopic pregnancy involves the introduction of medications that help to eliminate the symptoms of hemorrhagic shock. At the same time, the woman is inhaled oxygen. Therapy by the introduction of glucocorticoids is carried out only on indications. The patient is shown an urgent hospitalization in a hospital, while transportation is carried out in the supine position. During transportation, the pressure is maintained at a level of 80-100 mm Hg. Art. With very severe blood loss, hospitalization is carried out by a reanimation and surgical team.

In addition, with the presentation of the placenta or its detachment, hospitalization in a hospital and subsequent complex treatment are carried out. Note that any other problems and pathologies that cause bleeding, require the supervision of a doctor, so the pregnant must be hospitalized in the hospital.

Treatment of obstetric hemorrhages

Severe hemorrhage can trigger many different disorders and complications. In the treatment of obstetric hemorrhages, initially, blood loss must be stopped and the threat to women and children eliminated. A pregnant woman must show complete rest, restriction of physical activity and stay in the hospital. The complex of the therapy is selected strictly individually and depending on the period of bleeding started. Prevention, treatment and algorithm of management for obstetric hemorrhages was developed by the Ministry of Health and it must be observed by doctors at the admission of the patient to the hospital.

In the presence of bleeding in early pregnancy, drugs that increase blood viscosity, sedatives and restorative drugs are prescribed. In the case of a severe condition of the woman and the fetus, intensive care is indicated. In the third trimester, if bleeding is present, surgery for delivery is indicated. If postpartum obstetric hemorrhages are observed, the protocol of treatment can be different - from the use of medications and to the removal of the uterus. It all depends on the complexity of the problem, because the most important thing is to save the woman's life.

Prevention

Prevention of obstetric hemorrhages reduces to adherence to several important principles. First of all, you need to plan your pregnancy, register on time and regularly visit a doctor. Also, treatment of existing genital tract diseases should be carried out on time. If necessary, it is necessary to choose a complex of therapeutic physical training. In the process of childbirth, you need to behave correctly, taking into account all the doctor's recommendations, as well as assess indications and contraindications.

To prevent the occurrence of bleeding in the postpartum period, you must follow these rules:

• Breastfeed on demand;
• Follow the bladder;
• Lie on your stomach;
• Apply cold to the lower abdomen.

All these preventive measures will help to avoid bleeding and improve a woman's well-being.

Complications and consequences of bleeding

There may be quite dangerous complications and the consequences of bleeding. To such it is possible to carry:

• Hypoxia of the fetus;
• Death of the fetus;
• Hemorrhage in the thickness of the walls of the uterus;
• Hemorrhagic shock;
• Death of the mother.

In addition, complications include severe disorders of blood clotting with the formation of a variety of thrombi and the occurrence of bleeding. There may also be a lack of blood supply, disruption of the endocrine system and the lack of production of hormones.