Unfortunately, obstetric bleeding has always been considered one of the main causes of death in women after childbirth. That is why it is important to consider the possibility of pregnancy complications so that competent assistance can be provided.
Obstetric bleeding
Often during pregnancy, childbirth, as well as in the postpartum period, various kinds of complications can occur. One of them is obstetric bleeding. In gynecology, this term refers to any bloody strong discharge from the genital tract from the moment of conception until the late postpartum period.
According to statistics, most bleeding occurs in the second, third trimester and after childbirth. Due to the anatomical and physiological characteristics of a woman, there may be rapid or massive obstetric bleeding. In this case, immediate medical attention is required, since such a condition can become a serious threat to the woman and the child.
Classification of obstetric bleeding
This problem is classified according to different principles. Obstetric bleeding differs in causes,who provoked it, as well as the amount of blood lost. 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;
- at the very beginning of labor;
- in the middle of the birth process;
- in final stages;
- postpartum;
- a few days after delivery.
It is also possible to classify obstetric bleeding by the amount of blood lost. They are divided into types such as:
- acute blood loss;
- massive blood loss syndrome;
- hemorrhagic shock.
Depending on the existing violations and the period in which they occur, the 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;
- bubbly skid;
- cervical pregnancy;
- cervical pathology.
When a woman miscarries, the main symptoms are intense pain and severe blood loss. With the threat of a miscarriage, spotting is insignificant, and the pains are absent or have a dull, aching character. Spontaneous abortion may be complete or incomplete. The need and method of providing medical assistance largely depends on this.
In addition, bleeding can occur with a problem such asbubble drift. This pathology is characterized by the fact that the chorionic villi turn into vesicles containing estrogen. At risk are women with inflammation of the genital organs, as well as hormonal disorders. Treatment in this case is quite complicated and depends largely on the degree of damage to the uterine cavity.
Cervical pregnancy is interrupted mostly before 12 weeks. The risk group includes women with inflammatory diseases, pathologies of the cervix, as well as menstrual irregularities. Of great importance is the excessive mobility of the fertilized egg not in the uterine cavity, but in the cervical canal. Bleeding in this case is quite abundant, as the structure of the large vessels of the uterus is disturbed.
Cervical polyps can also cause bleeding, but they are minor. With a large overgrowth of polyps, bleeding can increase, so it is important to provide timely assistance for obstetric bleeding.
Malignant tumors of the uterus are rare during pregnancy, as this disease is typical mainly for women over 40 years old. Treatment is carried out after childbirth. If the period is short, then complete removal of the uterus is indicated. In addition, bleeding may be associated with an ectopic pregnancy. As a result of the placement of the embryo in the tubes, uterine rupture may occur.
Bleeding in the second half of pregnancy
Bleeding may also occur during the second and third trimester of pregnancy. Their main reasonsare:
- placenta previa;
- placental abruption;
- uterine rupture.
The risk group includes women who have previously had inflammatory diseases, with malformations of the uterus, as well as genital hypoplasia. Violations mainly occur if the placenta is located directly on the anterior 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, caesarean section, or the presence of a hydatidiform mole. When the uterus ruptures, as a rule, the situation ends lethally. In addition to bleeding, there are also quite strong pain sensations.
Postpartum hemorrhage
Obstetrical bleeding is quite common during childbirth and in the early postpartum period. Many women immediately begin to panic, because they have no idea how long this condition will last, and what exactly is considered the norm, and what belongs to the pathologies. Bleeding during childbirth occurs mainly due to:
- cervical rupture;
- uterine rupture;
- PONRP (premature abruption of a normally located placenta).
Due to rupture of the cervix, there can be very heavy bleeding. This happens because the rupture can reach the vault of the vagina or even affect the lower wall of the uterus. At risk are women with a violation of labor, a large fetus, as well as when using certain medications. Rupture of the cervix can manifest itself in the form of intense bleeding. It mostly happens in women with rapid labor. The doctor makes the final diagnosis during the examination of the birth canal.
In the first stage of labor, PONRP may occur, which is characterized by severe pain in the uterus, which does not coincide with contractions. In this case, the uterus does not relax or does not relax well enough, and large blood clots also appear. This condition is mainly diagnosed in women with incoordination of labor, with the introduction of certain medications, and the presence of hypertension. They can have very fast delivery.
When the uterus ruptures, the doctor may diagnose insufficiently strong contractions, while the woman is worried about intense pain. In this case, very strong bleeding from the vagina appears, and fetal hypoxia is also possible. If these signs appear, a caesarean section is performed.
There may be obstetric hemorrhage in the postpartum period for reasons such as:
- difficult birth;
- large fruit;
- multiple pregnancy;
- polyhydramnios.
Bleeding may also occur in the late postpartum period, which is why, before discharge, the doctor conducts a thorough examination of the woman in labor for ruptures and other disorders, and also makes recommendations regarding the duration and characteristics of the postpartum period. Normally, quite strong bleeding is observed onfor several days after childbirth, until the damaged tissue of the uterine mucosa heals. Severe postpartum hemorrhage is a very dangerous complication that can lead to the death of a woman in labor. The severity of bleeding largely depends on the amount of blood lost. This condition requires immediate resuscitation.
Causes of obstetric bleeding
Before treatment, it is necessary to establish exactly what causes provoked such a violation. Quite often observed obstetric bleeding. Help in this case is provided depending on the provoking factors, which differ in each period of pregnancy and labor. Large blood loss can be very dangerous for the woman herself and for the fetus. In the first half of pregnancy, bleeding occurs due to ectopic insemination or miscarriage. In the second or third trimester, bleeding may occur due to premature delivery of the placenta.
Especial attention should be paid to bleeding after the completion of labor. At this time, there may be problems related to the fact that:
- villi of the placenta grow into the uterus;
- parts of the placenta remain in the uterine cavity;
- the birth canal is injured.
Bleeding that is observed in the postpartum period may be associated with decreased uterine tone. At the same time, it does not contract, which means that the blood does not stop. Also, the problem may be in poor coagulation.blood.
Symptoms of obstetric bleeding
Bleeding can be internal, external, or a combination. 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 lateral placental abruption with a slight opening of the cervical canal.
Emergency care for obstetric bleeding must be provided at the first signs, such as:
- bloody discharge from the vagina, regardless of their volume and nature;
- pain in the uterus;
- dizziness, pale skin, weakness, fainting;
- pressure reduction;
- change in fetal heart rate.
Manifestations of postpartum hemorrhage are due to the amount and intensity of blood loss. If the uterus does not respond to medical manipulations, then the bleeding in this case is very strong and can be undulating. Periodically, it subsides somewhat under the influence of drugs. In addition, the woman has excessive pallor of the skin, tachycardia, hypotension.
The volume of blood loss up to 0.5% of the mass of a woman in labor is considered physiologically acceptable, and with an increase in this volume, dangerous changes occur 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 pulling pains in the lower abdomen.
Diagnostics
Algorithmtreatment of obstetric bleeding is compiled only after a comprehensive diagnosis. The diagnosis begins with a questioning of the patient to determine the duration of bleeding and its nature. Then the doctor begins to take an anamnesis to find out what the diseases were, how the pregnancy and childbirth proceeded.
At the same time, the woman is examined, the pulse, blood pressure are measured, the uterus is examined. This requires a gynecological examination with the help of mirrors, palpation of the uterus to determine muscle tension. As an additional study, an ultrasound is performed to determine if there is placental abruption, how the umbilical cord is located, and whether the integrity of the uterus is broken. It is important to build the algorithm very clearly. Obstetric bleeding is very dangerous for a woman and a child, so immediate assistance is required.
First aid
Emergency care is required for obstetric bleeding, as such a 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 be carried out only in the supine position. In the event of a 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 a complete miscarriage, drugs that promote uterine contraction are administered intravenously.
If observedobstetric bleeding, the emergency protocol for ectopic pregnancy involves the administration of medications that help eliminate the symptoms of hemorrhagic shock. At the same time, the woman is given inhalation of oxygen. Therapy by the introduction of glucocorticoids is carried out only according to indications. The patient is shown urgent hospitalization in a hospital, while transportation is carried out in the supine position. During transportation, the pressure is maintained at 80-100 mm Hg. Art. In case of very severe blood loss, hospitalization is carried out by the resuscitation and surgical team.
In addition, with placenta previa or its abruption, hospitalization is carried out in a hospital and subsequent complex treatment. Note that any other problems and pathologies that provoke bleeding require the supervision of a doctor, so the pregnant woman must be hospitalized in a hospital.
Treatment of obstetric bleeding
Severe blood loss can provoke many different disorders and complications. In the treatment of obstetric bleeding, it is initially necessary to stop blood loss and eliminate the threat to the woman and child. A pregnant woman must be shown complete rest, limitation of physical activity and stay in a hospital. The complex of therapy is selected purely individually and depending on how long the bleeding began. Prevention, treatment and management algorithm for obstetric bleeding has been developed by the Ministry of He alth and must be followed by doctors when a patient is admitted to a hospital.
In the presence of bleeding in the early stages of pregnancy, drugs are prescribed that increase blood viscosity, sedatives and tonics. In the case of a serious condition of the woman and the fetus, intensive care is indicated. In the third trimester, in the presence of bleeding, an operation is indicated for delivery. If postpartum obstetric bleeding is observed, the treatment protocol may be different - from the use of medications 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.
Prophylaxis
Prevention of obstetric bleeding comes down to a few important principles. First of all, you need to plan a pregnancy, register in a timely manner and visit the doctor regularly. You should also treat existing diseases of the genital organs on time. If necessary, it is necessary to choose a complex of physiotherapy exercises. During childbirth, you need to behave correctly, taking into account all the recommendations of the doctor, as well as evaluate the indications and contraindications.
To prevent the occurrence of bleeding in the postpartum period, you must follow these rules:
- breastfeed on demand;
- watch your bladder;
- lying on your stomach;
- apply cold to the lower abdomen.
All these preventive measures will help to avoid bleeding and improve the woman's well-being.
Complications and consequences of bleeding
May berather dangerous complications and consequences of bleeding. These include:
- fetal hypoxia;
- fetal death;
- hemorrhages in the thickness of the walls of the uterus;
- hemorrhagic shock;
- mother's death.
In addition, complications include severe clotting disorders with the formation of many blood clots and bleeding. There may also be a lack of blood supply, disruption of the endocrine system and lack of hormone production.
