Unfortunately, obstetric hemorrhage has always been considered one of the main causes of mortality in women after childbirth. That is why it is important to consider the possibility of complications of pregnancy, 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 means any bloody strong discharge from the genital tract from the moment of conception to the late postpartum period.
According to statistics, most often 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 a woman and a child.
Classification of obstetric bleeding
A similar problem is classified according to various principles. Obstetric hemorrhage is distinguished by the reasons that provoked him, as well as the volume of blood lost. Among the problems classified by the first principle, we can distinguish bleeding that occurs:
- in the first half of pregnancy;
- in the second half of pregnancy;
- at the very beginning of childbirth;
- in the middle of the birth process;
- in the final stage;
- after childbirth;
- a few days after delivery.
In addition, obstetric bleeding can be classified by the amount of blood lost. They are divided into such types as:
- acute loss of blood;
- massive blood loss syndrome;
- hemorrhagic shock.
Depending on the existing violations and in which period 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;
- cystic drift;
- cervical pregnancy;
- pathology of the cervix.
In miscarriages in women, the main symptoms are considered intense pain and severe blood loss. With the threat of a miscarriage, spotting is minor, and the pain is absent or have a dull dull character. Spontaneous abortion may be complete or incomplete. The need and method of providing medical care largely depends on this.
In addition, bleeding can occur with a problem such as cystic drift. This pathology is characterized by the fact that the chorionic villi turn into vesicles containing estrogen. At risk are women with genital inflammation, as well as hormonal disorders. The treatment in this case is quite complicated and depends largely on the degree of damage to the uterine cavity.
Cervical pregnancy is terminated mainly 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 plentiful, since the structure of the large vessels of the uterus is disturbed .
Polyps of the cervical canal can also cause bleeding, but they are minor. With a large proliferation of polyps, bleeding can intensify, therefore, timely assistance with obstetric bleeding is important.
Malignant tumors of the uterus are rare during pregnancy, since this disease is characteristic mainly for women older than 40 years. 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 location of the embryo in the tubes, there may be a uterine rupture.
Bleeding in the second half of pregnancy
Bleeding in the second and third trimester of pregnancy may also occur. Their main reasons are:
- placenta previa;
- placental abruption;
- uterine rupture.
The risk group includes women who have previously undergone inflammatory diseases, with malformations of the uterus, as well as genital hypoplasia. 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, cesarean section or the presence of cystic drift. When the uterus ruptures, as a rule, the situation ends fatally. In addition to bleeding, quite strong painful sensations are also observed.
Postpartum hemorrhage
Obstetric hemorrhages are often observed during childbirth and in the early postpartum period. Many women immediately start to panic, because they do not realize how long this condition will continue, and what exactly is considered the norm, and what applies to pathologies. Bleeding during childbirth occurs mainly due to:
- rupture of the cervix;
- uterine rupture;
- PONRP (premature detachment of a normally located placenta).
Due to rupture of the cervix, there may be very heavy bleeding. This happens because the rupture can reach the vaginal fornix or even affect the lower wall of the uterus. At risk are women with impaired labor, a large fetus, as well as when using certain medications. Rupture of the cervix can manifest as intense bleeding. This mainly happens in women with rapid childbirth. The doctor makes the final diagnosis when examining the birth canal.
In the first stage of childbirth, a POND 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 bloody clots also appear. This condition is mainly diagnosed in women with discoordination of labor, with the introduction of certain medications, and the presence of hypertension. They can have very fast delivery.
If the uterus ruptures, the doctor can diagnose insufficiently strong contractions, while the woman is worried about intense pain. In this case, very strong spotting from the vagina appears, and fetal hypoxia is also possible. When these signs appear, a cesarean section is performed.
There may be obstetric bleeding in the postpartum period, arising for reasons such as:
- difficult childbirth;
- large fruit;
- multiple pregnancy;
- polyhydramnios.
Bleeding may occur in the late postpartum period, which is why before discharge the doctor conducts a thorough examination of the woman in labor for gaps and other irregularities, and also gives recommendations regarding the duration and characteristics of the postpartum period. Normally, sufficiently strong spotting is observed for several days after childbirth, until the damaged tissue of the uterine mucosa heals. Severe postpartum hemorrhages are very dangerous complications that can lead to the death of a woman in childbirth. The severity of bleeding depends largely on the amount of blood lost. This condition requires immediate resuscitation.
Causes of Obstetric Bleeding
Before conducting treatment, it is necessary to establish exactly what causes triggered such a violation. Quite often, obstetric bleeding is observed. Help in this case is provided depending on the provoking factors, which differ in each period of pregnancy and labor. Great blood loss can be very dangerous for the woman herself and the fetus. In the first half of pregnancy, bleeding occurs due to ectopic fertilization or miscarriage. In the second or third trimester, bleeding may occur due to premature discharge of the placenta.
Of particular note are bleeding after completion of labor. At this time, there may be problems associated with the fact that:
- placental villi grow into the uterus;
- individual sections of the placenta remain in the uterine cavity;
- the birth canal is injured.
Bleeding, which is observed in the postpartum period, may be associated with a decreased tone of the uterus. At the same time, it does not contract, which means that the blood does not stop. There may also be a problem with poor blood coagulability.
Symptoms of Obstetric Bleeding
Bleeding can be internal, external or combined. External bleeding is observed with placental abruption and cervical dilatation. ANLD with the formation of a hematoma is characterized by internal bleeding. Combined bleeding can occur with lateral detachment of the placenta with a slight opening of the cervical canal.
Emergency care for obstetric hemorrhage must be provided when the first signs occur, such as:
- spotting from the vagina, regardless of their volume and nature;
- pain in the uterus;
- dizziness, pallor of the skin, weakness, fainting;
- pressure reduction;
- change in heart rate in the fetus.
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 wave-like. From time to time it calms down somewhat under the influence of drugs. In addition, the woman has excessive pallor of the skin, tachycardia, hypotension.
A volume of blood loss of up to 0.5% of the weight of a woman in labor is considered physiologically acceptable, and with an increase in this volume dangerous changes occur in the body, therefore it is important to fix 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
The treatment algorithm for obstetric bleeding is compiled only after a comprehensive diagnosis. The diagnosis begins with a survey of the patient to determine the duration of bleeding and its nature. Then the doctor begins to collect an anamnesis to find out what diseases were, how the pregnancy and childbirth proceeded.
At the same time, a woman is examined, the pulse is measured, blood pressure, the uterus is examined. In this case, you need a gynecological examination with the help of mirrors, palpation of the uterus to determine muscle tension. As an additional study, an ultrasound scan is performed to determine if there is a placental abruption, how the umbilical cord is located and whether the uterus is broken. It is important to build the algorithm very clearly. Obstetric hemorrhage is very dangerous for a woman and a child, therefore immediate care is required.
First aid
Emergency care for obstetric hemorrhage is definitely required, since 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 a prone position. In the event of a miscarriage and significant blood loss, emergency care implies the elimination of hemorrhagic shock. Drugs are administered intravenously until the patient enters the hospital. With a complete miscarriage, funds are introduced that contribute to the reduction of the uterus, intravenously.
If obstetric hemorrhage is observed, the emergency care protocol for an ectopic pregnancy involves the introduction of medications that help eliminate the symptoms of hemorrhagic shock. However, a woman is inhaled oxygen. Therapy by administration of glucocorticoids is carried out only according to indications. The patient is shown urgent hospitalization in a hospital, while transportation is carried out in a prone position. During transportation, the pressure is maintained at a level of 80-100 mm RT. Art. With very severe blood loss, hospitalization is carried out by the resuscitation and surgical team.
In addition, with placenta previa or its detachment, hospitalization is carried out in a hospital and subsequent comprehensive treatment. Note that any other problems and pathologies that provoke bleeding require the supervision of a doctor, so a 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 hemorrhage, blood loss must first be stopped and the threat to the woman and the child removed. A pregnant woman is necessarily shown complete rest, restriction of physical activity and stay in a hospital. The complex of therapy is selected purely individually and depending on how long the bleeding started. Prevention, treatment and management algorithm for obstetric hemorrhage developed by the Ministry of Health and it must be followed by doctors upon admission of the patient to the hospital.
In the presence of bleeding in the early stages of pregnancy, drugs that enhance blood viscosity, sedatives and restorative drugs are prescribed. 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, surgery for delivery is indicated. If postpartum obstetric hemorrhage is observed, the treatment protocol can 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 hemorrhage is reduced to the observance of several important principles. First of all, you need to plan a pregnancy, timely register and regularly visit a doctor. You should also timely treat existing diseases of the genital organs. If necessary, it is necessary to choose a complex of physiotherapy exercises. In the process of childbirth, you need to behave correctly, taking into account all the doctor's recommendations, as well as evaluate the indications and contraindications.
To prevent the occurrence of bleeding in the postpartum period, you must follow these rules:
- breastfeed as required;
- monitor your bladder;
- lie on your stomach;
- apply cold to the lower abdomen.
All these preventive measures will help to avoid the occurrence of bleeding and improve the well-being of women.
Complications and consequences of bleeding
There can be quite dangerous complications and consequences of bleeding. These include:
- fetal hypoxia;
- fetal death;
- hemorrhages in the thickness of the walls of the uterus;
- hemorrhagic shock;
- death of mother.
In addition, complications include severe coagulation disorders with the formation of many blood clots and the occurrence of bleeding. There may also be a lack of blood supply, a malfunction of the endocrine system and a lack of hormone production.