Obstetric bleeding

In obstetrical practice, bleeding problems are very relevant. After all, massive blood loss can become not only the cause of death of the fetus, but it is also a threatening condition for the life of a woman.

Classification of bleeding in obstetrics

Obstetric bleeding during pregnancy is classified into the following groups:

• bleeding in the first half of pregnancy;
• hemorrhages of the second half of pregnancy;
• bleeding during labor;
• postpartum hemorrhage.

Thanks to this classification of obstetric hemorrhages, it becomes clear that they can occur at various stages of pregnancy. It is worth noting that the causes of bleeding will be different depending on the gestation period. And accordingly, blood loss will be accompanied by specific for each pathological condition symptoms.

Obstetric bleeding causes

The causes of obstetric hemorrhages in the first half of pregnancy can be an ectopic pregnancy, a bladder , a miscarriage. In the second half of gestation, bleeding is accompanied by premature detachment of the placenta or its presentation.

Separately, we will analyze the causes of obstetric hemorrhages directly during childbirth. If the bleeding occurred during the first period of labor, that is, during the process of opening the cervix, then this may be a consequence:

• premature placental abruption;
• trauma of the cervix;
• rupture of the uterus .

The same conditions are the cause of blood loss in the second stage of the birth process. The third period of labor, that is, the separation of the placenta, is accompanied by massive obstetric hemorrhages in the following cases:

• with a dense, deep germination of the villi placenta into the wall of the uterus;
• with the delay of individual parts of the placental tissue in the uterine cavity;
• damage to the soft tissues of the birth canal.

In the postpartum period, bleeding may be caused by a decreased tone of the uterus. In this case, the muscle fibers do not contract and the blood vessels do not subside, as a result of which blood loss continues. Also to the causes of bleeding during this period include disorders of blood clotting and embolism by amniotic fluid.

Speaking about bleeding, it is necessary to note the most common causes of gynecological bleeding outside the period of bearing of the child. These include polyps and cervical cancer, uterine fibroids, endometriosis and hormonal disorders.

Prevention and treatment

Prevention of obstetric hemorrhages should begin long before the onset of pregnancy. After all, the harmonious development of the woman's reproductive system already reduces the risk of development of pathology during child bearing. Important in prevention is the treatment of extragenital diseases.

Any bleeding requires immediate transportation to the hospital. Treatment of obstetric hemorrhages should imply the following stages:

• stop bleeding;
• elimination of the cause that caused bleeding;
• restoration of hemodynamics by eliminating the deficit of the volume of circulating blood.

All manipulations aimed at eliminating blood loss should be carried out very quickly. Therapeutic tactics directly depends on the volume of blood loss and the duration of pregnancy. Surgical stopping of bleeding is often necessary. If it is not possible to eliminate massive bleeding, removal of the uterus is indicated. For example, with hypo- and atonic uterus in the postpartum period, when there are no effects from uterotonic drugs.

Emergency care in the occurrence of obstetric hemorrhage is the fight against hypovolemic shock. To do this, use infusion therapy with various solutions. To attempt to stop bleeding intravenously, Dicinone, aminocaproic and tranexamic acid, NovoSeven are administered.