- this is an outpouring of blood into the external environment, natural body cavities, organs and tissues. Clinical relevance pathology depends on the size and speed of blood loss. Symptoms - weakness, dizziness, pallor, tachycardia, decreased blood pressure, fainting. Identification of external bleeding is not difficult, since the source is visible to the naked eye. For the diagnosis of internal bleeding, depending on the localization, various instrumental techniques can be used: puncture, laparoscopy, radiopaque examination, endoscopy, etc. Treatment is usually surgical.

ICD-10

R58 Bleeding, not elsewhere classified

General information

Bleeding is a pathological condition in which blood from the vessels is poured into the external environment or into internal organs, tissues and natural cavities of the body. It is a condition requiring urgent health care. The loss of a significant volume of blood, especially within a short time, poses an immediate threat to the life of the patient and can cause lethal outcome. Orthopedic traumatologists, abdominal surgeons, thoracic surgeons, neurosurgeons, urologists, hematologists and some other specialists can treat bleeding, depending on the cause of their occurrence.

Classification

Taking into account the place in which the blood is poured, they secrete the following types bleeding:

• External bleeding - into the external environment. There is a visible source in the form of a wound, an open fracture or crushed soft tissues.
• Internal bleeding - into one of the natural cavities of the body, communicating with external environment: bladder, lung, stomach, intestines.
• Hidden bleeding- in tissues or cavities of the body that do not communicate with the external environment: in the interfascial space, ventricles of the brain, joint cavity, abdominal, pericardial or pleural cavities.

As a rule, in clinical practice, occult bleeding is also called internal, however, taking into account the characteristics of pathogenesis, symptoms, diagnosis and treatment, they are distinguished into a separate subgroup.

Depending on the type of damaged vessel, the following types of bleeding are distinguished:

• arterial bleeding. Occurs when the wall of an artery is damaged. Is different high speed blood loss is life threatening. The blood is bright scarlet, pouring out in a tense pulsating stream.
• Venous bleeding. It develops when the wall of the vein is damaged. The rate of blood loss is lower than when an artery of the same diameter is damaged. The blood is dark, with a cherry hue, flows in an even stream, and there is usually no pulsation. If large venous trunks are damaged, pulsation in the rhythm of breathing can be observed.
• capillary bleeding. Occurs when capillaries are damaged. Blood is released in separate drops, resembling dew or condensate (a symptom of "bloody dew").
• Parenchymal bleeding. It develops with damage to parenchymal organs (spleen, liver, kidneys, lungs, pancreas), cavernous tissue and cancellous bone. Due to the peculiarities of the structure of these organs and tissues, damaged vessels are not compressed by the surrounding tissue and do not contract, which causes significant difficulties in stopping bleeding.
• mixed bleeding. Occurs with simultaneous damage to the veins and arteries. The cause, as a rule, is the injury of parenchymal organs with a developed arterial-venous network.

Depending on the severity of bleeding can be:

• Lungs (loss of no more than 500 ml of blood or 10-15% of BCC).
• Medium (loss of 500-1000 ml or 16-20% of BCC).
• Severe (loss of 1-1.5 liters or 21-30% of BCC).
• Massive (loss of more than 1.5 liters or more than 30% of the BCC).
• Fatal (loss of 2.5-3 liters or 50-60% of BCC).
• Absolutely fatal (loss of 3-3.5 liters or more than 60% of BCC).

Taking into account the origin, traumatic bleeding is distinguished, which develops as a result of trauma of unchanged organs and tissues, and pathological bleeding, which occurs as a result of pathological process in any organ or are the result of increased permeability of the vascular wall.

Depending on the time of occurrence, specialists in the field of traumatology and orthopedics distinguish between primary, early secondary and late secondary bleeding. Primary bleeding develops immediately after the injury, early secondary - during or after surgery (for example, as a result of slipping of the ligature from the vessel wall), late secondary - after a few days or weeks. The cause of late secondary bleeding is suppuration with subsequent melting of the vessel wall.

bleeding symptoms

To the number common features pathologies include dizziness, weakness, shortness of breath, severe thirst, pale skin and mucous membranes, low blood pressure, increased heart rate (tachycardia), pre-syncope and fainting. The severity and rate of development of these symptoms is determined by the rate of blood flow. Acute blood loss is more difficult to tolerate than chronic, since in the latter case the body has time to partially “adapt” to the ongoing changes.

Local changes depend on the characteristics of the injury or pathological process and the type of bleeding. With external bleeding, there is a violation of the integrity of the skin. When bleeding from the stomach occurs melena (tarry black liquid stool) and vomiting of altered dark blood. With esophageal bleeding, hematemesis is also possible, but the blood is brighter, red, rather than dark. Bleeding from the intestine is accompanied by chalky, but there is no characteristic dark vomiting. At lung injury bright scarlet, light foaming blood is coughed up. For bleeding from renal pelvis or Bladder characteristic hematuria.

Latent bleeding is the most dangerous and most difficult in terms of diagnosis, they can only be detected by indirect signs. At the same time, the blood accumulating in the cavities compresses the internal organs, disrupting their work, which in some cases can cause the development of dangerous complications and death of the patient. Hemothorax is accompanied by shortness of breath, shortness of breath and weakening of percussion sound in lower sections chest(with spikes in pleural cavity dullness in the upper or middle sections is possible). With hemopericardium, due to compression of the myocardium, cardiac activity is disturbed, cardiac arrest is possible. Bleeding into the abdominal cavity is manifested by bloating and dullness of percussion sound in its sloping sections. With bleeding into the cranial cavity, neurological disorders occur.

The outflow of blood outside the vascular bed has a pronounced negative effect on the entire body. BCC decreases due to bleeding. As a result, cardiac activity worsens, organs and tissues receive less oxygen. With prolonged or extensive blood loss, anemia develops. The loss of a significant volume of BCC within a short period of time causes traumatic and hypovolemic shock. A shock lung develops, the volume of renal filtration decreases, oliguria or anuria occurs. Foci of necrosis are formed in the liver, it is possible parenchymal jaundice.

Types of bleeding

Bleeding from wounds

First aid consists of anesthesia and immobilization with a splint. For open fractures, apply to the wound sterile dressing. The patient is taken to the emergency room or trauma department. To clarify the diagnosis, an x-ray of the damaged segment is prescribed. With open fractures, PXO is performed; otherwise, the treatment tactics depend on the type and location of the injury. In case of intra-articular fractures accompanied by hemarthrosis, a joint puncture is performed. At traumatic shock carry out appropriate anti-shock measures.

Bleeding from other injuries

TBI can get worse occult bleeding and hematoma formation in the cranial cavity. At the same time, a fracture of the skull bones is not always observed, and patients in the first hours after the injury may feel satisfactory, which complicates the diagnosis. With closed fractures of the ribs, damage to the pleura is sometimes observed, accompanied by internal bleeding and the formation of a hemothorax. For blunt trauma abdominal cavity possible bleeding from a damaged liver, spleen or hollow organs (stomach, intestines). Bleeding from parenchymal organs is especially dangerous due to massive blood loss. Such injuries are characterized by the rapid development of shock, without immediate qualified assistance usually results in death.

For injuries lumbar region injury or rupture of the kidney is possible. In the first case, the blood loss is insignificant, evidence of bleeding is the appearance of blood in the urine, in the second, there is a picture of rapidly increasing blood loss, accompanied by pain in the lumbar region. With bruises in the lower abdomen, a rupture of the urethra and bladder may occur.

First aid for everyone internal bleeding traumatic nature is to anesthetize, ensure peace and immediate delivery of the patient to a specialized honey. institution. The patient is placed in horizontal position with raised legs. Cold is applied to the area of ​​suspected bleeding (a bladder or heating pad with ice or cold water). If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

At the prehospital stage, if possible, anti-shock measures are carried out, the BCC is replenished. Upon admission to medical institution continue infusion therapy. Scroll diagnostic measures depends on the nature of the injury. For TBI, a consultation with a neurosurgeon, skull x-ray and EchoEG are prescribed, with hemothorax - chest x-ray, with blunt abdominal trauma - a surgeon's consultation and diagnostic laparoscopy, etc.

Treatment in most cases is surgical - opening the corresponding cavity, followed by ligation of the vessel, suturing, removal of the entire damaged organ or part of it. With minor bleeding, expectant management can be used, combined with conservative measures. With hemothorax, treatment is usually conservative - pleural puncture or drainage of the pleural cavity. In all cases, the patient's condition is monitored, and if necessary, blood loss is compensated.

The pathological condition in question can be a symptom of a very serious ailments and can lead to certain complications. Therefore, uterine bleeding, regardless of intensity and duration, is a reason for immediate appeal to the doctor for a full examination and receiving qualified assistance.

What is considered uterine bleeding, what is the danger of bleeding from the uterus?

Uterine bleeding, which lasts no more than a week, and, in general, does not affect the general condition of the woman - menstruation, which is considered a normal condition.

In the event that bleeding from the uterus is intense, and / or they last longer than menstruation usually lasts, this indicates the presence systemic disease, or about violations in the work reproductive system.

Pathological uterine bleeding does not have age restrictions. They can occur in adolescence, menopause as well as in reproductive age.

The main consequence of uterine bleeding is the development in a woman anemia of various degrees. Specified pathology manifested by frequent dizziness, general loss of strength. Skin become pale, blood pressure drops sharply.

Lack of therapeutic measures in case of profuse blood loss is serious danger for life!

Causes of uterine bleeding at different ages of a woman

There are many reasons that can provoke the release of blood from the uterus, but the most common of them are the following:

• Hormonal imbalance. Blood loss during menstruation increases with an increase in the level of estrogen or progesterone in the circulatory system.
• Blood disease.
• Errors in work thyroid gland that are represented by such ailments as hyper- or hypothyroidism.
• Adenomyosis. With this pathology, the patient experiences severe pain during menstruation. Blood discharge while being intense.
• Polyps.
• Erosive changes in the cervix.
• Injury to the uterus during surgical procedures or during childbirth.
• Serious malfunction of the liver.
• Functional disturbances of cardio-vascular system: jumps blood pressure, atherosclerosis, etc.
• Internal uterine fibroids.
• Cancer of the reproductive organs.
• Complications during childbearing, as well as ectopic pregnancy.
• Taking contraceptives hormonal pills either use intrauterine device. In the first case, the dosage of drugs should be adjusted, or changed to others. If the cause of abundant spotting from the uterus is a spiral - it must be removed.
• Complications during childbirth: damage to the soft birth canal, incomplete exit gestational sac, infringement of the placenta, decrease in uterine tone, etc.

As mentioned above, the condition under consideration is characterized by the absence of age restrictions.

Video: Uterine bleeding

1. At the age of 12 to 18 years, the following phenomena can provoke disruptions in hormonal regulation:

1. Deficiency of vitamins in the body, which may be the result of inadequate nutrition.
2. Severe injury.
3. Blood clotting disorders.
4. Malfunctions of the adrenal glands and / or thyroid gland.
5. Tuberculosis of the pelvic organs.
6. A history of various childhood infectious diseases: measles, whooping cough, rubella, etc.

dysfunctional uterine bleeding early age may also be present in girls whose birth - or bearing - was accompanied by certain difficulties.

2. At the age of 18 to 45 years, the pathological condition in question is diagnosed quite rarely.

The main culprit of uterine bleeding in a similar age interval is ovarian dysfunction, which may be the result of the following phenomena:

• A sharp change in climatic conditions.
• Work in hazardous conditions.
• Taking medications that affect the work of the hypothalamus and / or pituitary gland.
• Prolonged stay in a stressful situation, mental exhaustion.
• Living in a region with poor environmental conditions.
• Ectopic pregnancy.
• Abortion (including spontaneous).
• Inflammatory ailments that are of a chronic nature and adversely affect the ovaries. Such diseases include:
  - Cancers of the ovaries.
  — Cancer tumors, benign neoplasms body/cervix.
  — Endometriosis, .

3. At the age of 45 to 55 years, the presence of uterine bleeding may be the result of a violation of ovulation against the background of an irregular release of gonadotropins

Although in some cases, the cause of bleeding from the uterus at this age may be some female diseases.

Clots with bleeding from the uterus - the norm or pathology?

The presence of clots during bleeding can be triggered by the following phenomena:

1. The specifics of the structure of the organs of the reproductive system, which contributes to stagnant blood processes. Doctors often associate such an anomaly with the period of intrauterine development, when the uterus undergoes certain modifications.
2. Hormonal imbalance, in which there is a rapid and excessive growth of the endometrium. Its flaking may occur ahead of schedule menstruation, or during it.

Causes and danger of uterine bleeding during pregnancy

Bleeding while carrying a child - dangerous signal, which requires urgent medical measures, otherwise a miscarriage or premature birth (depending on the gestational age) may occur.

Even with scanty spotting, you should immediately go to the hospital!

The main thing is not to get behind the wheel, because the load in this case must be minimized.

There may be several reasons for this pathological condition:

First 12 weeks:

• Pregnancy disorders (miscarriage, etc.).
• Cancer in the region of the chorion.
• Bubble drift.

After the 12th week - and until the end of pregnancy:

• Degenerative changes in the cervix.
• Detachment / placenta previa.
• The scar on the uterus that remained after caesarean section or surgical procedures.
• Cuweler's mother.

Video: Uterine bleeding: causes, how to stop, treatment

What to do with uterine bleeding - first and emergency medical care for sudden heavy or prolonged mild bleeding from the uterus

When the pathological condition under consideration appears, it is forbidden to perform the following measures:

1. Apply heat to the abdomen.
2. Take a warm shower, and even more so - a bath.
3. Do douching.
4. Take any drugs that promote uterine contraction without first consulting a doctor.

Before the arrival of the ambulance, you should adhere to the following recommendations:

• Adoption of a horizontal position. It is advisable to put your feet on a hill. This will minimize the severe consequences and help the patient remain conscious.
• Applying cold to lower part belly within 1-2 hours. Take 5 minute breaks every 15 minutes.
• Plentiful drink. For these purposes, sweet tea or still water will do. You can also prepare a rosehip decoction: the vitamin C contained in it has a positive effect on strengthening the walls of blood vessels.
• Taking hemostatic drugs. Possible only after consultation with a doctor. With extreme caution, they should be taken by pregnant women: such medicines have certain side effects. This group of drugs includes Aminocaproic acid, Dicinon, water pepper tincture, Vikasol.

If the bleeding is prolonged and/or intense, the following treatment may be provided to women within the hospital:

1. Taking oral combined contraceptives

Relevant if the cause of uterine bleeding is hormonal disbalance in organism. This method only suitable for nulliparous women who do not have endometrial cancer.

When diagnosing anemia, the type of treatment in question is unacceptable: it takes a long time. For each patient, the doctor individually calculates the dosage of the drug. However, often the initial dose is 6 tablets. With each subsequent day, the dosage decreases.

2. Treatment with hemostatic drugs

Their reception should be carried out under the supervision of a doctor. Absence desired effect may require surgical treatment.

Among the most popular hemostatic agents are:

1. Aminocaproic acid. Most often used drip introduction preparation: 100 ml. in a day. A contraindication to the use of this drug is DIC in a patient.
2. Traneksam. It is a very powerful hemostatic agent, which is also endowed with anti-inflammatory, anti-allergic properties. When the drug in question is combined with other hemostatic drugs, there is a risk of blood clots.
3. Dicynon. It can be administered intramuscularly or by ingestion of 1 tablet 4 times a day. Due to the absence of the effect of increased blood clotting this remedy can be used for a long period of time.
4. Oxytocin. Favors to increase the tone of the uterus, narrowing the lumen of blood vessels. There are a number of certain diseases in which the specified drug is prohibited from injecting patients: myocarditis, hypertension, serious disorders of the kidneys in pregnant women, etc.

3. Surgery

Indicated in the absence of positive effects from drug therapy within 2 days after the start of its use.

If this is not a normal menstruation, they are always a bad sign and become a reason for an immediate visit to the gynecologist. As for the causes of bleeding in women, they are very different, associated both with age-related changes in the body, and with a number of pathologies and diseases of the female genital area.

It should be noted that experts share sexual and uterine bleeding, since the nature of their origin in most cases is different. So, vaginal bleeding is usually caused by mechanical damage or some kind of infectious disease. Sexual bleeding occurs different reasons and come in various intensities.

The cause of bleeding from the uterus can be ovulation, some gynecological diseases and diseases of the circulatory system. But most often, such bleeding occurs due to hormonal imbalance. This can happen at any age period, and therefore uterine bleeding is usually classified according to the age of the woman:

• Pubertal and juvenile periods (12-18 years).
• Reproductive age (18-45 years).
• Menopause (45-55 years).

Bleeding can be suspected by pathologically heavy periods, increased duration of menstruation, acyclicity of menstruation (menstruation does not occur within 6-8 weeks, and then there is heavy bleeding).

Let us consider in more detail the causes of bleeding in women.

Common reasons

Most probable cause bleeding from the uterus in young girls and menopausal women is a failure in general hormonal background. IN normal condition when the hormones estrogen and progesterone are produced in optimal amount, menstrual blood loss does not exceed the allowable volume. If this balance is disturbed, pathological dysfunctional bleeding from the uterus occurs.

Increase the risk of bleeding thyroid disease (hypothyroidism, hyperthyroidism). In addition, pathological blood loss can be caused by diseases of the circulatory system, leading to a decrease in the number of platelets in the blood.

As a rule, such causes of bleeding in women are considered:

• Myoma (with internal uterine myoma, blood loss is very intense).
• Adenomyosis (characterized by long, very profuse, excruciatingly painful menstruation).
• Polyps (benign neoplasms leading to heavy periods with severe pain and uterine bleeding).
• Ectopic pregnancy.
• Detachment of the placenta, the threat of miscarriage, other complications of pregnancy.
• Malignant tumors. This is the most dangerous reason bleeding in women, regardless of the location of the neoplasm (ovaries, uterus, cervix, etc.). Requires immediate medical attention.

IN last years among women reproductive age Increasingly, there is a phenomenon such as breakthrough bleeding from the uterus. The reason for them is the use of intrauterine devices, other types of contraceptives, the use of hormonal contraceptives. Moreover, the risk of opening uterine bleeding increases while taking contraceptives and anticoagulants.

IN certain periods A woman's life bleeding can occur for various reasons. Therefore, they must be considered separately.

Thus, the bulk of gynecological pathologies in girls and girls aged 12-18 years is associated with a violation of the process of hormone regulation. The provoking factors of this condition are very different:

• Physical, moral injuries.
• Inadequate nutrition.
• Violation of the functions of the thyroid gland, pathology of the adrenal cortex.
• Baby infectious diseases(influenza, mumps, measles, chickenpox, chronic tonsillitis, etc.).
• Complicated pregnancy and difficult childbirth in the mother.
• Tuberculosis of the genital organs.
• Blood clotting disorders.

In childbearing age, uterine bleeding in women is mainly associated with impaired ovarian function. The cause of ovarian dysfunction may be:

• General overwork of the body, stress, constant neuropsychic tension.
• Unfavorable living conditions (regions with developed metallurgical, mining, chemical industries).
• Professional hazard.
• Climate change.
• Various infectious and inflammatory diseases of the female genital area.
• Myomas are uterine.
• Tumors of the ovaries.
• Malignant and benign neoplasms on the cervix and in the uterus itself.
• Ectopic pregnancy.
• Miscarriage.
• Medical or surgical abortion, curettage.
• Reception medicines leading to dysfunction of the pituitary and hypothalamus.

IN percentage to others gynecological diseases uterine bleeding is the most common pathology in premenopausal and menopausal women.

This is due to the extinction of the functions of the pituitary gland. There is a gradual decrease in the production of gonadotropins by the pituitary gland, the release of hormones, respectively, becomes irregular, as a result of which the ovulation cycle is disturbed, folliculogenesis develops, and the corpus luteum increases.

Uterine bleeding is especially common in menopausal syndrome, when the symptoms of menopause in women are most pronounced. This is explained by the fact that during this period, the deficiency of the hormone progesterone is especially acute, resulting in the growth of the endometrium and hyperestrogenism.

At the slightest suspicion of bleeding during menstruation, in the middle of the cycle, during the period of bearing a child, during menopause, a woman is obliged to consult a gynecologist without delay.

Only timely detection of any pathology, accurate identification of their causes and adequate treatment help avoid serious problems with health.

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is the discharge of blood from the uterus. Most often it is a serious symptom of diseases. female body. Any uterine bleeding should be diagnosed in time, and the woman should receive medical assistance. Ignoring such a symptom leads to serious consequences, even death. It is important to know that normal uterine bleeding includes only menstruation, the duration of which is up to 5 days, with stable interruptions, 28 days long. All other bleeding is a pathology and requires medical supervision.

According to statistics, uterine bleeding, which is pathological in nature, in 25% of cases is associated with organic diseases of this organ or ovaries. The remaining 75% are associated with hormonal disorders and diseases of the genital area.

Menstruation (menstruation) is the only physiological normal view uterine bleeding. Usually its duration is from three to five days, and the interval between menstruation (menstrual cycle) normally lasts from 21 to 35 days. Most often, the first couple of days of menstruation are not abundant, the next two are intensified and, at the end, again become scarce; blood loss these days should be no more than 80 ml. Otherwise, iron deficiency anemia develops.

At healthy women menstruation is painless. In case of pain, weakness and a woman should consult a doctor.

The onset of menstruation usually occurs at 11-15 years of age and lasts until the end of the reproductive period (menopause). During pregnancy and breastfeeding menstruation is absent, but this phenomenon is temporary.

It is important to remember that the early onset of spotting in girls (before 10 years of age), as well as in women after menopause (45–55 years of age), is an alarming sign of serious illness.

Sometimes spotting in the middle of the cycle (on the 10-15th day after the end) can become a variant of the norm. Their cause is hormonal fluctuations after ovulation: the walls of the uterine vessels become excessively permeable, so vaginal discharge may have blood impurities. Such discharge should not last more than two days. Sometimes the cause of spotting becomes an inflammatory process, so a woman should definitely consult a gynecologist.

A variant of the norm is also implantation bleeding, which occurs as a result of the introduction of the embryo into the uterine wall. This process occurs a week after conception.

Why are uterine bleeding dangerous?

Uterine bleeding has the ability to increase rapidly, not stop for a long time and hard to stop.

Therefore, depending on what type of bleeding a woman has, it can be dangerous with such consequences as:

With moderate but regular blood loss, varying degrees of severity can develop. It begins if the volume of released blood is 80 ml. Although at similar conditions there is no direct threat to the life of a woman, however, this process cannot be left without attention.

A large loss of blood may be due to simultaneous heavy bleeding, which is difficult to stop. Most often required surgical intervention, with replenishment of lost blood and removal of the uterus.

The risk of progression of the underlying disease. In this case, we are talking about small blood loss, to which the woman does not pay attention and does not go for medical assistance. At the same time, blood loss, even in a small amount, can eventually lead either to profuse bleeding, or to the fact that the disease that caused it will go into a neglected form.

The danger of bleeding in pregnant women or in women in the postpartum period is that it can end in a state of shock. The intensity and severity of this condition is due to the fact that the uterus is not able to fully contract and stop blood loss on its own.

There are many reasons that can cause uterine bleeding. In order to systematize them, it should be understood that the resulting blood loss can be a malfunction in organ systems, as well as disorders in the genital area.

TO extragenital causes uterine bleeding, that is, those caused by disorders in the work of non-genital organs include:

Diseases of the hematopoietic system, these are: hemophilia, low levels of vitamin C and K, etc.

Prolapse of the urethra.

Violations in the activity of the cardiovascular system, for example, etc.

Reduced functionality.

The causes of uterine bleeding are genital, in turn, may be associated with the bearing of a child by a woman.

During pregnancy, the following causes of bleeding from the uterus are distinguished:

Ectopic pregnancy.

Pathology of the fetal egg.

The presence of a scar on the uterus.

Placenta previa, her low position or early detachment.

Various processes of destruction of uterine tissues.

Rupture of the uterus during labor.

Injury to the birth canal (vagina or vulva).

Infringement or delay of the departed placenta.

Enometritis.

trophoblastic disease.

C-section.

chorionepitheloma.

Genital bleeding can occur in a woman who is not carrying a child. Causes for them include:

Dyscirculatory bleeding, which, in turn, can be climateric, reproductive and juvenile.

Syndrome chronic fatigue, especially enhanced by starvation and exhaustion of the body, can also cause bleeding.

Pronounced hormonal disorders occur during puberty girls, during pregnancy and after childbirth, after abortion.

Sometimes it can affect hereditary predisposition and taking some hormonal pills.

Prolonged bleeding can develop against the background of a medical abortion, which has recently gained momentum in popularity.

For the treatment of bleeding caused by hormonal disruptions, an individual approach is required. It will depend on the cause that caused bloody discharge from the uterus.

Uterine bleeding after cesarean

After a caesarean section, a woman should be under medical supervision. Most often, bleeding lasts a little longer than after childbirth. naturally. This is due to the fact that it is formed on the uterus, which makes it difficult to contract. Normally, bleeding stops completely after a couple of months. If it continues, then the woman needs to report this problem to the doctor.

The cause of pathological bleeding after surgery is most often hemostasis. Therefore, in order to eliminate this problem, doctors should carefully but carefully scrape the walls of the uterus. If bleeding cannot be stopped, extirpation is required.

If the bleeding is hypotonic, then it is not always possible to stop it, since it occurs after the uterus begins to contract. Profuse blood loss can lead to hypotonic shock. Replenishment of blood supplies by transfusion and manual examination of the uterus are necessary in order to detect possible remains of the placenta, determine the contractile function of the uterus and establish the existing rupture.

The critical measure that doctors take to save a woman's life is the removal of the uterus. This method is used if bleeding after caesarean section by other means (electrical stimulation of the uterus, ligation of blood vessels, administration of uterotonics) cannot be stopped.

Types of pathological uterine bleeding

Gynecologists divide uterine bleeding into many types. But there are those that are most common:

Juvenile bleeding. They are characteristic of the onset of puberty in girls. They can be caused by a number of factors, for example, frequent illnesses, increased physical activity, poor nutrition, etc. Depending on the amount of blood lost, such bleeding can lead to anemia of varying severity.

About profuse uterine bleeding should be said if it is not accompanied by painful sensations. In this case, the volume of fluid lost may vary. There are many reasons, it can be an abortion, and vaginal infections, and taking hormone-containing drugs, etc.

Acyclic bleeding characterized by the fact that it appears in the intervals between menstrual cycles. It can be caused by fibroids, endometriosis and other pathologies. If acyclic bleeding is observed regularly, then a doctor's consultation is necessary. Although this type is not always a symptom of any pathology.

Anovulatory bleeding is typical for women who have entered the period of menopause and for adolescents undergoing puberty. It is caused by the fact that the maturation of the follicles and the production of progesterone are disturbed, in the absence of ovulation. This species is dangerous because, without treatment, it can provoke the development of malignant tumors.

dysfunctional occurs when the functioning of the ovaries is disrupted. A distinctive feature is that it occurs after menstruation has been absent for a long time, and blood loss with it is plentiful.

Hypotonic bleeding occurs due to low tone of the myometrium, after an abortion, etc. most often appears after childbirth.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding refers to those that are associated with a violation of the production of sex hormones produced by the glands. internal secretion. They can appear at almost any age, both during puberty and during menopause, and in the reproductive period of a woman's life. This pathology is widespread.

This type of bleeding is expressed by the fact that the period of menstruation is lengthened, and the amount of fluid lost increases. Without treatment, it always leads to the development of anemia. Main feature - prolonged absence menstruation, sometimes up to six months, and then the occurrence of bleeding, which has a different strength.

Dysfunctional bleeding can be ovulatory (concerns women of reproductive age) and anovulatory (more common in adolescents and premenopausal women). Cycle disorders in this case are expressed in abundant and irregular periods, with long (more than 35 days) and short-term (less than 21 days) intervals, in the absence of menstruation for more than six months.

The treatment strategy depends on the age of the patient and whether she has concomitant pathology. It can be either medical or surgical. However, in adolescence, surgery is resorted to only in emergency cases. Conservative therapy is to take hormones. If dysfunctional uterine bleeding is left untreated, it can lead to miscarriage, chronic anemia, endometrial cancer, state of shock and even death.

Atonic uterine bleeding

Atonic bleeding is characterized by the fact that it is formed when the uterus becomes unable to contract. The lack of contractility in obstetric practice is called the uterus of Kuveler. A characteristic feature of atonic bleeding is zero tone and a similar reaction to the introduction of uterotonics.

When it is not possible to stop the bleeding with the help of specialized drugs, a thick suture is applied to the posterior lip of the cervix, clamps are additionally applied to clamp the uterine artery.

If these methods were ineffective, and blood loss could not be stopped, then they are considered as preparation for an operation to remove the uterus. Mass loss of blood is considered to be from 1200 ml. Before the uterus is completely removed, attempts are made to ligate the vessels using the Tsitsishvili method, electrical stimulation (this method is becoming less popular, and doctors are gradually abandoning it), acupuncture. It is important to constantly replenish the reserves of lost blood.

This type is characterized by the fact that the tone of the myometrium decreases. Such bleeding occurs when the fetal egg is retained in the uterine cavity, during the separation of the placenta, after its release. The reason lies in the uterus after childbirth, when contractions occur rarely and are spontaneous. The critical degree of such a state is referred to as atony, when contractions are completely absent.

The main tasks facing physicians are:

Stop bleeding as soon as possible.

Replenishment of the BCC deficit.

Avoiding blood loss of more than 1200 ml.

Tracking blood pressure and preventing it from falling to a critical level.

Treatment is aimed at ensuring that the motor function of the uterus is restored as soon as possible. If there are remnants of the fetal egg, then it must be removed either by hand or with a curette. When hypotonic bleeding occurs after childbirth, it is necessary to squeeze out the placenta as soon as possible, if it does not work, then it is removed manually. Most often, it is the removal of the placenta that helps restore the motor function of the uterus. If necessary, her gentle massage on the fist is carried out.

As medicines administration of pituitrin or oxytocin is indicated. Effective in some cases is the imposition of a bubble on the abdomen containing ice or irritation of the uterus with ether. For this purpose, a moistened swab is inserted into the posterior fornix of the vagina. If hypotension does not respond to this therapy, then measures are taken that are characteristic of uterine atony.

Acyclic uterine bleeding

Acyclic uterine bleeding is called metrorrhagia. It is not associated with the menstrual cycle, which is normal, it is characterized total absence any periodicity.

This condition can occur suddenly and be associated with a woman's pregnancy, incomplete abortion, placenta previa, development ectopic pregnancy, delay of part of the placenta, etc.

Acyclic bleeding, if a woman does not bear a child, can be observed with pathologies such as uterine fibroids, benign tumors. If the tumor is malignant, then metrorrhagia is observed at the stage of its decay.

It is not possible to describe the degree of intensity of blood loss, since the discharge can be spotting, abundant, with impurities blood clots and without them.

It is important to pay close attention to acyclic bleeding for women who are in menopause, both at its initial stage and several years later, after the cessation of constant menstruation. In no case should they be perceived as renewed ovulation. Metrorrhagia in this period requires careful study, as they are often signs malignant process, For example, .

Breakthrough uterine bleeding

Breakthrough uterine bleeding develops against the background of hormonal disorders. They are characterized by an imbalance between estrogen and progesterone. Sometimes this type of bleeding occurs when a woman takes oral contraceptives. In this case, breakthrough bleeding is an adaptation reaction to the drug. If, after taking the prescribed remedy, bleeding occurs that does not correspond to the menstrual cycle, then it is necessary to consult a doctor about adjusting the dose or replacing the remedy.

Breakthrough bleeding can also be observed when the uterine wall is damaged by a spiral. This cannot be ignored, the spiral must be removed immediately.

Most often, blood loss from breakthrough bleeding is minor, however, a visit to the doctor should not be postponed.

Anovulatory uterine bleeding

These bleedings occur during the break between menstruation, their causes are varied, including they can be a manifestation of any disease. Most often, anovulatory bleeding is prolonged in time, lasts more than 10 days, and is acyclic. Women suffer such blood loss either during fading reproductive function or during its development.

This bleeding is also called single-phase, during its opening the corpus luteum is not formed, the development of the follicle occurs with disturbances, and there is no ovulation.

This bleeding it can be hyperestrogenic when the follicle matures but does not rupture and hypoestrogenic when several follicles mature but do not fully mature.

Rarely, anovular uterine bleeding occurs during the reproductive period of a woman's life. Similar phenomena associated with violations of the hypophozotropic zone, after suffering, poisoning, infections.

Among adolescents, according to statistics, this type of bleeding is quite common. Such violations account for up to 12% of all gynecological diseases. In this case, the decisive factor may be irrational nutrition, mental trauma, physiological overload.

Discirculatory uterine bleeding

The occurrence of discirculatory uterine bleeding is caused by impaired ovarian function. Sometimes the impetus is provided by external factors such as transferred viral infections, stress, etc. Blood loss is not great, observed after menstruation was absent for a long time.

Often, women observe the presence of clots in uterine bleeding. Most often, doctors explain their appearance by the fact that the uterus during fetal development has undergone certain anomalies. Therefore, the blood stagnates in its cavity, forming clots.

Most often, menstruation causes more pronounced discomfort in such women, especially when it occurs with an increased hormonal background. Sometimes just like this congenital anomaly can cause increased bleeding and the presence of numerous clots in the secretions.

In addition to the fact that anomalies are congenital in nature, they can be acquired during life. Such phenomena are associated with the professional characteristics of a woman and with the abuse of bad habits. Often during menstruation with blood clots, women experience strong cutting pains. In order to exclude the presence of a pathological process, it is important to seek advice from a gynecologist.

Sometimes changes in the hormonal background can also lead to the formation of clots. To clarify the cause, you need to pass a series of tests, including thyroid hormones and adrenal hormones, and examine the level of progesterone and estrogen.

The presence of clots severe pain in the lower abdomen, heavy blood loss during menstruation, acyclic mini-bleeding - all this most often indicates endometriosis. Such a diagnosis is established after a thorough diagnosis and requires appropriate treatment.

Sometimes the reason may be poor clotting blood and some complications that arose after childbirth.

Uterine bleeding during pregnancy

The most common causes of uterine bleeding during pregnancy are miscarriage, uterine disease, ectopic pregnancy, and damage to the placenta.

A miscarriage is accompanied by strong cramping pains in the lower abdomen, bleeding is intense, the color of the blood is from bright scarlet to dark. With an ectopic pregnancy, bleeding is accompanied by a deterioration in the general condition, malaise, nausea, and sweating. Blood is dark in color and usually comes out in clots.

Damage to the blood vessels of the cervix during pregnancy can occur during sexual intercourse or gynecological examination. This bleeding is usually not heavy or prolonged.

If the placenta is damaged or previa, uterine bleeding may occur in the second or third trimester. The bleeding is usually very heavy. It poses a serious threat to the life and health of the expectant mother and her child.

It should be remembered that uterine bleeding in pregnant women is very dangerous, so a woman must definitely call a medical team that will provide her with urgent assistance.

First aid for uterine bleeding is to call as soon as possible ambulance. This is especially true in the case when a woman is carrying a child, her blood loss is plentiful, her condition worsens sharply. In this case, every minute counts. If it is not possible to call a team of doctors, then it is necessary to take the woman to the hospital on her own.

Any uterine bleeding is a serious threat to life and health, so the reaction must be appropriate.

It is strictly forbidden to apply a hot or warm heating pad to the stomach in case of dysfunctional bleeding, douching with any compositions, take a bath, use drugs that promote uterine contraction.

Independently, at home until the ambulance arrives, a woman can be helped as follows:

The woman must be put to bed, preferably on her back, and her legs placed on some kind of elevation. To do this, you can put a pillow or a roller from a blanket. Thus, it will be possible to preserve the consciousness of the patient, especially if the blood loss is impressive.

Something cold should be applied to the stomach. If there was no heating pad at hand, then the ice can be wrapped in a regular cloth. You can replace the ice with an ordinary bottle filled with cold water. Cold exposure time - up to 15 minutes, then a break of 5 minutes. This will achieve vasoconstriction, and therefore somewhat reduce bleeding.

The woman needs to drink. Since it is not possible to put a dropper at home, you need to offer the patient plenty of fluids. Suitable plain water and sweet tea. This will contribute to the loss of fluid along with the blood, glucose will provide nutrition to the nerve cells of the brain.

To the reception medications should be treated with extreme caution, especially if a woman is carrying a child. Before taking them, you should always consult with your doctor, but sometimes it happens that there is no such possibility. Therefore, it is necessary to know the names of hemostatic agents and their minimum dosage. These include Vikasol (taken 3 times a day, at a dosage of 0.015 g), ascorbic acid (maximum daily dose of 1 g), Dicyon (taken 4 times a day, at a dosage of 0.25), calcium gluconate (1 tablet up to 4 times per day). Before use, it is important to remember that all drugs have side effects.

How to stop uterine bleeding?

When the ambulance arrives at the scene, its actions will be as follows:

A bubble containing ice is applied to the woman's stomach.

If the bleeding is heavy, then the woman should be taken to the car on a stretcher.

Hospitalization of the patient with transfer directly to a specialist.

The introduction of a solution of sulfate, with a threat or the onset of a miscarriage. Or if a spontaneous abortion occurs, the woman is given intravenous calcium chloride, and ascorbic acid diluted with glucose. An injection of Etamzilat can be made.

Hospital doctors use to stop bleeding hormonal preparations, in the event that a woman has not yet given birth, she does not have a suspicion of a tumor. TO hormonal drugs include Jeannine Regulon, etc. On the first day, they give an increased dose (up to 6 tablets), in the following days, one tablet less, bringing up to 1 piece. Sometimes gestogens are used, but it can be used only in the absence of severe anemia.

Hemostatic agents can also be used, for example, Dicinon, Vikasol, Askorutin, Aminocaproic acid.

Sometimes surgery is used, such as uterine curettage ( effective method stopping blood loss), cryodestruction (a method without contraindications), laser removal of the endometrium (used in those women who do not plan to have more children).

Treatment of uterine bleeding largely depends on its causes and the age of the patient.

Adolescents are most often prescribed drugs that reduce the uterus, drugs that stop blood and strengthen the walls of blood vessels. It is also recommended to take, herbal medicine, less often - hormonal drugs that regulate the menstrual cycle. Women of reproductive age are prescribed hormonal drugs, sometimes surgical operations are performed (for fibroids, endometriosis of the uterus, etc.) After menopause, uterine bleeding most often indicates oncological pathologies of the uterus and ovaries, so treatment requires mainly surgical intervention, including the removal of the uterus and its appendages.

In treatment, it is most important to diagnose the causes of bleeding in time, so sick women should seek medical help without delay.

Education: Diploma in Obstetrics and Gynecology obtained from the Russian State medical university Federal Agency for Health and Social Development (2010). In 2013, she completed her postgraduate studies at the NMU. N. I. Pirogov.

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Uterine bleeding (vaginal bleeding)

Uterine bleeding (vaginal bleeding)

Uterine bleeding may occur with physiological and a number of pathological conditions. Since the woman herself cannot determine the source of bleeding, a manifestation of uterine bleeding is vaginal bleeding. Uterine bleeding can be an absolutely physiological phenomenon in two cases: during menstruation, if its duration is not more than 7 days and the frequency of occurrence is not less than 1 time in 25 days. Also, uterine bleeding in the form of short-term spotting may be normal during ovulation.

What uterine bleeding is considered pathological

Uterine bleeding may be found in women of all ages. Pathological vaginal bleeding occur in the following cases:

• Long periods (menorrhagia), increased bleeding (menorrhagia and hypermenorrhea), and too frequent periods (polymenorrhea)
• Bleeding that is not associated with menstruation, occurring irregularly - metrorrhagia
• Bleeding in the postmenopausal period (if more than 6 months have passed since the last normal period)

Also, uterine bleeding can occur in pregnant women in the early and later dates.

Why does uterine bleeding occur?

The main mechanisms for the development of uterine bleeding are as follows:

• Hormonal disorders regulation of the relationship between the elements of the axis hypothalamus-pituitary-ovaries-endometrium
• Structural, inflammatory and other gynecological disorders (including tumors)
• Blood coagulation disorders

The most common mechanism of uterine bleeding is this: during the anovulatory cycle (the follicle does not mature), the corpus luteum does not develop. As a result, in the second phase of the cycle, progesterone (one of the female sex hormones) is not produced in sufficient quantities. At the same time, estradiol (another female sex hormone) continues to be produced in excess. Under the influence of estradiol, there is an increased growth of the endometrium (the inner layer of the uterus), which becomes so thick that blood vessels stop supplying it adequately with blood. As a result, the endometrium dies and undergoes desquamation. The process of desquamation is incomplete, accompanied by uterine bleeding and delayed for a long time.

The most common causes of uterine bleeding

• Bleeding early pregnancy occur during spontaneous abortion. In this case, vaginal bleeding begins immediately or some time after the start of the abortion due to the leakage of accumulated blood. Also, bleeding can occur with an ectopic (ectopic) pregnancy.
• Bleeding in late pregnancy may be associated with placental rupture, hydatidiform mole, placental polyps, and placenta previa.
• Uterine bleeding can be symptoms of diseases associated with changes in the structure of the reproductive organs, such as adenomyosis (endometriosis of the uterus), cancer of the uterus, cervix or vagina, endometrial hyperplasia, submucosal nodes in uterine fibroids or emerging nodes, cervical and endometrial polyps.
• Vaginal bleeding may be signs atrophic vaginitis, cervicitis, a foreign body of the vagina, with damage to the cervix, uterus or vagina.
• Uterine bleeding in violation of ovarian function can occur in such conditions: dysfunctional uterine bleeding, functional ovarian cysts, polycystic ovary syndrome (polycystosis).
• Endocrine disorders: hypothyroidism or hyperprolactinemia.
• Vaginal bleeding due to a blood clotting disorder develops with hereditary diseases of the coagulation system, with liver diseases, while taking certain medications
• Uterine bleeding can occur with the use of contraceptives and hormone therapy. Most often in cases of prescribing drugs such as Depo Provera, with hormone replacement therapy, with an intrauterine device, with levonorgestrel implants and in case of long gaps in taking contraceptives.

When to See a Doctor for Uterine Bleeding

In cases where menstruation lasts more than 7 days, if the amount of discharge during menstruation is greater than usual, if menstruation occurs more often than once every 25 days, if bleeding occurs outside of menstruation, you should consult a doctor. When viewed on a chair, you can see damage to the vagina and cervix, vaginitis that has begun, erosion of the cervix. Also, upon examination, you can see a submucosal node being born with uterine myoma or a cervical polyp. Often uterine bleeding accompanies infertility, since they are always based on a violation of the structure of the endometrium or a violation hormonal regulation ovulation and menstrual cycle. In addition to the study on the chair, it is often necessary to do a transvaginal ultrasound, since with this method it is possible to assess changes in the ovaries and in the uterine cavity. Often, ultrasound of the uterus is crucial for diagnosing the causes of uterine bleeding. If the ultrasound of the uterus is detected structural changes that do not have unambiguous signs, a blood test for the content of sex hormones and thyroid hormones can be prescribed. Always with uterine bleeding, a pregnancy test is performed. To assess the degree of acute or chronic blood loss, a general blood test is prescribed, where the indicators of erythrocytes, hemoglobin, hematocrit, platelets and ESR are monitored.

Treatment of uterine bleeding

Treatment of uterine bleeding depends on the reason causing it. Most often, treatment is conservative and consists in the use of drugs that increase the ability of blood to clot and drugs that correct hormonal imbalance. Right choice These medications take into account many factors that are brought together by the doctor. If bleeding is not eliminated medically or has an underlying cause that cannot be eliminated conservatively, surgical treatment is performed. Surgical treatment can consist of both therapeutic and diagnostic curettage of the endometrium, and hysterectomy (removal of the uterus).

in obstetrics and gynecology, we work in such areas as:

• Vaginal discharge in women, discharge during pregnancy

• Ultrasound diagnostics of Down syndrome and other chromosomal abnormalities

We treat such problems.