- Gynecologic hemorrhage
Gynecologic hemorrhage represents excessive bleeding of the
female reproductive system . Such bleeding could be visible or external, namely bleeding from thevagina , or it could be internal into the pelvic cavity or form ahematoma . Normalmenstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or duringdelivery is anobstetrical hemorrhage .Definition
Menstruation occurs typically monthly, lasts 3-7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from amiscarriage or anectopic pregnancy , while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage.Causes
Causes of gynecologic bleeding include:
Hormonal
Anovulation is a common cause of gynecological hemorrhage. Under the influence ofestrogen theendometrium (uterine lining) is stimulated and eventually such lining will be shed off (estrogen breakthrough bleeding). The anovulation chapter discusses its multiple possible causes. longstanding anovulation can also lead toendometrial hyperplasia and facilitate the development of endometrial cancer.Neoplasm
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Cancer of the uterus is always a concern, specifically when the bleeding occurs aftermenopause . Other types of cancer include cervical cancer; bleeding in that case can sometimes be triggered by intercourse and is termed postcoital bleeding. Cancers of the vagina or fallopian tubes are rare causes of hemorrhage.
#Uterine fibroids represent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity.
#Polyps of the uterine lining are a common cause of bleeding, but such bleeding tends to be light.Trauma
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Sexual assault and rape can lead to injury and gynecological hemorrhage.
#Accident s to the lower abdomen may lead to internal or external bleeding.Bleeding disorder
Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause.
Other
On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur during
ovulation or as a result ofendometriosis .If the
pregnancy test is positive, considerpregnancy related bleeding (seeobstetrical hemorrhage ), includingmiscarriage andectopic pregnancy .Diagnosis
A history will establish if the condition is acute or chronic, and if external circumstances are involved. A gynecologic examination is usually complemented by a
gynecologic ultrasonography . A blood count determines the degree ofanemia and may point out bleeding problems. Thepregnancy test is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal.Prevention
Generally gynecologic hemorrhage does not arise out of nowhere. Regular gynecologic examinations, cancer screening, and contraceptive measures go a long way in preventing and forestalling unsuspected acute bleeding events.
First aid
Gynecologic hemorrhage needs to be evaluated as soon as possible by a physician. The amount and duration of bleeding will dictate whether a bleeding event is an emergency event.
Clinical treatment
Treatment depends on diagnosis and may include hormonal therapy, iv fluids,
blood transfusion , and/or adilation and curettage . Internal bleeding requireslaparoscopy or abdominal surgery.ee also
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Medical emergency
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