Obstetrical hemorrhage
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2008-06-23T09:19:42Z
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{{DiseaseDisorder infobox |
Name = Obstetrical hemorrhage |
ICD10 = O20, O46, O67, O72 |
ICD9 = |
}}
'''Obstetrical hemorrhage''' refers to heavy bleeding during [[pregnancy]], [[labor (childbirth)|labor]], or the [[puerperium]]. Bleeding may be vaginal and external, or, less commonly but more dangerously, internal, into the abdominal cavity. Typically bleeding is related to the pregnancy itself, but some forms of bleeding are caused by other events.
Obstetrical hemorrhage is a major cause of [[maternal mortality]].
==Early pregnancy bleeding==
The most common bleeding event is the loss of a pregnancy, a [[miscarriage]], medically also called an abortion. Bleeding from an early miscarriages may be similar to that of a heavy [[menstruation]], but later on, a pregnancy loss may be accompanied but excessive or prolonged bleeding. A physician may propose to perform a [[Dilation and curettage|D&C]] for treatment. An [[ectopic pregnancy]] may lead to bleeding, often internally, that could be fatal if untreated.
==Late pregnancy bleeding==
The primary consideration is the presence of a [[placenta previa]], a condition that usually needs to be resolved by delivering the baby via [[cesarian section]]. Also a placental [[abruption]] can lead to obstetrical hemorrhage, some times concealed.
==Bleeding during labor==
Beside placenta previa and placental abruption, [[uterine rupture]] can occur as a very serious condition leading to internal or external bleeding. Bleeding from the [[fetus]] is rare, usually not heavy, but always very serious for the baby.
==After delivery (Postpartum)==
Postpartum hemorrhage is the loss of ≥500mL of blood, and is the most common cause of death of the delivering mother within the developed world.<ref>
{{cite journal
| author = Anderson JM, Etches D.
| date = 15
| year = 2007
| month = 3
| title = Prevention and Management of Postpartum Hemorrhage
| journal = American Family Physician
| volume = 75
| issue = 6
| pages = 875–882
| pmid = 17390600
| url = http://www.aafp.org/afp/20070315/875.html
| accessdate = 2007-12-01
| laysummary = A discussion of postpartum hemorrhage, including how to identify, manage and prevent it.
}}</ref>
Causes of postpartum hemorrhage are generally broken down into four categories, commonly called "The Four T's":
* [[Physical trauma|Trauma]] from the delivery may tear tissue and vessels leading to significant postpartum bleeding.
* [[Uterine atony]] (Tone) refers to the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony.
* [[Tissue (biology)|Tissue]] refers to any cellular debris from the [[placenta]] or [[fetus]] that may be left in the uterus, causing the uterus to not contract.
* [[Thrombin]] refers to some failure of [[clotting]], such as with diseases known as [[coagulopathy|coagulopathies]].
==Unrelated bleeding==
Pregnant patients may have bleeding from the reproductive tract due to trauma, including [[sexual assault]], neoplasm, most commonly [[cervical cancer]], and [[hematologic disorder]]s.
==Management==
The success of modern obstetrics is based to a good degree on the ability to recognize risk patients for obstetrical hemorrhage and their appropriate management. Key in this are methods of examination, including [[obstetric ultrasonography]], surgical obstetrics, [[blood transfusion]], and pharmacological support.
==See also==
* [[Gynecologic hemorrhage]]
* [[Antepartum haemorrhage]]
==Footnotes==
<references />
{{Pathology of pregnancy, childbirth and the puerperium}}
[[Category:Obstetrics]]
[[Category:Emergency medicine]]
[[Category:Medical emergencies]]