Gynecologic hemorrhage

Gynecologic hemorrhage represents exessive bleeding of the female reproductive system. Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruationis not considered a gynecologic hemorrhage as it is not excessive. Hemorrhage associated with a pregnantstate or during deliveryis an obstetrical hemorrhage.

Definition

Menstruationoccurs typically monthly, lasts 3-5 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant women constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a miscarriageor an ectopic 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

Anovulationis a common cause of gynecological hemorrhage. Under the influence of estrogenthe endometrium(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 to endometrial hyperplasiaand facilitate the development of endometrial cancer.

Neoplasm

1. Cancerof uterus is always a concern, specifically when the bleeding occurs after the menopause. Other types of cancer includecervical cancer; sometimes bleeding here can be triggered by intercourse and is termed postcoital bleeding. Cancer of the vagina or fallopian tubes are rare causes of hemorrhage.
2. Uterine fibroidsrepresent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity.
3. Polypsof the uterine lining are a common cause of bleeding, but such bleeding tends to be light.

Trauma

1. Sexual assaultand rape can lead to injury and gynecological hemorrhage.
2. Accidentsto 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 ovulationor as a result of endometriosis.

If the pregnancy testis positive, consider pregnancyrelated bleeding (see obstetrical hemorrhage), including miscarriageand ectopic 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 of anemiaand may point out bleeding problems. The pregnancy testis 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. In the wilderness, evacuation may be necessary.

Clinical treatment

Treatment depends on diagnosis and may include hormonal therapy, iv fluids, blood transfusion, and/or a dilatation and curettage. Internal bleeding requires laparoscopyor abdominal surgery.

See also

Medical emergency

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It uses material from the http://en.wikipedia.org/wiki/Gynecologic+hemorrhage Wikipedia article Gynecologic hemorrhage.