Lecture bleeding during labor and postpartum

2021-03-21 12:00 AM

Amniocentesis to lower the fetal position, try to stop bleeding in other cases. If after the amniocentesis, the bleeding will be stopped, the labor will continue to be monitored. If the blood does not stop, then a cesarean section is required.

Define

Bleeding during labor and postpartum includes all cases of women with vaginal bleeding of any cause during labor, before and after the pregnancy leaves the uterus within the first 6 hours after delivery.

This is a very dangerous pathology for the mother's life as well as the fetus, which can lead to rapid death due to blood loss. Therefore, it is necessary to have an attitude to handle quickly and decisively.

It can be divided into two phases:

The period of labor when the fetus is not out of the uterus.

The postpartum period after the pregnancy or the placenta has left the uterus.

The stage of labor

Symptoms: Vaginal blood is often bright red, can bleed a lot, massively, causing the patient to feel dizzy and faint because of acute blood loss. Other symptoms, such as uterine contractions may also be present. The fetal heart fluctuates, possibly even losing the fetal heart.

Vaginal examination: Found in the vagina a lot of blood, both blood thinning and blood clots. The cervix is ​​erased, the amniotic fluid may remain or ruptured, the cervix can feel part or all of the placenta covering the cervix.

Ultrasound: Determine the status of the fetus, amniotic fluid and placenta. Only when absolutely necessary, should do on the spot to avoid moving the patient.

Causes of bleeding during labor

Vegetable forwards

Account for about 0.5-1% of the total number of births. It is a condition in which the vegetables do not completely cling to the uterine body, but part or all of the vegetable cake is attached to the lower uterus.

Symptom:

Bright red bleeding, often massive bleeding in the central striker completely vegetable. Therefore, with the contribution of ultrasound, nowadays, it is often indicated that cesarean section is early when the pregnancy is full term, not to have labor, to avoid the risk of bleeding.

The whole body: If the bleeding is heavy, not promptly handled, the state of the pregnant woman can collapse quickly, dizziness, heart failure.

Examination: Manipulation can see abnormal fetal position such as horizontal throne (14.3%), fetal heart can change depending on the amount of blood loss

Vaginal examination: through the cervical opening you can feel all the vegetables in the central striker, or see 1 part vegetables, 1 part amniotic fluid in semi-center striker vegetables, or just feel the edge of the vegetable cake Not even to touch anything, but only thick, hard amniotic fluid.

To solve:

Specify absolute surgery in the case of vegetable center striker, semi-center, as quickly as possible, even when the fetus is dead.

Amniocentesis to lower the fetal position, try to stop bleeding in other cases. If after the amniocentesis, the bleeding will be stopped, the labor will continue to be monitored. If the blood does not stop, then a cesarean section is required.

During surgery, if the vegetable clingy is bleeding, it is necessary to stop the bleeding with the X or U-shaped catgut. to save mom.

If lower sugar is laid, during the period of bleeding, artificial vegetable peeled and uterus control must be removed, note the lower section, for uterotonic drugs to stop bleeding. In the case that the bleeding cannot be stopped, sometimes surgery is required to remove the lower half uterus or even completely remove the uterus.

Mother needs to be monitored and blood transfusion if there is anemia.

Young vegetables

Juvenile spinach is a vegetable that sticks to the correct position but peels off before birth, common in patients with pre-eclampsia, but can sometimes be found in post-traumatic cases.

Symptom:

Because the disease is common in patients with pre-eclampsia, there are symptoms such as edema, high blood pressure, headache, blurred vision ...

Basic increases in muscle tone of the uterus, even the uterine muscle spastic like wood in the case of severe. The height of the bottom of the uterus increases gradually.

Fetal heart fluctuation, even loss of fetal heart depending on the disease.

Vaginal bleeding, possibly red or thin, pink due to mixed with amniotic fluid.

Visiting the vagina, in case of unbroken amniotic fluid, the end of the amniotic fluid will be swollen and very tight.

Test:

Ultrasound: Seeing a hematoma behind the vegetables, the fetal heart may not be seen.

Urine: There is Albumin in the urine.

Biochemistry: there may be a decrease in serum Fibrinogen.

To solve:

Principle of removing the pregnancy as quickly as possible to avoid serious damage to the uterus

In mild cases, if the cervix is ​​completely open, the tip of the cervix can be delivered quickly by Forceps intervention.

In other cases, the caesarean section should be done as soon as possible, even when the fetal heart has been lost, to try to preserve the uterus, because in the premature peeling vegetable, the damage to the uterus is sometimes disproportionate. with clinical symptoms.

During cesarean section, to determine the damage to the uterus, if the uterus is much bruised or bleeding, the lower part of the uterus should be removed.

In cases where the uterus is to be preserved, great care must be taken after the risk of bleeding has definitely been ruled out.

Broken uterus 

Common in patients with signs of mismatch between the fetus and pelvis, with pelvic abnormality, old surgical scarring of the uterus, and taking inotropic drugs during labor. This is an obstetric complication, usually caused by not strictly controlled during labor.

Clinical symptoms:

Patients often show signs of threatening rupture of the uterus before, except in cases of old surgery. It is a rapid, strong, intense uterine contraction, making the patient much pain, panic, the lower uterine stretches up high, the sign of Bandl-Formelle. If detected during this period to intervene in a timely manner, it will be very gentle and safe for both mother and child. But if not found, it can lead to a true rupture of the uterus:

The patient suddenly feels a sharp pain and then subsides, but then gradually goes into dizziness due to blood loss.

The signs of the uterus rupture disappear, the fetal heart disappears.

Parts of the fetus can be seen touching just under the skin of the abdomen.

Vaginal bleeding bright red.

Visiting the vagina, the throne fell high, and could not even identify the throne.

To solve:

Emergency surgery as soon as possible, even when the mother is shocked, the fetal heart is lost. Maybe both surgery and recovery, blood transfusion.

Depending on the mother's injury and the need of childbirth, it is possible to preserve the uterus or remove the uterus.

Bleeding due to a rupture of a blood vessel in the vegetable membrane

This is a rare case but has the same clinical condition as the striker vegetables.

Symptoms: Vaginal bleeding bright red, with no accompanying symptoms.

Vaginal visit: Normally, no signs of a striker have been found.

Test: Normal.

Treatment: In the absence of rupture of the amniotic fluid, the amniotic fluid can be pressed to stop the bleeding. If there is no result, a cesarean section.

Causes of bleeding during vegetable book period

Vegetables do not peel off

It is a phenomenon that after 30 minutes or more of pregnancy, the vegetable peeling test shows that the vegetables are still not peeling and go down. Often, incomplete peeling of vegetables will cause bleeding, while vegetables that do not peel off completely will not have this phenomenon.

Symptoms: After the birth certificate, the vagina is bright red blood. Experiment with the failure of vegetables.

The mother's condition changes depending on the state of blood loss.

Treatment: Recovery, pain relief. Carry out peeling artificial vegetables and controlling the uterus.

Vegetable tooth comb

This is also one of the causes of vegetables not peeling.

Symptoms: Often detected only while peeling artificial vegetables, finding it difficult to peel, the surface of the uterus is in the area of ​​sticky vegetables, the blood continues to flow.

Management: Emergency surgery and often partial hysterectomy.

Pour vegetables

This is one of the most common causes of bleeding during the third stage of labor. Easily detectable by vegetable inspection.

Symptoms: After the bleeding, vaginal blood continues to bleed a lot, or a little bit, the blood will be bright red. The mother's condition changes depending on the amount of blood lost.

Poor elasticity of the uterus.

Check the vegetable cake to see the lack.

Treatment: Pain relief. Control of the uterus. The uterus and antibiotic elastic measures.

Sputum of the uterus

Commonly seen in women with multiple pregnancies, large pregnancies, multiple pregnancies, or prolonged labor.

Symptoms: After the pregnancy and vegetables come out, the vaginal blood continues to bleed, the blood is bright red, even though the cake is checked enough.

Exam: On abdominal examination, there was no safe volume of the uterus.

Management: uterotonic drugs, can carry out control of the uterus in combination with massage in place.

Broken uterus

This is one of the dangerous obstetric complications that, if not detected in time, can quickly lead to death of the mother. Commonly seen in cases of difficult procedures such as forcep when the throne is still high, internal rotation, or in women with old surgical scars.

Symptoms: Vaginal bleeding is bright red, the abdomen may be slightly distended, but this symptom is often difficult to detect. The mother's condition changes depending on the state of blood loss.

Control of the uterus shows an incomplete uterine cavity.

Management: Both resuscitation and emergency surgery immediately, depending on the mother's condition, the need for delivery, the extent and location of the uterine rupture, hysterectomy or conservative stitching should be performed.

Fluttering of the uterus

Very rare, often seen in women giving birth many times, conducting too harshly to deliver vegetables

Symptoms: The uterine chamber is turned upside down and pulled out of the vagina, vulva, red like beef. The patient is in pain and dizziness.

On external examination, there was no safe mass on the abdominal wall

Vaginal examination feels the border of the cervical edge

Treatment: Pain relief, anti-dizziness for patients (mainly pain). Proceed to push the uterus back inward. Medications that constrict the uterus to avoid turning back.

Software bleeding in the genital tract

Symptoms: Vaginal bleeding bright red, a little, oozing. Although the uterus has been controlled to rule out uterine causes, vaginal bleeding persists.

Management: Place 2 vaginal valves to check the integrity of the cervix, vaginal wall, and vulva.

Stitch hemostasis and restore soft damaged areas. Make sure to sew all cuts and no tunnels left.

Bleeding caused by a blood clotting disorder 

Stillbirth:

Often in large pregnancies, have been dead for a long time.

Management: To avoid the risk of bleeding, all stillbirths must be tested for fibrinolysis before pregnancy. In cases of low or even absent fibrinolytic, fibrinolytics or fresh blood must be rehydrated.

Viral hepatitis:

This is a very dangerous form of the disease in laboring women who are suffering from advanced hepatitis, due to the risk of coma and postpartum bleeding due to acute liver atrophy.

Symptoms: Patients with advanced hepatitis with jaundice, sclera.

Test: Increased liver enzymes, decreased fibrosis.

Treatment: Mainly resuscitating the mother and fusing blood fibers to restore.

Other diseases: such as thrombocytopenic hemorrhage ...., depending on the cause, it will handle and restore the missing coagulation factors.

In principle, surgical intervention should be minimized in cases of bleeding caused by blood clotting disorders.