Obstetrics and gynecology. Bleeding in the early postpartum period (most important)

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Obstetrics and gynecology. Bleeding in the early postpartum period (most important)

Lecture notes, cheat sheets

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36. Bleeding in the early postpartum period

Bleeding from the birth canal that occurs within the first 4 hours after delivery is called early postpartum bleeding.

Bleeding after childbirth can be caused by various reasons:

1) retention of part of the placenta in the uterine cavity;

2) hypotension or atony of the uterus;

3) rupture of the soft tissues of the birth canal;

4) dysfunction of the blood coagulation system (hypo- and afibrinogenemia).

Hypotension of the uterus - This is a pathological condition characterized by a sharp decrease in the tone and contractility of the uterus.

Uterine atony - this is a formidable complication that can accompany labor. At the same time, drugs and ongoing activities do not have any effect on the uterus. The state of the neuromuscular apparatus of the myometrium is regarded as paralysis. Atony of the uterus occurs very rarely, but causes profuse bleeding.

Causes hypotonic and atonic bleeding are diverse:

1) violation of the neurohumoral regulation of the contractile function of the uterine muscles as a result of the exhaustion of the forces of the body of the puerperal and especially her nervous system during prolonged and complicated childbirth;

2) severe forms of preeclampsia, hypertension;

3) the anatomical features of the uterus: infantilism and malformations of the uterus, tumors of the uterus, scars on the uterus after surgery, extensive inflammatory and degenerative changes after past inflammatory diseases or abortions;

4) prolonged overstretching of the uterus with polyhydramnios, multiple pregnancies, large fetuses;

5) rapid emptying of the uterus during operative delivery, especially after the application of obstetric forceps;

6) presentation and low attachment of the placenta, especially in the presence of an extensive placental area;

7) adhesive processes in the abdominal cavity.

The cause of hypo- and atonic bleeding may be a combination of several causes.

Clinic. The leading symptom of hypotonic bleeding is massive bleeding from the uterus in the postpartum period. In addition, symptoms develop due to hemodynamic disturbances and acute anemia. A clinical picture of hemorrhagic shock appears.

Diagnostics. The diagnosis of hypotension is made based on existing uterine bleeding and data from its objective examination. With uterine hypotension, pathological bleeding is inconsistent. Blood is released in portions, often in the form of clots. The uterus is flabby, rarely contracts, contractions are rare and short-lived. The uterus is enlarged in size due to blood clots accumulated in it; in some cases, it is poorly defined through the anterior abdominal wall. When performing an external massage, it contracts, and then it relaxes again, and bleeding continues.

With atony, the uterus completely loses its tone and contractility, does not respond to mechanical and pharmacological stimuli. Blood flows out in a wide stream or is released in large clots.

Author: Ivanov A.I.

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