| Obstetrical hemorrhage | |
|---|---|
| Classification and external resources | |
| ICD-10 | O20, O46., O67, O72. |
| ICD-9 | 641, 666 |
Obstetrical hemorrhage refers to heavy bleeding during pregnancy, 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.
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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 by excessive or prolonged bleeding. A physician may propose to perform a D&C for treatment. An ectopic pregnancy may lead to bleeding, internally, that could be fatal if untreated.
The primary consideration is the presence of a placenta previa, a condition that usually needs to be resolved by delivering the baby via cesarean section. Also a placental abruption can lead to obstetrical hemorrhage, some times concealed.
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.
Hemorrhage after delivery, or postpartum hemorrhage, is the loss of greater than 500 ml of blood following vaginal delivery, or 1000 ml of blood following cesarean section.
Pregnant patients may have bleeding from the reproductive tract due to trauma, including sexual assault, neoplasm, most commonly cervical cancer, and hematologic disorders.
The success of modern obstetrics is based 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.
In developing countries, deaths from obstetrical hemorrhage are very high. It has been recognized that to reduce morbidity and death, it is necessary to prevent obstetric hemorrhage and reduce the impact of hemorrhage when it does occur through early diagnosis and timely, appropriate management. Three simple technologies have been used to prevent and manage post-partum hemorrhage. These are: use of misoprostol prophylactically immediately after childbirth, which reduces risk of post-partum hemorrhage by 50%,[1] a blood drape that collects and measures blood loss, allowing for early recognition of hemorrhage,[2] and the non-pneumatic anti-shock garment which can be used to stabilize and resuscitate a woman, and keep her alive while she is being transported for further treatment or waiting at a facility for care.[3]
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   | Prevention and Management of Postpartum Hemorrhage - Prevention and Management of Postpartum Hemorrhage - March 15, 2007 -- American Family Physician |
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