Post-calving bleeding is a serious obstetric accident, which often occurs unexpectedly, which is the leading cause of death in the mother. Quickly find out the cause of post-calving bleeding and properly handle post-calving bleeding is the task of the physician to save the patient's life.
1. What is post-calving bleeding?
Post-calving bleeding is a serious complications and one of the main causes of death of obstetrics. Post-calving bleeding is when the amount of blood loss is greater than 500ml or stunned by post calving blood loss, which usually occurs after the first 24 hours, however can also occur up to 6 weeks after calving. In some cases, women lose blood in less quantities but still affect the general condition due to the previous condition and pathology.
In literature, the frequency of post-calving bleeding above 300ml is 18-26%, heavy bleeding per 1000ml with birth is usually 3-4.5%, with cesarean section is 6%.
The most common causes of post-calving bleeding are:
- Pathology in the period of vegetable books: due to vegetable omissions, uterine phlegm.
- Genital damage caused by rupture of the uterus, tearing of the cervical cervical, tearing of the peri layer of the perus, tearing of the vagina.
- Pathology of blood clot disorders (this cause is rare).
The principle of post-calving bleeding management is internal resuscitation in combination with obstetrics and gynecology management. Find the cause of bleeding and handle according to the cause.
2. Causes and treatment of post-calving bleeding
2.1 Diseases of the vegetable book period
2.1.1 Vegetable omissions
More or less vegetables in the uterus cause bleeding. The causes of vegetable omissions can be caused by:
- Disorders of uterine contraction: may experience uterine sputum or increased uterine tone. Increased intra-uterus force forms a tightening ring in the hole in the cervical that makes the fetal vegetable retain on the tightening ring,
- Abnormally clinging vegetable cakes: comb-toothed vegetables are cases of tightly clinging vegetables, vegetables attached to the muscles of the uterus, vegetables through the muscles of the uterus. These are rare cases, the rate is 1 in 10,000 calving. Comb root vegetables often occur in abnormal cases of the lining of the uterus such as old scars, fibroids, endometriosis, uterine malformation.
- Abnormalities in the position of vegetable cakes: vegetables cling to the lower segment, on the deformed wall of the uterus, on the top of the thin uterus. Uterus activity in these areas is less effective so it is difficult to peel off vegetables.
Common symptoms of vegetable omission are poor contraction of the uterus, bleeding, more or less blood flow, bright red blood and blood clots. Vegetable omissions can be detected early by examining vegetables and vegetable membranes, if detected late, patients with excessive blood loss can lead to shock.
Treatment of post-calving bleeding due to vegetable omission: intravenous infusion, giving the patient analgesic and conducting control of the uterus. Injections of the uterus shrinkage drugs Oxytocin 5-10ui or/and Ergometrin 0.2mg. Use of body antibiotics, vascular monitoring, blood pressure, bleeding and uterus contraction. Resuscitation of blood transfusions if anemia is urgent. If the patient is still bleeding, inject intramuscular or intravenous oxytocin (or intramuscularly carbetocin 100mcg). Control the uterus again if necessary.
2.1.2 Uterine phlegm
Uterine phlegm is a common cause of post-calving bleeding. Uterine phlegm may be caused by:
- Anemic maternity, weakness, hypertension, pre-seizures,…
- Excessive dilated uterus due to multiple amniotic fluid, large pregnancy or twin pregnancies
- Myalnia cons of the uterus due to prolonged labor
- Loss of uterus force after calving too quickly
- Missed vegetables, vegetable membranes in the uterus
- Uterine abnormalities such as fibroids, malformed uterus
Symptoms of patients with uterine sputum are:
- Bleeding immediately after the vegetable book, blood may flow continuously or when pressed to the bottom of the uterus blood will flow massively out.
- The uterus is soft, pasty due to poor elasticity, there are no safe masses even though the vegetables are already in the window.
Treatment of post-calving bleeding due to uterine sputum: conduct urgently, perform in parallel between hem bleeding and resuscitation.
- Urination to empty the bladder. Use all mechanical measures to prevent bleeding such as rubbing the uterus through the abdominal wall, squeezing the uterus by hand, blocking the abdominal aortic. Remove all the leftover vegetables and blood clots to cleanse the uterus.
- Intramuscularly or injected into the muscles of the uterus 5-10 UI Oxytocin, if the uterus still does not contract, intramuscularly or intravenously Ergometrin 0.2mg. Infusion to combat stun. In the first 2 hours, every 15 minutes the bottom of the uterus once lasts for 2 minutes until there is a feeling that the uterus shrinks into blocks under the hands.
- If after rubbing the uterus, inject the uterine shrinkage drugs and the blood continues to flow, when the uterus stops rubbing, the uterus may be sputum ins not recovering. Patients may need surgical intervention to force two arteries of the uterus or a part-time uterus removal,…
2.2 Genital damage
2.2.1 Rupture of the uterus
Rupture of the uterus usually occurs during labor, which is a dangerous accident in obstetrics that threatens the life of the mother and fetus. There are many possible causes of rupture of the uterus such as:
- Causes from the mother: distorted, narrow, abnormal pelvis; malformed, underdeve developed uterus; scarring in the uterus due to old cesarean section or lesions when peeling artificial vegetables, abortion,…
- Causes of pregnancy: full or pieceular pregnancy, deformed pregnancy, sticking together, hydrocephalus, abnormal pregnancy,…
- Causes of the physician: lesions caused by calving, interventions that tear the cervical pull up the lower segment, improper use of drugs to increase uterus contraction,…
The symptoms of rupture of the uterus are:before the rupture of the uterus, the pregnant woman is in severe pain, after a sudden glare, the pain is gone, it can be shocking. The fetal heart is gone, the contraction of the uterus is no longer; distorted abdomen, obstruction, pain; palpation of the fetus just below the skin of the abdomen, vaginal bleeding,…
Treatment of post-calving bleeding due to rupture of the uterus: anti-shock resuscitation, emergency surgery and treatment of lacerations in the uterus.
Torn, vagina, biological layer
The causes of post-genital genital tearing are usually:
- On the mother's side: solid biological layer (due to older childbirth), bacterial infections, edema, scarring.
- On the side of pregnancy: large pregnancy, reverse pregnancy
- Due to the trick: to assist with suction, forceps….
Diagnose the cause of post-genital bleeding by observing blood coming out of a laceration or a biological cut, carefully examining the tear site to determine the extent of the tear. The degree of slight tearing affects only the skin and mucous membranes of the vagina, the degree of heavier tearing can damage the skin, vaginal mucosa, mesmenis to the central node.
Treat post-calving bleeding caused by genital tears by local anesthesia or painkillers. Check if the uterus has no vegetable left, then proceed to the recovery.
Take care of maternity bleeding after calving due to genital tearing by keeping stitches clean and dry, washing the 2-3 times / day especially after urination, urination; after washing, use a clean towel to dry. Follow a snack diet to avoid constipation.
2.3 Hemulation disorders
If the cause of post-calving bleeding is caused by a blood clot disorder, the bleeding is often severe. Coa clotting disorders can be a primary cause of blood diseases but are often a primary cause of bleeding in obstetric diseases such as intra-uterus death, young peeling vegetables, uterus infections, amniotic embolism,…
Treatment of post-calving bleeding due to blood clot disorders is as follows:
- Fresh blood transfusions, fresh serum, provide anti-blood clot elements. Fibrinogen in particular is in place in case of severe reduction of fibrinogen.
- After adjusting the coa clotting factors and the blood stops flowing, it is recommended to take a thromboembotic embolic prevention drug for 21 days.
- In some cases, patients may be prescribed a semi-sheer uterus surgery with a hypopermous artery
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