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| | | '''For patient information, click [[Gynecologic hemorrhage (patient information)|here]]''' |
| | {{Gynecologic hemorrhage}} |
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| | ==[[Gynecologic hemorrhage overview|Overview]]== |
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| ==Overview== | |
| '''Gynecologic hemorrhage''' represents excessive 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 [[menstruation]] is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a [[pregnancy|pregnant]] state or during [[delivery]] is an [[obstetrical hemorrhage]].
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| ==Definition== | | ==[[Gynecologic hemorrhage pathophysiology|Pathophysiology]]== |
| [[Menstruation]] occurs typically monthly, lasts 3-7 days, and involves up to 80 ml blood. Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a [[miscarriage]] or an [[ectopic pregnancy]], while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy bleeding is usually handled like a gynecological hemorrhage. | |
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| ==Causes== | | ==[[Gynecologic hemorrhage causes|Causes]]== |
| Causes of gynecologic bleeding include:
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| ===Hormonal=== | | ==[[Gynecologic hemorrhage differential diagnosis|Differentiating Gynecologic hemorrhage from other Diseases]]== |
| [[Anovulation]] is a common cause of gynecological hemorrhage. Under the influence of [[estrogen]] the [[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 hyperplasia]] and facilitate the development of endometrial cancer. | |
| ===Neoplasm=== | |
| #[[Cancer]] of the uterus is always a concern, specifically when the bleeding occurs after [[menopause]]. Other types of cancer include [[cervix|cervical cancer]]; bleeding in that case can sometimes be triggered by intercourse and is termed postcoital bleeding. Cancers of the vagina or fallopian tubes are rare causes of hemorrhage.
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| #[[Uterine fibroids]] represent a common, benign condition that may lead to bleeding, specifically if the lesion affects the uterine cavity.
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| #[[Uterine polyp|Polyps]] of the uterine lining are a common cause of bleeding, but such bleeding tends to be light.
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| ===Trauma=== | | ==[[Gynecologic hemorrhage epidemiology and demographics|Epidemiology and Demographics]]== |
| # [[Sexual assault]] and rape can lead to injury and gynecological hemorrhage.
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| # [[Trauma]] to the lower abdomen may lead to internal or external bleeding.
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| ===Bleeding disorder=== | | ==[[Gynecologic hemorrhage risk factors|Risk Factors]]== |
| Women with a bleeding disorder may be prone to more excessive bleeding. A hematologic work-up should discover the cause.
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| ===Other===
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| On occasion an ovarian cyst can rupture and give rise to internal hemorrhage. This may occur during [[ovulation]] or as a result of [[endometriosis]].
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| If the [[pregnancy test]] is positive, consider [[pregnancy]] related bleeding (see [[obstetrical hemorrhage]]), including [[miscarriage]] and [[ectopic pregnancy]].
| | ==[[Gynecologic hemorrhage natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==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 [[anemia]] and may point out bleeding problems. The [[pregnancy test]] is important, particularly as bleeding in early pregnancy presents as gynecological hemorrhage and ectopic pregnancy can be fatal.
| | [[Gynecologic hemorrhage history and symptoms|History and Symptoms]] | [[Gynecologic hemorrhage physical examination|Physical Examination]] | [[Gynecologic hemorrhage laboratory findings|Laboratory Findings]] | [[Gynecologic hemorrhage CT|CT]] | [[Gynecologic hemorrhage ultrasound|Ultrasound]] | [[Gynecologic hemorrhage other imaging findings|Other Imaging Findings]] | [[Gynecologic hemorrhage other diagnostic studies|Other Diagnostic Studies]] |
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| ==Prevention== | | ==Treatment== |
| 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.
| | [[Gynecologic hemorrhage medical therapy|Medical Therapy]] | [[Gynecologic hemorrhage primary prevention|Primary Prevention]] | [[Gynecologic hemorrhage cost-effectiveness of therapy| Cost-Effectiveness of Therapy]] | [[Gynecologic hemorrhage future or investigational therapies|Future or Investigational Therapies]] |
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| ==First aid== | | ==Case Studies== |
| 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. | | [[Gynecologic hemorrhage case study one|Case #1]] |
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| ==Clinical treatment==
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| Treatment depends on diagnosis and may include hormonal therapy, iv fluids, [[blood transfusion]], and/or a [[dilation and curettage]]. Internal bleeding requires [[laparoscopy]] or abdominal surgery.
| | {{WikiDoc Sources}} |
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| ==See also==
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| [[Medical emergency]]
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| [[Category:Gynecology]] | | [[Category:Gynecology]] |
| [[Category:Medical emergencies]] | | [[Category:Disease]] |
| [[Emergency medicine]] | | [[Category:Emergency medicine]] |
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