Periodic blood loss accompanies a woman from early adolescence. Regular menstruation from ages 9–15 indicates maturity reproductive system, become familiar and do not cause concern. But when the nature and frequency of bleeding in women changes, it can be difficult to independently understand what is happening - a normal process or there is a danger. Heavy periods or bleeding, how to identify and recognize the pathology in time? After all, many women, not knowing exactly the difference, mistaking one for the other, risk their health and sometimes their lives.

What is considered normal?

Gynecologists call only a few types of bleeding from the uterus normal:

• ovulation (in the middle of the cycle when the egg is released);
• implantation (at the time of attachment of the fetus in the uterus);
• regular menstruation.

The first two types of discharge do not occur in all women; they are short-term, not abundant, and indicate the normal course of reproductive processes. Regular menstruation is a sign of maturity reproductive organs and ensure the body’s readiness for conception.

Any other blood loss is considered abnormal and requires medical attention. To determine dangerous symptoms, you should clearly know the boundaries of the norm, for any deviations from which you should contact a gynecologist.

Normal periods

Signs that menstruation occurs without pathologies:

1. The period through which normal menstruation occurs ranges from 21 to 35 days. Any deviation to less or big side requires additional examination.
2. Normally, discharge lasts from 3 days to a week. Sometimes longer periods (up to 10 days) are also not a sign of deviation, but the gynecologist must establish this fact.
3. From the beginning to the middle of menstruation, the amount of blood released increases, then gradually decreases.
4. The color of the discharge from bright red to brown, even black, is considered the physiological norm.
5. The presence of clots of a darker shade indicates the detachment of areas of the uterine epithelium during its renewal. The absence of such clots should alert you, as should their excessive quantity.

The amount of discharge during the entire menstruation does not always correspond average norm in 100 ml. If a fully filled pad has to be changed more than once every 2 hours, such menstruation is considered heavy.

Heavy periods

Regular discharge in a large volume does not indicate any violation. If such menstruation is normal and is not accompanied by other unpleasant symptoms, then there is no need to worry. It is worth seeking advice from a gynecologist if there has been a noticeable change in the amount of blood released, and this is not the typical course of menstruation for a woman.

Additional factors for contacting a doctor are pale skin, weakness, and loss of performance. This may be a symptom that bleeding has started and anemia has occurred due to blood loss.

“Disguised” blood loss that occurs during menstruation often goes unnoticed. In itself, such uterine bleeding may be a symptom of more dangerous disease. If you have heavy periods or bleeding, how can you tell the difference yourself?

Symptoms of bleeding

Signs of how to distinguish heavy or irregular menstruation from uterine bleeding, some. Main symptoms of the pathology:

• the pad or tampon is completely filled within an hour;
• the color of the discharge is scarlet, there are no clots at all or there are more of them than usual;
• on the third day of menstruation, the amount of blood does not decrease or the discharge continues for more than 7 days a month;
• severe pain, fatigue, constant weakness.

Menstrual blood contains enzymes that prevent it from clotting and are responsible for the specific smell of discharge. With abnormal bleeding there is no such smell.

Abnormal discharge may begin in the middle of the cycle, immediately, or during menstruation. Therefore, if you experience any of the symptoms, you should consult a doctor to establish an accurate diagnosis and eliminate the causes of vaginal bleeding.

Classification and reasons

There are chronic and acute abnormal bleeding. Chronic includes all types of atypical bleeding from the uterus that last more than six months and do not require immediate medical attention.

TO acute condition include sudden heavy (profuse) bleeding that occurs against a background of chronic bleeding or occurs for the first time. Acute uterine blood loss requires urgent medical attention.

Bleeding is not a disease itself, but only a symptom that a certain malfunction has occurred in a woman’s body. Simply stopping the bleeding without understanding the causes of the anomaly will not solve the problem. The cause of bleeding can be: organic disorders(diseases) and functional disorders without visible physical changes.

Dysfunctional uterine bleeding (DUB)

The causes of the pathology in this case may be disturbances in the functioning of the pituitary gland, hypothalamus, and ovaries, as a result of which the balanced production of hormones is disrupted. Organic lesions tissues and organs may not be detected.

There are two types of DMC:

1. Ovulatory. The discharge can be scanty, spotting, and occur before menstruation, after it ends, or in the middle of the cycle. Ovulation occurs, but conception and pregnancy can be problematic due to hormonal imbalances. It is characterized by various irregularities of the menstrual cycle, deviations in duration, frequency, and amount of discharge in any direction from the norm.
2. Anovulatory. The monthly cycle passes without ovulation. Characterized by abundant prolonged bleeding after a delay or occurring as a continuation of normal menstruation.

Hormonal causes of bleeding in women also include functional disorders of the thyroid gland with an increase or decrease in the production of thyroid hormones.

Organic bleeding

Diseases internal organs or pathological changes in the tissue structure that can provoke abnormal bleeding:

• endometrial pathology (hyperplastic process);
• ovarian tumors;
• polyps;
• inflammation and infections;
• malignant formations of different localization;
• systemic diseases affecting hematopoiesis.

The classification of uterine bleeding according to its causes is conditional. At comprehensive examination Several causes, both organic and dysfunctional, can be diagnosed simultaneously.

Breakthrough bleeding

Iatrogenic bleeding, otherwise called “breakthrough”, occurs while taking hormonal drugs(including contraceptives), anticoagulants or other medications. Surgical interventions or trauma to the uterus during displacement can provoke the same reaction intrauterine device.

Iatrogenic bleeding does not differ in dangerous profuseness or duration, but requires immediate consultation with the treating gynecologist to change drug treatment or immediate removal of the coil.

Unlike breakthrough bleeding, profuse bleeding develops rapidly, and blood loss can be large. Distinctive feature profuse process – painlessness.

Age classification

The most common causes of vaginal bleeding in women vary depending on age. There are three age groups in relation to reproductive function.

Juvenile bleeding

This pathology is observed from the time of the first menstruation (menarche) and is typical for girls under 18 years of age. Not knowing what's different abnormal bleeding from physiological norm, it is easy to confuse them.

At this age, the cause of vaginal bleeding most often lies in the immaturity of the reproductive system. Hormonal balance just being established, the menstrual cycle is not regular. Disturbances in the production of progesterone, estrogen or follicle-stimulating hormones can cause bleeding. Having become permanent, they lead to anemia, further abnormal development of reproductive function in girls and hormonal infertility in women.

Disorders of the thyroid gland (hyperthyroidism, hypothyroidism) can also cause blood loss both at a young age and in older adults. mature women. But, most often, the cause of pathology in girls is severely suffered infectious diseases, considered “children’s”: measles, chickenpox, mumps, tonsillitis or influenza.

Bleeding before menarche in girls is extremely rare and requires attention special attention, as they can be a sign of malignant tumors.

It is important to know! If hormonal imbalances in puberty(during puberty) are not diagnosed and treated, it affects reproductive health during childbearing years. Later, during menopause, problems with gynecology lead to serious complications, including oncology. The disorder is continuous and does not “outgrow” with age, but gets worse.

Bleeding during reproductive age

A third of all women of childbearing age experience the problem of abnormal uterine bleeding. Violation of normal ovarian function is their most common cause.

Among the factors that can provoke ovarian pathology in reproductive age, gynecologists note:

• stress and nervous tension;
• increased physical activity;
• harmful working and living conditions;
• change of climate zone;
• obesity or underweight;
• genital infections and inflammatory processes;
• chronic diseases reproductive organs: endometritis, endometriosis, fibroids, polyps, tumors;
• endocrine diseases.

Termination of pregnancy (surgical, medicinal, spontaneous) can also provoke various gynecological disorders accompanied by blood loss.

Bloody discharge during pregnancy indicates a threat to life for both the mother and the fetus. Such pathological conditions are considered separately.

Bleeding in menopause

In the period preceding menopause (menopause), a decrease in the production of female hormones can cause profuse bleeding immediately after a timely period. Such conditions, which recur periodically in women over 40 years of age, are the first signs of approaching menopause, before other symptoms appear.

The naturalness of the process of attenuation of fertile (childbearing) function does not mean that such accompanying phenomena can be ignored. Profuse bleeding can continue for a long time and threaten serious blood loss. In addition, sometimes it indicates the presence or possible development other organic disorders.

During the most severe symptoms menopause bleeding can occur due to excessive growth of the endometrium of the uterus and require surgical intervention. Without treatment, the process (adenomyosis, GPE) can spread to neighboring organs and lead to malignant degeneration of the endometrium.

Note! Any postmenopausal bleeding (when there have been no periods for more than a year) should prompt a woman to see a doctor immediately. The risk of cancer at this age is especially high.

Bleeding during pregnancy

There are only a few cases when discharge during pregnancy mixed with blood does not pose a threat:

1. The moment of implantation of the egg in the uterus.
2. Removal of the mucus plug before the onset of labor.

Such discharge is not dangerous provided it is scanty (spotting), painless, pink or brown, end quickly. Any other discharge of blood from the vagina during pregnancy - dangerous signal. Urgent seeking medical help is required at any time.

Possible causes of bleeding during pregnancy that threaten the life of the woman and the fetus:

• ectopic attachment of the fetus;
• spontaneous termination of pregnancy (miscarriage);
• uterine rupture;
• placental abruption;
• blood clotting disorders in the mother;
• polyp of the cervical canal.

After childbirth, the placenta separates and comes out, and the uterus contracts. These processes are accompanied by abundant bloody discharge– lochia, which lasts up to 6 weeks.

Any changes in the color or smell of lochia, a sharp increase in their number, or the absence of clots may indicate the beginning of abnormal bleeding from the uterus. The abnormal postpartum process is usually accompanied by fever, headaches, and decreased blood pressure, signs of anemia.

The condition of the reproductive organs of a woman of any age is of great importance and atypical discharge should be diagnosed in a timely manner. If there is heavy menstruation or bleeding, it is imperative to accurately determine the cause, and after stopping the discharge, eliminate this disorder. Without treating the root of the problem, uterine bleeding recurs, the disease becomes chronic and entails the development of new pathologies.

Bleeding during pregnancy: should you tell your doctor?

Yes. Any bleeding during pregnancy should be reported to your gynecologist immediately.

Any vaginal bleeding before the 24th week of pregnancy is considered a potential risk of miscarriage. After 24 weeks it is called antepartum hemorrhage.

To those who Rh negative factor, it is necessary to consult a doctor within 72 hours after bleeding, since there is a suspicion that the child’s blood may be mixed with yours. If mixing occurs, the mother's body may begin to produce antibodies against the child's Rh positive blood.

Positive Rh is much more common than negative Rh. For the first pregnancy, mixing the blood does not have any consequences, but in subsequent pregnancies the body may decide that it needs to attack the unfamiliar matter with antibodies if the child is Rh positive again.

Below are the most common causes of bleeding during pregnancy. Not all of them are scary and dangerous. During pregnancy, minor cramps and tugging sensations occur, and this is normal. But if bleeding is accompanied by severe pain and cramps, immediately seek medical help.

Implantation bleeding

Breakthrough bleeding

Some women experience what is called a breakthrough period, or when they should have had their period. Thus, such discharge appears at 4, 8, 12 weeks, respectively. They are often accompanied by the sensations you usually experience with your period, such as back pain, cramps, heaviness in the lower abdomen, feeling bloated and lack of energy.

Of course, because you're pregnant, your periods don't come, even though you think they should. During pregnancy, hormones prevent bleeding, but sometimes, when hormone levels have not yet reached their peak and cannot stop the period, “breakthrough” occurs—breakthrough bleeding.

This can continue for up to 3 months, and after that the placenta takes responsibility for the production of hormones by the ovaries. There are women who experience breakthrough bleeding almost all the time during pregnancy, and under constant medical supervision, they easily give birth to healthy babies.

Threatened miscarriage or miscarriage

According to research, a third of all pregnancies end in miscarriage ( medical term- spontaneous abortion). It sounds scary, but don't despair, as this number includes miscarriages at very early stages, the first 12 weeks, when a woman may not even realize that she was pregnant at all.

This type of miscarriage often occurs due to fetal damage, that is, the woman’s body rejects the non-viable fetus.

If you've passed the 14-16 week mark, you can take it easy.

The wisest thing to do is to refrain from announcing your pregnancy to the world until you are 2 months pregnant. Naturally, you may be bursting with emotion and joy, but if a miscarriage occurs, it will be twice as painful for you to again report a failed pregnancy. Compassion is important, but sometimes it can only deepen your grief over your shattered dreams of being a mom.

Signs of a miscarriage include bleeding, cramps, and pain in the lower back and abdomen. Women often say they "don't feel pregnant" when they have a miscarriage or bleeding. The main signs of pregnancy disappear - nausea, breast tenderness and a swollen belly.

If you are bleeding and you feel any of the above, there is a risk that you have lost your baby. If you experience bleeding but don't feel like your pregnancy has stopped, there's a good chance it might be, but overall the baby is fine.

A miscarriage can also happen without bleeding, which is often called "miscarriage" when the fetus dies but is still retained inside your body. In this case, signs of pregnancy will disappear, but cardiac arrest in the fetus can only be determined using ultrasound. A curette may be needed to remove the dead fetus.

Bleeding after intercourse

Bleeding after sex is one of the most common causes of bleeding during pregnancy. This is completely harmless and is due to increased blood supply and softening of the cervix. Although this bleeding is not a serious cause for concern, you should still report it to your doctor. Be prepared for a very personal question about whether you've had sex recently.

This doesn't mean you should stop having sex, but you may need to reassure your partner that he won't harm the baby and that he is protected in the uterus, which is much higher than the vagina.

Ectopic pregnancy

Occurs when a fertilized egg implants outside the uterus, usually in the fallopian tube.

You may have severe pain in the lower abdomen on one side, or cramping pain, as well as weakness and nausea. The pain may go away suddenly if the tube ruptures, but will return after a few hours or days and feel even worse.

This situation is quite dangerous. An ectopic pregnancy can rupture the fallopian tubes and cause internal bleeding, which can lead to infertility. You may have to have your fallopian tube removed and end the pregnancy, but this does not mean you will have trouble conceiving in the future, as long as your second ovary and Fallopian tube healthy.

Placental bleeding

Another question you may hear at your doctor's appointment is whether you have had a scan and how the placenta is located.

Painless vaginal bleeding may result from abnormal placement of the placenta. Sometimes the placenta is located very low on the wall of the uterus, and sometimes it is located directly above the cervix. This is called placenta previa and occurs in about 0.5% of pregnancies.

It will inevitably lead to bleeding at some point in your pregnancy - usually after 20 weeks. Exist various degrees severity of this condition, but they all require repeated ultrasounds for an accurate diagnosis. To prevent risk to the baby, you may be advised to remain on bed rest, be offered induction, or C-section if the placenta continues to attach to the cervix.

Another cause of bleeding later in pregnancy is placental abruption, which is when the placenta partially or completely separates from the wall of the uterus. This occurs in about 1 in 200 pregnancies. Symptoms include general severe pain and heavy bleeding. The bleeding may be visible or hidden in the uterus, which will be tense, firm, hard to the touch and very painful.

If you smoke, have high blood pressure, kidney problems or preeclampsia, you are at high risk of placental abruption. This condition requires urgent hospitalization, and depending on the severity of the bleeding, you may be prescribed bed rest, induction or caesarean section.

Uterine fibroids

Uterine fibroids are masses of hardened muscle and fibrous tissue, which can be inside or outside the walls of the uterus. They can be both problematic and non-problematic during pregnancy - this primarily depends on the location of the fibroid and whether it is enlarging or not.

There is no consensus among doctors on this matter, but it is known that hormones produced during pregnancy can cause both a decrease and an increase in fibroids.

It is best to remove fibroids before pregnancy, as there is a chance that they will lead to an ectopic pregnancy, heavy bleeding during pregnancy, or miscarriage.

However, many women give birth without any complications. If you have fibroids, it is important to contact a specialist to understand your specific situation and determine the next steps. Avoid online self-medication as the matter is serious and should not be left to armchair experts.

What should I do if I'm bleeding?

If you are more than 20 weeks pregnant, consult your doctor immediately if you experience bleeding. Never use tampons if you experience bleeding during pregnancy; always take a gasket.

If the bleeding is minor and you are not in pain, still talk to your doctor or nurse. If the bleeding is heavy (stream or clots) and is accompanied by abdominal cramps, back pain and pain similar to menstruation, call an ambulance immediately.

It's understandable that you're upset, but try to remain calm and remember that bleeding happens during pregnancy, it's not an abnormality.

The blood belongs to you, not the baby, so the continuation of a completely healthy pregnancy and birth healthy child possible and most likely. Don’t be surprised if, with such complaints in the early stages (up to 12 weeks), you are advised to just watch and wait.

What to do if a miscarriage occurs

If you are experiencing a miscarriage, unfortunately, nothing can stop or prevent the process. Losing a child is always painful, disappointing and depressing, but the best thing you can do is take care of yourself physically and emotionally. It's not your fault that you lost your child, and there's nothing you can do to change it, but there are things that can help you feel more physically comfortable:

1. Bed rest
2. Paracetamol / Panadeine (drug for relieving cramps during menstruation)
3. A heating pad or bottle of warm water on your stomach
4. Tea and partner support

Along with the discharge, various lumps of tissue and an undeveloped fetus may come out, but soon the bleeding will stop. If the bleeding does not stop, you should immediately seek medical help.

Remember that in most cases, bleeding in early pregnancy occurs spontaneously, and after that, the pregnancy continues healthy and unharmed.

The body of humans and mammals is penetrated by thousands of small, medium and large vessels, which contain a valuable liquid that performs a huge number of functions - blood. Throughout life, a person is influenced by a considerable amount of harmful factors, among them the most common traumatic effects are: mechanical damage fabrics. As a result, bleeding occurs.

What it is? Medical Science " pathological physiology” gives the following definition of this condition: “this is the release of blood from a damaged vessel.” At the same time, it pours out or into the body cavity (abdominal, thoracic or pelvic) or organ. If it remains in the tissue, saturating it, it is called hemorrhage; if it freely accumulates in it, it is called a hematoma. A condition in which blood vessels are damaged, most often occurring suddenly, and if there is a strong rapid leakage of vital fluid, a person can die. That is why first aid for bleeding often saves his life, and it would be nice for everyone to know the basics. After all, such situations do not always occur when there are medical workers nearby or even just specially trained people.

What types of bleeding are there and why do they occur?

There are many classifications of this pathological condition and specialists teach them all. However, we are interested in dividing bleeding into types, first of all, from a practical point of view. The following classification is important for successful first aid. It shows the types of bleeding depending on the nature of the damaged vessel.

Arterial bleeding

It comes from the arteries containing oxygenated blood flowing from the lungs to all organs and tissues. Makes up serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations where they are injured are the result of very strong impacts. Sometimes this type of bleeding stops on its own, since the arteries have a pronounced muscular layer. When such a vessel is injured, the latter goes into spasm.

Venous bleeding

Its source is venous vessels. Through them, blood containing metabolic products and carbon dioxide flows from cells and tissues to the heart and further to the lungs. Veins are located more superficially than arteries, so they are damaged more often. These vessels do not contract during injury, but they can stick together because their walls are thinner and their diameter is larger than that of arteries.

Capillary bleeding

Blood bleeds from small vessels, most often the skin and mucous membranes; usually such bleeding is insignificant. Although it can be frighteningly abundant with a wide wound, since the number of capillaries in the tissues of the body is very large.

Parenchymal bleeding

Separately, so-called parenchymal bleeding is also distinguished. The organs of the body are hollow, essentially “bags” with multi-layered walls, and parenchymal, which consist of tissue. The latter include the liver, spleen, kidneys, lungs, and pancreas. Typically, this type of bleeding can only be seen by a surgeon during an operation, since all parenchymal organs are “hidden” deep in the body. It is impossible to determine such bleeding based on the type of damaged vessel, because the organ tissue contains all their varieties and all of them are injured at once. This is mixed bleeding. The latter is also observed with extensive wounds of the extremities, since the veins and arteries lie nearby.

Depending on whether the blood remains in the cavity of the body or organ or pours out of the body, bleeding is distinguished:

• Internal. Blood does not come out, staying inside: in the abdominal, thoracic, pelvic cavities, joints, and ventricles of the brain. A dangerous type of blood loss that is difficult to diagnose and treat because external signs there is no bleeding. There are only general manifestations of its loss and symptoms of significant dysfunction of the organ(s).
• External bleeding. Blood pours into the external environment, most often the causes of this condition are injuries and various ailments, striking individual organs and systems. These bleedings can be from the skin and mucous membranes, gastric and intestinal, or from the urinary system. In this case, visible effusions of blood are called obvious, and those that occur in a hollow organ communicating with external environment- hidden. The latter may not be detected immediately after bleeding begins, because it takes time for blood to come out, for example, from a long digestive tube.

Typically, bleeding with clots is external, hidden or internal, when the blood is retained inside the organ and partially coagulates.

1. Spicy. In this case, in a short period of time it is lost a large number of blood, it usually occurs suddenly as a result of injury. As a result, a person develops an acute state (anemia).
2. Chronic. Long-term loss of small volumes of this biological fluid is usually caused by chronic diseases of organs with ulceration of the vessels of their walls. Causes a state of chronic anemia.

Video: bleeding in the “School of Doctor Komarovsky”

Main causes of bleeding

What can cause bleeding? It is appropriate to note here that two fundamentally different types are also distinguished, based on the factor of whether the normal vessel is damaged or the pathological condition arose against the background of destruction of the altered vascular wall. In the first case, bleeding is called mechanical, in the second - pathological.

The following main causes of bleeding can be identified:

• Traumatic injuries. They can be thermal (from exposure to critical temperatures), mechanical (from a bone fracture, wound, bruise). The latter occur in various extreme situations: road accidents, train and plane crashes, falls from a height, fights involving piercing objects, gunshot wounds. There are also industrial and domestic injuries.
• Vascular diseases, including tumors (purulent tissue lesions involving blood vessels, atherosclerosis, hemangiosarcoma).
• Diseases of the blood coagulation system and liver (fibrinogen deficiency, hypovitaminosis K, hepatitis, cirrhosis).
• General diseases. For example, diabetes, infections (viral, sepsis), lack of vitamins, poisoning cause damage vascular walls throughout the body, resulting in plasma and blood cells leaking through them and causing bleeding.
• Diseases affecting various organs. Bleeding from the lungs can cause tuberculosis, cancer; from the rectum - tumors, hemorrhoids, fissures; from digestive tract- stomach and intestinal ulcers, polyps, diverticula, tumors; from the uterus - endometriosis, polyps, inflammation, neoplasms.

What is the risk of bleeding for a person?

One of the most important, but by no means the only function of blood is the transport of oxygen and nutrients. It delivers them to the tissues, and takes metabolic products and carbon dioxide from them. With significant bleeding, there is a significant loss of this necessary for the body substances. Very sensitive to oxygen deficiency nervous system and heart muscle. Brain death, when the flow of blood into it completely stops, occurs in humans and animals in just 5-6 minutes.

However, in addition to the immediate loss of precious oxygen-containing fluid, there is another problem. The fact is that it keeps the blood vessels in good shape and with a significant loss of blood vessels, they collapse. In this case, the oxygen-containing blood remaining in the human body becomes ineffective and can help little. This condition is very dangerous, it is called vascular shock or collapse. It occurs in acute severe cases.

Its consequences described above are life-threatening patient and develop very quickly after bleeding.

Blood performs a huge number of functions, among them maintaining balance is very important. internal environment body, as well as ensuring the connection of organs and tissues with each other through the transfer of various biologically active substances. In this way, billions of cells in the body exchange information and, as a result, can work harmoniously. Bleeding, to one degree or another, disrupts the constancy of the internal environment of the body and the functions of all its organs.

Often, blood loss does not directly threaten the patient’s life; this is observed in many diseases. In such cases, blood loss is chronic and mild. Replacement of the outflowing blood occurs through the synthesis of plasma proteins by the liver and bone marrow- cellular elements. Bleeding becomes important diagnostic sign to recognize the disease.

Signs of bleeding

Are common

Patient complaints:

1. Weakness, unmotivated drowsiness;
2. Dizziness;
3. Thirst;
4. Feeling of palpitations and shortness of breath.

External symptoms of blood loss that are observed with any type of bleeding are as follows:

• Paleness of the skin and mucous membranes;
• Cold sweat;
• Increased heart rate;
• Dyspnea;
• Urinary disorders up to complete absence urine;
• Drop in blood pressure;
• Frequent weak pulse;
• Impaired consciousness up to and including loss of consciousness.

Local

External effusion of blood

The main local symptom is the presence of a wound on the surface of the skin or mucous membrane and visible bleeding from it. However, the nature of bleeding varies and is directly dependent on the type of vessel.

1. Capillary is manifested by that the blood collects in large drops and oozes from the entire surface of the wound. Its loss per unit of time is usually small. Its color is red.
2. Signs of venous bleeding: Blood can bleed quite quickly when wounded. large vein or several at once, it flows from the wound in strips. Its color is dark red, sometimes burgundy. If the large veins of the upper body are injured, there may be intermittent bleeding from the wound (however the rhythm is synchronized not with the pulse, but with breathing).
3. Signs of arterial bleeding: blood pours out from the site of injury in pulsating tremors - “fountains” (their frequency and rhythm coincide with heartbeats and pulse), its color is bright scarlet, red. Blood loss per unit time is usually rapid and significant.

Manifestations of hidden bleeding

• From the lungs - blood is released with a cough (a symptom of hemoptysis), it is foamy, the color is bright red.
• From the stomach - brown color (hydrochloric acid gastric juice reacts with blood, the latter changes color). There may be clots.
• From the intestines - feces acquire a dark brown or black color and a viscous, viscous consistency (tarry stool).
• From the kidneys and urinary tract - urine becomes red (from a brick shade to brown with “rags” - clots and pieces of tissue).
• From the uterus and genitals - blood is red, often there are pieces of mucous membrane in the discharge.
• From the rectum - scarlet blood can be found in drops on the feces.

Signs of internal bleeding

1. No bleeding is observed in environment. There are general symptoms of blood loss.
2. Local manifestations will depend on the location of the vessel damage and in which body cavity the blood accumulates.
3. - loss of consciousness or confusion, local disturbances motor functions and/or sensitivity, coma.
4. In the pleural cavity - chest pain, shortness of breath.
5. IN abdominal cavity- abdominal pain, vomiting and nausea, tension in the muscles of the abdominal wall.
6. In the joint cavity there is swelling, pain on palpation and active movements.

Can the body cope with bleeding?

Nature has provided for the possibility that fragile and delicate living tissues of the body will be injured over a long life. This means that a mechanism is needed to resist the flow of blood from damaged vessels. And people have it. The composition of blood plasma, that is, the liquid part that does not contain cells, contains biologically active substances- special proteins. Together they make up the blood coagulation system. It is assisted by special blood cells - platelets. The result of complex multi-stage blood clotting processes is the formation of a thrombus - a small clot that clogs the affected vessel.

In laboratory practice, there are special indicators that show the state of the blood coagulation system:

• Duration of bleeding. An indicator of the duration of blood effusion from a small standard injury caused by a special stylet on a finger or earlobe.
• Blood clotting time - shows how long it takes the blood to clot and form a blood clot. Conducted in test tubes.

The normal duration of bleeding is three minutes, time - 2-5 minutes (according to Sukharev), 8-12 minutes (according to Lee-White).

Often, trauma or damage to a vessel by a pathological process is too extensive and natural mechanisms to stop bleeding cannot cope, or a person simply does not have time to wait due to the threat to life. Without being a specialist, it is difficult to assess the condition of the victim, and treatment tactics will vary depending on the cause.

Therefore, a patient who has severe bleeding from a vein or artery must be urgently transported to medical institution. Before this he must be provided urgent Care. To do this, you need to stop the bleeding. Usually this is a temporary cessation of blood flow from the vessel.

First aid

What methods are known to temporarily stop bleeding? Here they are:

1. Pressure (pressing a vessel in the wound, applying a pressure bandage).
2. Applying a hemostatic sponge, ice, irrigation with hydrogen peroxide (for capillary bleeding).
3. Very strong flexion of the limb.
4. Dense tamponade with bandage, gauze, cotton wool (for the nasal cavity, deep external wounds).
5. Application of a hemostatic tourniquet.

Methods to finally stop bleeding, which can only be performed by a doctor and in a hospital setting, are:

• Mechanical: ligation of a vessel in a wound, making a vascular suture, suturing the tissue together with the vessel.
• Chemical: anti-clotting and vasoconstrictor drugs (calcium chloride, epinephrine, aminocaproic acid)
• Thermal: electrocoagulation.
• Biological (to stop capillary and parenchymal bleeding during operations): fibrin films, hemostatic sponges, suturing of the body’s own tissues (omentum, muscle, fatty tissue).
• Embolization of a vessel (introduction of small air bubbles into it).
• Removal of the affected organ or part thereof.

It is very important to determine the type of damaged vessel, because this will determine how to stop the flow of blood from it.

First aid for arterial bleeding

Applying a tourniquet is very effective if a limb vessel is damaged. The method of pressure and tight wound tamponade is also used.

Rules for applying a tourniquet

While he is preparing, you need to press the artery to the bones above the injury with your fist or fingers, remember that in case of injury large vessel minutes count down. The brachial artery is pressed against the shoulder bone along its inner surface, the ulnar artery in the elbow bend, the femoral artery in the groin fold, the tibia in the popliteal fossa, the axillary artery in the cavity of the same name.

The injured leg or arm needs to be raised. Apply a tourniquet, tightening it tightly and placing a towel or rag between it and the skin. If there is no special rubber band, you can use a regular bandage, scarf, thin rubber hose, trouser belt, scarf or even rope. Then it is tied loosely around the limb, a stick is inserted into the loop and twisted until the desired compression is achieved. The criterion for correct application of a tourniquet is the cessation of bleeding. Time spent on the limb: no more than two hours in summer and half an hour in winter. To record the moment of vascular compression, the time is written on a piece of paper and secured to the affected limb.

Danger

The problem is that it is impossible to apply a tourniquet for more than the above-mentioned time interval due to poor circulation in the injured leg or arm; the tissues die. The function of the limb will then not be fully restored, and sometimes amputation becomes necessary. In addition, there is a danger of development in the area of ​​damage (bacteria that live in the soil and multiply in living tissues in the absence of oxygen enter the wound). If the person has not yet been delivered to the hospital within the specified time, in any case the tourniquet should be loosened for a few minutes. The wound is then clamped using a clean cloth..

When wounded carotid artery and bleeding from it, it is necessary to pinch it with a finger and tamponade the wound with a sterile dressing. A tourniquet can be applied to the neck; a special technique is used for this to prevent suffocation of the victim. Raise the arm on the side opposite to the injury and tighten the neck with a tourniquet below places of injury along with the limb.

Video: emergency care for severe bleeding

Venous bleeding

For venous bleeding, tight bandaging or a tourniquet works well. The peculiarity of the latter’s technique is that its location is not above the site of injury, as with arterial injury, but, on the contrary, below.

With any method of stopping bleeding, the wound itself is covered with a sterile napkin or clean cloth. If pain medication is available, you can give the person an injection or a pill if they are conscious. A person lying on the ground should be covered to prevent hypothermia. The victim must not be moved or turned over.

If internal bleeding caused by injury is suspected, it is necessary to ensure the patient is completely rested and send him to the hospital as soon as possible.

Video: first aid for venous bleeding

Capillary bleeding

At capillary bleeding a pressure method is used, including with the palm or fingers, bandaging, hemostatic sponges, and cold objects. With adequate functioning of the coagulation system, temporary cessation of bleeding becomes final.

Therapy after stopping bleeding in the hospital

The use of blood coagulation improving drugs, blood replacement drugs, whole blood/plasma/platelet suspension is mandatory. Intravenous fluid therapy is also necessary to restore ion balance. Since bleeding is usually not the only problem after serious traumatic incidents, in parallel with the work to stop it, doctors carry out emergency diagnosis and treatment of concomitant disorders.

The main thing is not to lose your head if something bad happens to someone around you and the person is bleeding. In order to cope with it, you can use materials from your car first aid kit, items from your own bag, items of clothing or household items.

The task and duty of everyone normal person is providing first aid to the victim, which consists of temporarily stopping the loss of blood. And then you should immediately take the patient to a medical facility under your own power or urgently call an ambulance.

Heavy bleeding during menstruation: reasons, how to stop

Bleeding during menstruation - for what reason does it occur, do you need to see a doctor and how can you reduce blood loss on your own? These are all very important and frequently asked questions. After all, from heavy menstruation Many women, both young and approaching menopause, suffer. Let's start with the theory.

Norm and pathology

Normally, a woman during menstruation loses no more than 50 grams of blood during all days of menstruation. Usually in the first 2-3 days the bleeding is heavier, and there may be minor pain in the uterine area caused by its contraction. 40-50 grams is moderate discharge. Less than 40 grams is meager.

With a blood loss of 50 to 80 grams, they talk about the possible occurrence of iron deficiency, especially if the woman is not eating well or does not eat enough iron-containing foods. Another sign of iron deficiency is profuse hair loss hair all over the head.

If blood loss is from 80 to 120 grams, they speak of the need to reduce it with the help of hemostatic or hormonal drugs. And be sure to get checked for iron deficiency.

Don't forget to tell your doctor if you have heavy bleeding during your period with clots, especially if they are large - more than 2 cm. This may indicate significant blood loss. If this has not been observed before, there is a possibility of miscarriage, that is, the woman may be pregnant; termination of pregnancy should also be considered as one of the possible causes of bleeding. Usually a miscarriage is accompanied painful sensations in the uterine area, cramps, sometimes fever, nausea, weakness.

Urgent health care, or at least a consultation, is needed if there is very heavy bleeding during menstruation, in 2 or less hours one sanitary (not daily) pad gets completely wet. Simply, if there is heavy discharge, you can wait for it to end and go for an examination to a gynecologist to discuss this situation.

But, by the way, such emergency situations arise infrequently. The question of uterine bleeding or menstruation usually arises in women around the middle of the cycle. And then doctors, regardless of the abundance of discharge, say that this is precisely bleeding, the so-called dysfunctional. There is a minimum standard for cycle length - 21 days. If blood appears, say, on the 18th day, then you must remember how to distinguish menstruation from bleeding, and that in this case you can and should consult a doctor.

How to understand how much blood you are losing and what to do

The easiest way is to weigh the clean sanitary pad on a small scale that accurately shows grams, and then the used one. The difference between the two quantities will be the volume lost blood. Write down this difference each time and add it up.

If you lose more than 50-60 grams of blood, you can think about taking oral contraceptives ( hormonal pills). If the cause of heavy discharge is endometriosis, and if the woman does not plan to this moment pregnancy is a great way to make your blood loss moderate or even scanty. But you just need to remember that you shouldn’t start taking contraceptives on your own, especially for the first time. Perhaps you have contraindications for taking them that you do not take into account. So, hormonal contraceptives should not be taken by women who smoke, especially those over 35 years of age, with severe hypertension, hepatic and renal failure, history of thrombosis, etc.

If oral contraceptives are not suitable for some reason, you can try taking non-steroidal anti-inflammatory drugs. They have analgesic and antipyretic properties (the well-known “Ibuprofen”). But besides this, it has the ability to somewhat reduce blood loss. There’s just one problem: you can’t take it if you have a bad stomach.

How to stop bleeding during menstruation most quickly, effectively and safely? Many doctors, in the old fashioned way, recommend Dicinon, but a more modern and effective remedy is Tranexam. Should be taken according to instructions. But drinking nettle is completely ineffective. It only makes sense if there is absolutely no way out. For example, when you are outside the city and there are no pharmacies nearby.

But sometimes it is better not to try to find the most effective and suitable pills to stop bleeding during menstruation, but to eliminate the cause of this pathology. It could be an endometrial polyp. It is removed during the curettage procedure, or better yet, hysteroscopy, so the doctor will definitely not make a mistake. By the way, the polyp also causes bleeding after menstruation, between menstrual periods. You definitely need to get rid of it.

Another common cause is uterine fibroids, especially submucous and/or large subserous, intramural fibroids. The myomatous node does not allow the uterus to contract well. Therefore, menstruation can be not only heavy, but also long. Submucous fibroids are usually removed of any size; no peritoneal incision is required. Myoma is removed during hysteroscopy through the vagina. Intramuscular myomatous nodes and subserous nodes (growing on the uterus like “mushrooms”) up to 7 cm in size can be removed laparoscopically. And more than 7-8 cm laparotomy. But it is worth noting that there is a conservative hormonal treatment uterine fibroids. True, it doesn't help for long. But it serves good preoperative preparation. After treatment, the nodes are reduced in size by about half.

And, of course, we must not forget about uterine artery embolization (UAE). This is a procedure for “killing” fibroids without making an incision. Under X-ray control, the doctor introduces emboli - particles that should cut off the supply to the fibroid - into the artery that feeds the fibroid. After this, it becomes necrotic. There are already successful results of the procedure in women planning pregnancy. But now UAE is not considered the best choice for them, since it can potentially harm the uterus and ovaries. But for women who are not planning a pregnancy, over 35 years of age and multiple fibroids The uterus is a great way to get rid of problems, including heavy menstruation.

And finally, the problem of abundant menstrual flow may be a consequence of iron deficiency. Yes, oddly enough, iron deficiency is provoked by large blood loss, and blood loss can be a consequence of iron deficiency. But just to get correct result(iron deficiency can be hidden), you need to donate blood not for hemoglobin, but for ferritin. If this diagnosis is confirmed, when taking iron supplements medicines, and menstruation becomes less abundant.

By the way, a consultation with a hematologist and endocrinologist, in general, will not harm if the gynecologist has not found the cause of hypermenorrhea (heavy menstruation). After all, the problem may be their part...

Remember that hypermenorrhea is not the norm. You can and should get rid of it. This will be good for your health and will improve your quality of life.

Uterine bleeding (vaginal bleeding)

Uterine bleeding (vaginal bleeding)

Uterine bleeding may occur during physiological and a number of pathological conditions. Since the woman herself cannot determine the source of bleeding, a manifestation of uterine bleeding is vaginal bleeding. Uterine bleeding can be an absolutely physiological phenomenon in two cases: during menstruation, if its duration is no more than 7 days and the frequency of occurrence is not less than once every 25 days. Also, uterine bleeding in the form of short-term bloody discharge may be normal during ovulation.

What uterine bleeding is considered pathological?

Uterine bleeding may occur in women of different ages. Pathological vaginal bleeding occur in the following cases:

• Increased length of periods (menorrhagia), increased bleeding (menorrhagia and hypermenorrhea) and too frequent periods (polymenorrhea)
• Bleeding not associated with menstruation, occurring irregularly - metrorrhagia
• Bleeding in the postmenopausal period (if more than 6 months have passed since the last normal menstruation

Also, uterine bleeding can occur in pregnant women in the early and late stages.

Why does uterine bleeding occur?

The main mechanisms for the development of uterine bleeding are as follows:

• Hormonal disorders regulation of the relationship between the elements of the hypothalamus-pituitary-ovaries-endometrium axis
• Structural, inflammatory and other gynecological disorders (including tumors)
• Blood coagulation disorders

The most common mechanism of uterine bleeding is this: during the anovulatory cycle (the follicle does not mature) does not develop corpus luteum. As a result, progesterone (one of the female sex hormones) is not produced in sufficient quantities during the second phase of the cycle. At the same time, estradiol (another female sex hormone) continues to be produced in excess. Under the influence of estradiol, increased growth of the endometrium (the inner layer of the uterus) occurs, which becomes so thick that blood vessels they cease to adequately supply it with blood. As a result, the endometrium dies and undergoes desquamation. The desquamation process is not complete, is accompanied by uterine bleeding and is delayed for a long time.

The most common causes of uterine bleeding

• Bleeding during early pregnancy occur during spontaneous abortion. In this case, vaginal bleeding begins immediately or some time after the start of the abortion due to the leakage of accumulated blood. Bleeding can also occur during ectopic (ectopic) pregnancy.
• Bleeding in late pregnancy can be associated with placental rupture, hydatidiform mole, placental polyps, and placenta previa.
• Uterine bleeding can be symptoms of diseases associated with changes in the structure of the reproductive organs, such as adenomyosis (endometriosis of the uterus), cancer of the uterus, cervix or vagina, endometrial hyperplasia, submucosal nodes with uterine fibroids or nascent nodes, cervical and endometrial polyps.
• Vaginal bleeding may be signs of atrophic vaginitis, cervicitis, foreign body vagina, if the cervix, uterus or vagina are damaged.
• Uterine bleeding due to impaired ovarian function can occur in the following conditions: dysfunctional uterine bleeding, functional ovarian cysts, polycystic ovary syndrome (polycystic).
• Endocrine disorders: hypothyroidism or hyperprolactinemia.
• Vaginal bleeding due to blood clotting disorders develops when hereditary diseases coagulation systems, with liver diseases, when taking certain medications
• Uterine bleeding may occur when using contraceptives and hormone therapy. Most often in cases of prescription of drugs such as Depo Provera, with hormone replacement therapy, in the presence of an intrauterine device, with levonorgestrel implants and in case of long gaps in taking contraceptives.

When should you see a doctor if you have uterine bleeding?

In cases where menstruation lasts more than 7 days, if the amount of discharge during menstruation is greater than usual, if menstruation occurs more often than once every 25 days, if you have bleeding outside of menstruation, you should consult a doctor. When examined in a chair, you can see damage to the vagina and cervix, the onset of vaginitis, and erosion of the cervix. Also, upon examination, you can see a nascent submucosal node with uterine fibroids or a cervical polyp. Uterine bleeding often accompanies infertility, since it is always based on a violation of the structure of the endometrium or a violation of the hormonal regulation of ovulation and menstrual cycle. In addition to the examination on the chair, it is often necessary to do a transvaginal ultrasound, since with this method it is possible to evaluate changes in the ovaries and in the uterine cavity. Often, a uterine ultrasound is critical to diagnosing the causes of uterine bleeding. If an ultrasound of the uterus reveals structural changes that do not have clear signs, a blood test may be prescribed to measure the content of sex hormones and thyroid hormones. Whenever there is uterine bleeding, a pregnancy test is performed. To assess the degree of acute or chronic blood loss, it is prescribed general analysis blood, where the indicators of red blood cells, hemoglobin, hematocrit, platelets and ESR are monitored.

Treatment of uterine bleeding

Treatment of uterine bleeding depends on the reason causing it. Most often, treatment is conservative and consists of the use of drugs that increase the ability of blood to clot and drugs that correct hormonal imbalance. Right choice These medications take into account many factors that are brought together by the doctor. If the bleeding is not eliminated by medication or has an underlying cause that cannot be eliminated conservatively, surgical treatment is performed. Surgery may consist of both therapeutic and diagnostic curettage of the endometrium and hysterectomy (removal of the uterus).

In obstetrics and gynecology we work in the following areas:

• Vaginal discharge in women, discharge during pregnancy

• Ultrasound diagnosis of Down syndrome and other chromosomal abnormalities

We treat such problems.