Obstetrics and Gynecology - A.M. Gromova 2000

Obstetric Hemorrhage

Obstetric Hemorrhage is defined as any Blood loss from the female genital tract during Pregnancy, as well as pathological blood loss during labor and the postpartum period. Uterine bleeding during labor and the early postpartum period within physiological limits (up to 0.3% of body weight, which is approximately 250 ml) is due to the hemochorial connection between the Placenta and the Uterus; it does not affect the General condition of the postpartum woman and does not require the engagement of the body's compensatory mechanisms. The permissible blood loss is 250–400 ml, which corresponds to 0.3–0.5% of body weight and is generally tolerated without complications. Blood loss exceeding 0.5% of body weight is considered pathological. Given that pregnant women, women in labor, and postpartum women have a reduced tolerance to blood loss and Shock symptoms can develop at a volume of 800–1000 ml, blood loss up to 1–1.5% of body weight is classified as moderate, while anything exceeding 1% of body weight is regarded as massive.

The incidence of obstetric hemorrhage remains high, ranging from 2.5% to 4.7%. Uterine bleeding remains the leading cause of emergency conditions and ranks among the top contributors to maternal mortality. As a sole primary cause of death, this pathology accounts for 20–45% of cases, and it also complicates the patient's condition when other leading pathologies are present.

Bleeding during pregnancy and labor is most frequently caused by Placenta Previa, placental abruption of a normally situated placenta, Uterine rupture, ruptured VARICOSE Veins OF the Vagina, and pathological conditions of the uterine cervix. Bleeding in the Third Stage of labor and the early postpartum period results from impaired placental Separation and expulsion; uterine hypotonia and atonia; Traumatic injuries of the birth canal; and congenital or acquired Disorders of the hemostatic system.