Hemostatic agents uterine bleeding

Uterine bleeding in obstetrics and gynecology is one of the most frequently diagnosed emergency conditions that require specialized medical care and treatment. There are two main types of bleeding:

• acyclic dysfunctional due to hormonal imbalance;
• bleeding associated with pregnancy and childbirth.

Hemostatic agents uterine bleeding are presented in two groups.

1. Antifibrinolytic agents (inhibitors of proteolysis), the mechanism of action which is aimed at inhibiting fibrinolizina - natural component anticoagulative system of blood. The most often used in the treatment Tranexam, aminocaproic acid, Contrycal, Aproteks, Gordoks, ingitrila.
2. Means, which increase clotting (haemostatics), whose action is based on the activation form thromboplastin - one of the blood clotting factors, leading to the restoration of damaged capillaries. Treatment is carried uterine bleeding such gemostatiki: Etamsylate, Dicynonum.

Features of treatment of uterine bleeding drugs that inhibit fibrinolysis associated with the ability of drugs to block certain blood enzymes that inhibit clot formation.

Haemostatics, in turn, normalize vascular permeability, improve blood circulation. In the walls of damaged blood vessels thromboplastin preparations stepping formation, platelet adhesion, which results in an overlap of the defect in the capillaries. A feature of this group of drugs is a lack of haemostatic ability of thrombus formation. In addition, during treatment of uterine bleeding gemostatiki strengthens blood vessels.

Action haemostatic preparations begin After 5 - 15 minutes after intravenous administration and lasts for 4 - 6 hours. When administered tablets bleeding from the uterus is stopped after 1.5 - 2 h.

Additional agents for treatment are calcium gluconate and vitamin K (Vikasol). ions of calcium and vitamin K is involved in the clotting process, however, they are used as a hemostatic agent in the main circuit.

In addition to such hemostatic drugs, as inhibitors of fibrinolysis and hemostatics, in the treatment of uterine bleeding used a number of tools aimed at the normalization of uterine contractions, her tone of anemia therapy, strengthening the vascular wall.

Causes and treatment guidelines

Obstetric hemorrhage considered one of the most frequent causes of death among women in childbirth. In the structure of the causes of pathology leading place of placenta praevia and premature detachment. Related maternal diseases, gynecological pathology, diseases of the blood system often result in complicated pregnancy. Improper placentation may cause profuse blood outpouring still in the process of gestation due to uterine throat overlap. A premature detachment often occurs when preeclampsia, renal disease, cardiac, infectious, endocrine disorders in pregnancy.

Risks and consequences of uterine bleeding:

• anemia;
• intrauterine fetal hypoxia;
• death of mother and child.

Principles of emergency treatment of pathologies during gestation and delivery are reduced to comply with several successive stages.

1. Stop blood via haemostatic preparations - hemostatics and fibrinolysis inhibitors.
2. Reinforce uterine contractions of the uterus after childbirth hypotension via oxytocin, ergot alkaloids, prostaglandins preparations. Loosen reduction in preterm birth (ginipral, magnesia, dexamethasone).
3. Restore blood loss.
4. Eliminate the effects (anemia, hypoxia).
5. Provide vital functions of the fetus (continuation of the pregnancy, emergency caesarean and resuscitation).

Dysfunctional uterine bleeding is often disturbed adolescent girls and young women who have problems with the cycle. Sometimes this condition is diagnosed in women during menopause. Often, the cause may be polyps, fibroids and endometrial hyperplasia.

The essence of the disease in women is a long build-up of the internal layer of the uterus on the background of an excess of estrogen and a lack of progesterone. Due to hormonal imbalance, the endometrium is not typical cycling - proliferation and secretion phases. Increased estrogen production leads to a steady increase in endometrial thickness, which food is broken due to vasospasm in the uterus. Layers of the endometrium are rejected out monthly and lead to profuse hemorrhage requiring emergency treatment in the form of a stop.

In older women large tumor in the uterus and endometrial pathology can also lead to bleeding.

Principles of treatment of uterine bleeding not related to pregnancy, the steps are similar, but supplemented by some groups of drugs for the therapy of hormone dysfunction.

1. Introduction of hemostatic agents.
2. The use of funds for uterine contractions.
3. Use in Scheme preparations to strengthen the vascular wall.
4. Hormonal treatments to stop bleeding from the uterus.
5. Correction of endocrine imbalance.

Treatment is carried out only in a hospital. When the drug ineffective hemostasis woman operate scraping.

during pregnancy and childbirth treatment

Bleeding is a common cause of complications in childbirth and postpartum activity. Proper treatment strategy to avoid blood transfusions, leave the uterus, to save the life of mother and baby because in some situations, the account goes on a minute. The pregnant uterus invades the newly formed blood vessels feeding the placenta. Any damage pathological processes, impaired uterine contractions can lead to hemorrhage.

The causes of uterine bleeding during labor are:

• placenta previa, when it closes out of the uterus, is the way of being born child;
• premature detachment of the placenta.

Factors that may lead to detachment considered multiple pregnancy, intrauterine infection, preeclampsia, scarring, uterine anomalies, polyhydramnios and large fruit, frequent deliveries.

A frequent cause uterine bleeding in childbirth and early postpartum considered receiving blood thinners during pregnancy - low molecular weight heparins. Frakisparin, Clexane, which are used on a regular basis women with thrombophilia, mutations in the folate cycle have a cumulative effect, which may cause sudden profuse uterine bleeding.

Physicians should be prepared to stop uterine bleeding. All delivery rooms present resuscitation packing with full set of hemostatic agents. Hemorrhage can occur suddenly, against the background of well-being, so every woman should be carefully weigh the "pros" and "cons" of home births, gaining popularity these days.

Bleeding previa during pregnancy begins suddenly and completely painless. In such situations, a woman needs to call an ambulance and hospitalized because only in hospital settings can be applied hemostatic agents.

Hemostatic agents and additional agents which are used for complex treatment of:

• to normalize the tone of the uterus using Nospanum, magnesium lactate;
• to stop bleeding or administered Etamsylate Dicynonum;
• to eliminate the hypertonicity of uterine contractions and the early stages of use ginipral.

If there uterine bleeding in the third trimester of pregnancy (28 - 34 weeks) female administered dexamethasone for respiratory distress syndrome in the child - this drug is used for the light opening in the event of premature delivery or emergency Caesarean section.

In the event of hemorrhage during delivery the hemostatic agent is selected from the group of inhibitors of fibrinolysis: Tranexam, Contrycal, aminocaproic acid, Aproteks. In addition, use of calcium gluconate.

In the postnatal period for stopping uterine bleeding in addition to hemostatic agents is considered necessary for introduction means uterine contractions - oxytocin, ergometrine.

Since a pregnant woman loses a large amount of blood for the prevention of infectious complications apply antibiotics. Against the backdrop of a sharp anemia, tissue hypoxia occurs, which makes them susceptible to bacteria.

To restore the lost blood substitutes used: plasma, cryoprecipitate, platelet and red cell mass, fibrinogen.

Treatment continues until a full stop blood preparations administered every few hours. Depending on the severity of the condition may be assigned pregnant as intravenous or oral administration.

Treatment

Clinical manifestations of menstrual irregularities, consisting in endometrial hyperplasia, characterized by the appearance of abundant, prolonged bleeding from the uterus at 20 - 40 day cycle. This process is due to the lack of harmony in the hypothalamus, pituitary and ovaries. In young women, this leads to a lack of ovulation amid growing endometrium. At menopause representatives noted long-term persistence of the follicle. But the result is the same - uterine bleeding with prolonged estrogen stimulation. If profuse bleeding from the uterus not related to the hormonal failure, the cause of his education often become pathological (fibroids, polyps).

Treatment is carried hemostatic drugs from different groups:

• uterine contractions using oxytocin and ergometrine preparations;
• Use styptic from the group hemostatics (Etamsylate) or fibrinolysis inhibitor (Tranexam, aminocaproic acid);
• administration of calcium gluconate or calcium chloride;
• vitamin K;
• use of hormone hemostatic treatment;
• Diagnosis and treatment causes of bleeding.

For drugs to stop bleeding from the uterus based on hormones include the following:

• oral contraceptives (Rigevidon, Mikroginon, Non-ovlon) starting with 3 tablets a day, with a gradual decrease in dose - duration of treatment 21 days;
• progestins (progesterone) - Djufaston, Norkolut, Utrozhestan - the total duration of treatment is 21 days.

Hormonal Hemostatic agents necessarily used in the treatment scheme when the thickness of the endometrium by ultrasound than 10 mm.

After stopping hemorrhage via hemostatic drugs, diagnosis and treatment of the underlying disease. Examine the levels of sex hormones in the blood, perform ultrasound, hysteroscopy, laparoscopy, diagnostic curettage. After determination of the cause of menorrhagia, usually prescribe drugs for normalizing the hormonal endometrial growth (COCs progesterone).

As part of the rehabilitation of the woman it takes drugs to normalize the blood and strengthen the walls of blood vessels. For the treatment of anemia using iron supplements, vitamins B and E (Totem, vitamin B1, B6, B9) for 2 - 3 months.

Please be aware that if the cause of the bleeding began uterus tumors, treatment is carried out in other ways, the essence of which lies in their removal.