Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
H. Breakthrough bleeding
Breakthrough bleeding is defined as a condition of an abnormal flow of
blood from the uterus that occurs between menstrual periods especially
due to irregular sloughing of the endometrium in women on contraceptive
hormones(1).
H.1. Causes and Risk factors
1. Excessive thick uterine lining (edometrium)
During the last stage of the menstrual cycle, normally a layer of
endometriosis lining on the inside of the uterus is expelled, known as
menstruation blood. In some women, excessive thick of uterine lining
(edometrium) may cause breakthrough bleeding.
2. Hormonal fluctuations
Fluctuating hormones around ovulation may experience breakthrough bleeding.
3. Taking oral contraceptives
In the study of dilated thin-walled blood and lymphatic vessels in human endometrium: a potential role for VEGF-D in progestin-induced break-through bleeding, researchers at the Department
of Obstetrics and Gynaecology and Monash Institute for Medical
Research, Monash University, wrote that using a NOD/scid mouse model
with xenografted human endometrium
we were able to show that progestin treatment causes decidualisation,
VEGF-D production and endometrial vessel dilation. Our results lead to a
novel hypothesis to explain BTB, with stromal cell decidualisation
rather than progestin treatment per se being the proposed causative
event, and VEGF-D being the proposed effector agent(2).
4. Amenorrhea
In the study of The induction of amenorrhoea by Hipkin LJ. indicated
that a survey has shown that many women favour eliminating menstruation
and it has been suggested that therapeutic induction of amenorrhoea might be an advantage in female personnel mobilised for war, but it poses some side effects including bleeding and spotting, 2 kg weight gain, breast tenderness, depression, and headaches(3).
5. Progestin treatment
Clinicians routinely prescribe progestins along with estrogens during
menopausal hormone therapy (HT) to block estrogen-dependent endometrial
proliferationmay cause breakthrough bleeding.
6. Polyps
In teh study to determine the effectiveness of different treatments for abnormal uterine bleeding in women with known endometrial polyps, showed that polypectomy and other treatments of women with abnormal uterine bleeding who had benign polyps detected by sonohysterography. Women with endometrial polyps
diagnosed by sonohysterography between January 1997 and July 1998 were
sent questionnaires on pretreatment and posttreatment uterine bleeding and satisfaction with their treatments(4).
7. Other causes
Stopping or missing estrogens or oral contraceptives, stress, weight
gain or loss, diet change, displaced intra uterine device, vagina
injury, taking anticoagulant medications, etc.(5)
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Sources
(1) http://www.merriam-webster.com/medical/breakthrough%20bleeding
(2) http://www.ncbi.nlm.nih.gov/pubmed/22383980
(3) http://www.ncbi.nlm.nih.gov/pubmed/1533675
(4) http://www.ncbi.nlm.nih.gov/pubmed/11084172
(5) http://www.targetwoman.com/articles/breakthrough-bleeding.html
Monday, 2 December 2013
Hemorrhaging: Postpartum hemorrhage - The Treatments
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
Treatments
According to the researchers at the Department of Obstetrics and Gynecology, Orbis Medical Centre, in the current treatment of severe PPH, first-line therapy includes transfusion of packed cells and fresh-frozen plasma in addition to uterotonic medical management and surgical interventions. In persistent PPH, tranexamic acid, fibrinogen, and coagulation factors are often administered. Secondary coagulopathy due to PPH or its treatment is often underestimated and therefore remains untreated, potentially causing progression to even more severe PPH. In most cases, medical and transfusion therapy is not based on the actual coagulation state because conventional laboratory test results are usually not available for 45 to 60 minutes. Thromboelastography and rotational thromboelastometry are point-of-care coagulation tests. A good correlation has been shown between thromboelastometric and conventional coagulation tests, and the use of these in massive bleeding in nonobstetric patients is widely practiced and it has been proven to be cost-effective. Fibrinogen seems to play a major role in the course of PPH and can be an early predictor of the severity of PPH. The FIBTEM values (in thromboelastometry, reagent specific for the fibrin polymerization process) decline even more rapidly than fibrinogen levels and can be useful for early guidance of interventions(12).
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Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(12) http://www.ncbi.nlm.nih.gov/pubmed/22430921
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
Treatments
According to the researchers at the Department of Obstetrics and Gynecology, Orbis Medical Centre, in the current treatment of severe PPH, first-line therapy includes transfusion of packed cells and fresh-frozen plasma in addition to uterotonic medical management and surgical interventions. In persistent PPH, tranexamic acid, fibrinogen, and coagulation factors are often administered. Secondary coagulopathy due to PPH or its treatment is often underestimated and therefore remains untreated, potentially causing progression to even more severe PPH. In most cases, medical and transfusion therapy is not based on the actual coagulation state because conventional laboratory test results are usually not available for 45 to 60 minutes. Thromboelastography and rotational thromboelastometry are point-of-care coagulation tests. A good correlation has been shown between thromboelastometric and conventional coagulation tests, and the use of these in massive bleeding in nonobstetric patients is widely practiced and it has been proven to be cost-effective. Fibrinogen seems to play a major role in the course of PPH and can be an early predictor of the severity of PPH. The FIBTEM values (in thromboelastometry, reagent specific for the fibrin polymerization process) decline even more rapidly than fibrinogen levels and can be useful for early guidance of interventions(12).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(12) http://www.ncbi.nlm.nih.gov/pubmed/22430921
Hemorrhaging: Postpartum hemorrhage- Managements and Diagnosis
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
Prevention and management
According to the article of Active versus expectant management in the third stage of labour (Review) by Prendiville WJ, Elbourne D, McDonald S, routine ’active management’ is superior to ’expectant management’ in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in amaternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries)(10).
G.4. Diagnosis and Treatments
1. Diagnosis
The aim of diagnosis is to determine the underlined causes of the disease, inmost cases , it is caused by 4Ts. Estimation of blood loss by calibrated bags has been shown to be significantly more accurate than visual estimation at vaginal delivery. Careful monitoring of the mother's vital signs, laboratory tests, in particular coagulation testing, and immediate diagnosis of the cause of PPH are important key factors to reduce maternal morbidity and mortality(11).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(10) http://apps.who.int/rhl/reviews/CD000007.pdf
(11) http://www.ncbi.nlm.nih.gov/pubmed/21332452
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
Prevention and management
According to the article of Active versus expectant management in the third stage of labour (Review) by Prendiville WJ, Elbourne D, McDonald S, routine ’active management’ is superior to ’expectant management’ in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in amaternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries)(10).
G.4. Diagnosis and Treatments
1. Diagnosis
The aim of diagnosis is to determine the underlined causes of the disease, inmost cases , it is caused by 4Ts. Estimation of blood loss by calibrated bags has been shown to be significantly more accurate than visual estimation at vaginal delivery. Careful monitoring of the mother's vital signs, laboratory tests, in particular coagulation testing, and immediate diagnosis of the cause of PPH are important key factors to reduce maternal morbidity and mortality(11).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(10) http://apps.who.int/rhl/reviews/CD000007.pdf
(11) http://www.ncbi.nlm.nih.gov/pubmed/21332452
Hemorrhaging: Postpartum hemorrhage- The Causes and Risk Factors
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
G.1. Causes and Risk factors
1. Causes
Causes of Postpartum hemorrhage (PPH) are of result of uterine atony, trauma, retained placenta, and coagulopathy(4Ts)
a. Uterine atony
Uterine atony is a loss of functions of compression of the vessels to reduce blood flow after child birth. According to the study of Department of Obstetrics and Gynecology, Duke University School of Medicine, omen with severe PPH had a mean oxytocin area under the curve of 10,054 mU compared to 3762 mU in controls (P < .001). After controlling for race, body mass index, admission hematocrit, induction status, magnesium therapy, and chorioamnionitis using logistic regression, oxytocin area under the curve continued to predict severe PPH(2).
b. Trauma
Trauma due to a body wound or shock as a sudden physical injure such as car accidence are associated to the to the cause of Postpartum hemorrhage (PPH.Uncontrolled bleeding continues to be a major cause of mortality in trauma, cardiac surgery, postpartum hemorrhage and liver failure, according
to the study of Use of Activated Recombinant Factor VII in Severe Bleeding - Evidence for Efficacy and Safety in Trauma, Postpartum Hemorrhage, Cardiac Surgery, and Gastrointestinal Bleeding(3).
c. Tissues
Blood clots or retained tissues after birth, including retained placenta accounts for 10% of PPH. The primary tissue-based etiology of PPH is retained placenta. In the study of intravenous sulprostone infusion in the treatment of retained placenta, showed that the placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity(4).
d. Coagulopathy
Coagulopathy is defined as a condition of coagulation abnormalities in which blood clots fail to form. According to the study by the Duke University Medical Center, Durham, systemic bleeding at the time of postpartum hemorrhage (PPH) is usually the result of coagulopathy that has developed acutely as a result of massive hemorrhage after uterotonics and sutures have failed(5).
e. Etc.
2. Risk factors
a. In vaginal delivery
According to the study of University of Uruguay, Montevideo, Uruguay, moderate and severe postpartum hemorrhage occurred in 10.8% and 1.9% of deliveries, respectively. The risk factors more strongly associated and the incidence of moderate postpartum hemorrhage in women with each of these factors were: retained placenta (33.3%) (adjusted odds ratio [OR] 6.02, 95% confidence interval [CI] 3.50-10.36), multiple pregnancy (20.9%) (adjusted OR 4.67, CI 2.41-9.05), macrosomia (18.6%) (adjusted OR 2.36, CI 1.93-2.88), episiotomy (16.2%) (adjusted OR 1.70, CI 1.15-2.50), and need for perineal suture (15.0%) (adjusted OR 1.66, CI 1.11-2.49). Active management of the third stage of labor, multiparity, and low birth weight were found to be protective factors. Severe postpartum hemorrhage was associated with retained placenta (17.1%) (adjusted OR 16.04, CI 7.15-35.99), multiple pregnancy (4.7%) (adjusted OR 4.34, CI 1.46-12.87), macrosomia (4.9%) (adjusted OR 3.48, CI 2.27-5.36), induced labor (3.5%) (adjusted OR 2.00, CI 1.30-3.09), and need for perineal suture (2.5%) (adjusted OR 2.50, CI 1.87-3.36)(6).
b. In caesarean section
caesarean section is associated to increased risk of recurrent massive uterine bleeding, according to the report of a 37 yr old patient suffered severe atonic bleeding requiring different operating procedures (Clipping of the uterine arteries) in combination with an uterotonic and haemostaseological medication as well as massive transfusion of blood components and recombinant factor VIIa. After a period of 17 days without any bleeding the patient presented to the emergency room with recurrent massive uterine bleeding(7).
c. Racial and ethnic disparities
Hispanic ethnicity and Asian/Pacific Islander race were associated with a statistically significant increased odds of atonic PPH in comparison with Caucasians, despite adjustment for potential mediators (adjusted odds ratio [OR] for Hispanics: 1.21, 99% confidence interval [1.18, 1.25]; for Asians/Pacific Islanders: 1.31 [1.25, 1.38], with Caucasians as reference)(8).
d. Others risk factors
According to the study of Risk Factors for Postpartum Hemorrhage: Can We Explain the Recent Temporal Increase?, major independent risk factors for PPH included primiparity, prior Caesarean section, placenta previa or low-lying placenta, marginal umbilical cord insertion in the placenta, transverse lie, labour induction and augmentation, uterine or cervical trauma at delivery, gestational age < 32 weeks, and birth weight ≥ 4500 g. An overall increase in rate of PPH over the study period (OR 1.029; 95% CI 1.024 to 1.034 per year) disappeared (OR 0.995; 95% CI 0.988 to 1.001 per year) after inclusion of maternal age, parity, prior Caesarean section, labour induction and augmentation, placenta previa or low-lying placenta, and abnormal placenta, with most of the reduction attributable to rises in previous Caesarean section and labour augmentation(9). Also according to the length of the third stage of labor and the risk of postpartum hemorrhage, Obstet Gynecol. 2005;105:290–3 and Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15–8., risk factors for postpartum hemorrhage also include a prolonged third stage of labor, multiple delivery, episiotomy, fetal macrosomia, and history of postpartum hemorrhage.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(2) http://www.ncbi.nlm.nih.gov/pubmed/21047614
(3) http://www.ncbi.nlm.nih.gov/pubmed/22670132
(4) http://www.ncbi.nlm.nih.gov/pubmed/22862433
(5) http://www.ncbi.nlm.nih.gov/pubmed/22430921
(6) http://www.ncbi.nlm.nih.gov/pubmed/19461428
(7) http://www.ncbi.nlm.nih.gov/pubmed/22628026
(8) http://www.ncbi.nlm.nih.gov/pubmed/22886840
Postpartum hemorrhage
Postpartum hemorrhage (PPH) is a loss of blood greater than 500 ml, following vaginal delivery, or 1000 ml, following cesarean section.The mortility rate is of 1000 women per 100,000 live births as a result of Postpartum hemorrhage (PPH). In the evaluation of all randomly assigned participants,active bleeding was controlled within 20 min with study treatment alone for 440 (90%) women given misoprostol and 468 (96%) given oxytocin (relative risk [RR] 0·94, 95% CI 0·91—0·98; crude difference 5·3%, 95% CI 2·6—8·6). Additional blood loss of 300 mL or greater after treatment occurred for 147 (30%) of women receiving misoprostol and 83 (17%) receiving oxytocin (RR 1·78, 95% CI 1·40—2·26). Shivering (229 [47%] vs 82 [17%]; RR 2·80, 95% CI 2·25—3·49) and fever (217 [44%] vs 27 [6%]; 8·07, 5·52—11·8) were significantly more common with misoprostol than with oxytocin. No women had hysterectomies or died(1).
G.1. Causes and Risk factors
1. Causes
Causes of Postpartum hemorrhage (PPH) are of result of uterine atony, trauma, retained placenta, and coagulopathy(4Ts)
a. Uterine atony
Uterine atony is a loss of functions of compression of the vessels to reduce blood flow after child birth. According to the study of Department of Obstetrics and Gynecology, Duke University School of Medicine, omen with severe PPH had a mean oxytocin area under the curve of 10,054 mU compared to 3762 mU in controls (P < .001). After controlling for race, body mass index, admission hematocrit, induction status, magnesium therapy, and chorioamnionitis using logistic regression, oxytocin area under the curve continued to predict severe PPH(2).
b. Trauma
Trauma due to a body wound or shock as a sudden physical injure such as car accidence are associated to the to the cause of Postpartum hemorrhage (PPH.Uncontrolled bleeding continues to be a major cause of mortality in trauma, cardiac surgery, postpartum hemorrhage and liver failure, according
to the study of Use of Activated Recombinant Factor VII in Severe Bleeding - Evidence for Efficacy and Safety in Trauma, Postpartum Hemorrhage, Cardiac Surgery, and Gastrointestinal Bleeding(3).
c. Tissues
Blood clots or retained tissues after birth, including retained placenta accounts for 10% of PPH. The primary tissue-based etiology of PPH is retained placenta. In the study of intravenous sulprostone infusion in the treatment of retained placenta, showed that the placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity(4).
d. Coagulopathy
Coagulopathy is defined as a condition of coagulation abnormalities in which blood clots fail to form. According to the study by the Duke University Medical Center, Durham, systemic bleeding at the time of postpartum hemorrhage (PPH) is usually the result of coagulopathy that has developed acutely as a result of massive hemorrhage after uterotonics and sutures have failed(5).
e. Etc.
2. Risk factors
a. In vaginal delivery
According to the study of University of Uruguay, Montevideo, Uruguay, moderate and severe postpartum hemorrhage occurred in 10.8% and 1.9% of deliveries, respectively. The risk factors more strongly associated and the incidence of moderate postpartum hemorrhage in women with each of these factors were: retained placenta (33.3%) (adjusted odds ratio [OR] 6.02, 95% confidence interval [CI] 3.50-10.36), multiple pregnancy (20.9%) (adjusted OR 4.67, CI 2.41-9.05), macrosomia (18.6%) (adjusted OR 2.36, CI 1.93-2.88), episiotomy (16.2%) (adjusted OR 1.70, CI 1.15-2.50), and need for perineal suture (15.0%) (adjusted OR 1.66, CI 1.11-2.49). Active management of the third stage of labor, multiparity, and low birth weight were found to be protective factors. Severe postpartum hemorrhage was associated with retained placenta (17.1%) (adjusted OR 16.04, CI 7.15-35.99), multiple pregnancy (4.7%) (adjusted OR 4.34, CI 1.46-12.87), macrosomia (4.9%) (adjusted OR 3.48, CI 2.27-5.36), induced labor (3.5%) (adjusted OR 2.00, CI 1.30-3.09), and need for perineal suture (2.5%) (adjusted OR 2.50, CI 1.87-3.36)(6).
b. In caesarean section
caesarean section is associated to increased risk of recurrent massive uterine bleeding, according to the report of a 37 yr old patient suffered severe atonic bleeding requiring different operating procedures (Clipping of the uterine arteries) in combination with an uterotonic and haemostaseological medication as well as massive transfusion of blood components and recombinant factor VIIa. After a period of 17 days without any bleeding the patient presented to the emergency room with recurrent massive uterine bleeding(7).
c. Racial and ethnic disparities
Hispanic ethnicity and Asian/Pacific Islander race were associated with a statistically significant increased odds of atonic PPH in comparison with Caucasians, despite adjustment for potential mediators (adjusted odds ratio [OR] for Hispanics: 1.21, 99% confidence interval [1.18, 1.25]; for Asians/Pacific Islanders: 1.31 [1.25, 1.38], with Caucasians as reference)(8).
d. Others risk factors
According to the study of Risk Factors for Postpartum Hemorrhage: Can We Explain the Recent Temporal Increase?, major independent risk factors for PPH included primiparity, prior Caesarean section, placenta previa or low-lying placenta, marginal umbilical cord insertion in the placenta, transverse lie, labour induction and augmentation, uterine or cervical trauma at delivery, gestational age < 32 weeks, and birth weight ≥ 4500 g. An overall increase in rate of PPH over the study period (OR 1.029; 95% CI 1.024 to 1.034 per year) disappeared (OR 0.995; 95% CI 0.988 to 1.001 per year) after inclusion of maternal age, parity, prior Caesarean section, labour induction and augmentation, placenta previa or low-lying placenta, and abnormal placenta, with most of the reduction attributable to rises in previous Caesarean section and labour augmentation(9). Also according to the length of the third stage of labor and the risk of postpartum hemorrhage, Obstet Gynecol. 2005;105:290–3 and Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15–8., risk factors for postpartum hemorrhage also include a prolonged third stage of labor, multiple delivery, episiotomy, fetal macrosomia, and history of postpartum hemorrhage.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2961924-3/abstract
(2) http://www.ncbi.nlm.nih.gov/pubmed/21047614
(3) http://www.ncbi.nlm.nih.gov/pubmed/22670132
(4) http://www.ncbi.nlm.nih.gov/pubmed/22862433
(5) http://www.ncbi.nlm.nih.gov/pubmed/22430921
(6) http://www.ncbi.nlm.nih.gov/pubmed/19461428
(7) http://www.ncbi.nlm.nih.gov/pubmed/22628026
(8) http://www.ncbi.nlm.nih.gov/pubmed/22886840
Hemorrhaging: Vaginal bleeding - The Treatments
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
F.4. Treatments
Treatments depends to the finding of the underlined causes of vaginal bleeding, such as
F4.1. Fibroids and uterine bleeding
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.2. Endometriosis
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.3. Ectopic pregnancy
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.4. Polycystic ovary syndrome
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
4. Permanently Eliminate All Types of Ovarian Cysts and PCOs Within 2 Months for Only $4?
F.4.5. Pelvic Inflammation Disease
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
F.4. Treatments
Treatments depends to the finding of the underlined causes of vaginal bleeding, such as
F4.1. Fibroids and uterine bleeding
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.2. Endometriosis
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.3. Ectopic pregnancy
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
F.4.4. Polycystic ovary syndrome
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
4. Permanently Eliminate All Types of Ovarian Cysts and PCOs Within 2 Months for Only $4?
F.4.5. Pelvic Inflammation Disease
Please check the women health section for the related articles http://kylejnorton.blogspot.ca/p/women-health.html
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
Hemorrhaging: Vaginal bleeding - The Symptoms and Diagnosis
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
Symptoms
a. Bleeding or spotting between periods
b. Bleeding after sex
In most case, it is caused by sexual transmitting diseases
c. Irregular menstruation (menstrual cycle less than 28 days (more common) or more than 35 days apart)
d. Variable menstrual flow ranging from scanty to profuse
e. Menopausal bleeding
f. Etc.
F.3. Diagnosis
After a complete physical exam, including pelvic examination and questions related to your general health, including episode of vaginal bleeding, last normal menstrual cycle, previous abnormal bleeding, use of birth control pill, numbers of sexual partners, history of abnormal bleeding, etc.
a. Bacteria culture
If you are experience vaginal bleeding, bacteria cultire may be the first that you doctor orders to rule out sexually transmitted diseases such as gonorrhea and chlamydia.
b. Pap smear
To rule out irregular cervicl cell growth cause of vaginal bleeding
c. Endometrial biopsy
If you doctor suspect that the bleeding is of result of endometrial cells overgrowth.
d. Pelvic ultrasound
Pelvic ultrasound allows your doctor to examine the structures and organs in the lower abdomen and pelvis with an aim to find the underlined causes of vaginal bleeding
e. Blood tests such as thyroid function tests, complete blood count
To rule out Ovulatory abnormal uterine bleeding caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease.
f. Pregnancy test
the aim of the Pregnancy test is to rule out the bleeding caused by complication of pregnancy,
g. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
Symptoms
a. Bleeding or spotting between periods
b. Bleeding after sex
In most case, it is caused by sexual transmitting diseases
c. Irregular menstruation (menstrual cycle less than 28 days (more common) or more than 35 days apart)
d. Variable menstrual flow ranging from scanty to profuse
e. Menopausal bleeding
f. Etc.
F.3. Diagnosis
After a complete physical exam, including pelvic examination and questions related to your general health, including episode of vaginal bleeding, last normal menstrual cycle, previous abnormal bleeding, use of birth control pill, numbers of sexual partners, history of abnormal bleeding, etc.
a. Bacteria culture
If you are experience vaginal bleeding, bacteria cultire may be the first that you doctor orders to rule out sexually transmitted diseases such as gonorrhea and chlamydia.
b. Pap smear
To rule out irregular cervicl cell growth cause of vaginal bleeding
c. Endometrial biopsy
If you doctor suspect that the bleeding is of result of endometrial cells overgrowth.
d. Pelvic ultrasound
Pelvic ultrasound allows your doctor to examine the structures and organs in the lower abdomen and pelvis with an aim to find the underlined causes of vaginal bleeding
e. Blood tests such as thyroid function tests, complete blood count
To rule out Ovulatory abnormal uterine bleeding caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease.
f. Pregnancy test
the aim of the Pregnancy test is to rule out the bleeding caused by complication of pregnancy,
g. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
Hemorrhaging: Vaginal bleeding - The Cause and Risk Factors
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
Causes and Risk factors
1. Causes
a. Hormonal imbalance
Menstrual bleeding that falls outside the range of normal is often a cause of great concern, before treating with hormonal interventions or blood products, PCOS, should always be ruled out with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding(2). Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia(2a).
b. Von Willebrand disease
Von Willebrand disease is defined as a hereditary condition of coagulation abnormality. There is a report of a 17 year old woman presented with severe anaemia due to menorrhagia. On investigation, she was shown to have abnormalities of her haemostatic mechanism consistent with von Willebrand's disease Type I, although there was no family history of this disorder(3).
c. cervical cancer
In the study to determine the presentation, pathological findings, treatment, and outcome of patients with cervical sarcom, f 1804 patients in the study with cervical malignancies, 8 cervical sarcomas were identified. All patients presented with vaginal bleeding and discharge(4).
d. Birth control pill
The Pill normally is prescribed by your doctor to reduce the heavy period blood for woman as well as in treating of period pain, or for contraceptive purpose ( 21 days on and 7 days off). Oral contraception is the dominant method of contraception for women in the world wide, in Canada there is more than 43% of sexually active women use it. It is defined as medications taken by mouth to prevent unwanted pregnancy. Bleeding and spotting is normal for the first six months for women starting any oral contraceptive combination pill because our body needs time to adjust to the new medication(5).
e. Endometrial hyperplasia
Endometrial hyperplasia is a condition of over growth of endometrial cell causing too thick of the endometrium of that can lead to abnormal bleeding. Researchers at the Department of Pathology, Aarhus University Hospital found that the mean (+/-s.d.) endometrial thickness was significantly different in patients with hyperplasia 11.5 mm (+/-5.0), polyps 11.8 mm (+/-5.1), sub-mucous myomas 7.1 mm (+/-3.4) and in patients without these abnormalities(abnormal uterine bleeding) 8.37 (+/-3.9) (p<0.001)(6).
f. Intrauterine device (IUD)
Researchers at the School of Medicine, Zhejiang University, in the study of the expression of angiopoietin-1 and -2 in the endometrium of women with abnormal bleeding induced by an intra-uterine device, found that Immunohistochemical analysis showed elevated Ang-2 protein levels in secretory phase endometrium from IUD patients compared with the control women. These results suggest that the angiopoietin/Tie-2 system promotes vascular remodelling in the endometrium and that changes in the expression of Ang-1, Ang-2 and Tie-2 may contribute to abnormal uterine bleeding in some IUD users(7).
h. Miscarriage or ectopic pregnancy
h.1. Miscarriage
Miscarriage is defined as the loss of an embryo before the 20th week of pregnancy as it is incapable of surviving independently. In medical terminology, miscarriage is a type of abortion, as it refers to the pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or medically induced abortion. In US alone, over 15% of pregnancy ends in miscarriage.
Most common symptoms of miscarriage. 50% of bleeding during 20 weeks of pregnancy ends in miscarriage(8).
h.2. Ectopic pregnancy
Ectopic pregancy is defined as a condition in which the fertilized implant in somewhere else other than in the uterus. In most case, ectopic pregnancy occurrs in the one of the Fallopian tube, causinf tubal pregnancy. Ectopic pregnancy will end up in miscarriage as the fertilized can not survive outside of uterus. Bleeding occurs between 6 - 8 weeks of pregnancy may be a sign of miscariage due to the implant egg inability to survive out side of uterus(9).
i. Amenorrhea, age, PID, fibroids and ovarian masses
In the document sonographically identifiable causes of vaginal bleeding in secondarily amenorrhoeic women of child bearing age, showed that 75(73.2%) patients had pregnancy-related conditions, 14(13.7%) had normal, non-pregnant uteri while the remaining 13 (12.8%) had other gynaecological conditions namely pelvic inflammatory disease (PID), uterine fibroids and ovarian masses. Though pregnancy-related conditions are the major causes of vaginal bleeding in amenorrhoeic women of childbearing age, PID, fibroids and ovarian masses are possible findings(10).
j. Polycystic ovary syndrome
Polycystic Ovarian Syndrome is defined as endocrinologic diseases caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries as resulting of enlarged ovaries, leading to hormone imbalance( excessive androgen), resulting in male pattern hair development, acne,irregular period or absence of period, weight gain and effecting fertility. It effects over 5% of women population or 1 in 20 women(11).
h. Etc.
2. Risk factors
a. Physical, psychological and environmental factors
questionnaire survey was conducted on 14,752 women by trained doctors, when pregnant women came for the first antenatal examination, including sociodemographic characteristics, prior adverse pregnancy outcomes, diseases history, life event stress, adverse environmental exposure and detailed information on VB(12).
b. Age
The rate of postmenopausal vaginal bleeding during the study period peaks at the age of 55-59 years (25.9/1000 postmenopausal women/year) and declines thereafter(13).
c. Medical conditions and medication
People who have had medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus or taken certain medication such as steroids or blood thinnersare at incresed risk of vaginal bleeding(14)
d. Inherited bleeding disorders (IBDs)
Inherited bleeding disorders (IBDs) are by definition life-long. Women with IBDs are more likely to suffer HMB, to be symptomatic, and to present with bleeding in association with gynaecological problems. Heavy and/or abnormal menstrual bleeding increases with age due increased anovulatory cycles and gynaecological pathologies in older women(15).
d. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
(2) http://www.ncbi.nlm.nih.gov/pubmed/22764555
(2a) http://www.ncbi.nlm.nih.gov/pubmed/22230306
(3) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014910/
(4) http://www.ncbi.nlm.nih.gov/pubmed/22740005
(5) http://medicaladvisorjournals.blogspot.ca/2012/01/oral-contraception-pill-combined-oral.html
(6) http://www.ncbi.nlm.nih.gov/pubmed/11437723
(7) http://www.ncbi.nlm.nih.gov/pubmed/20233519
(8) http://medicaladvisorjournals.blogspot.ca/2012/01/miscarriage.html
(9) http://medicaladvisorjournals.blogspot.ca/2012/01/ectopic-pregnancy.html
(10) http://www.ncbi.nlm.nih.gov/pubmed/18923588
(11) http://medicaladvisorjournals.blogspot.ca/2012/01/overcome-infertility-fertility-and_13.html
(12) http://www.ncbi.nlm.nih.gov/pubmed/22584214
(13) http://www.ncbi.nlm.nih.gov/pubmed/20424279
(14) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014910/
(15) http://www.ncbi.nlm.nih.gov/pubmed/22445218
Vaginal bleeding
Vaginal bleeding is defined a condition of abnormal vaginal bleeding or spotting between periods as a result of hormonal imbalances (abnormal uterine bleeding), pregnancy, menopause, diseases, bleeding disorders, medications, etc. Researchers at the 2nd Department of Obstetrics and Gynecology, University of Athensuggested that the occurrence of irregular, prolonged or heavy abnormal uterine bleeding is one of the most urgent gynecological problems in adolescence and the diagnosis of dysfunctional uterine bleeding should be used only when all other organic and structural causes of abnormal vaginal bleeding have been ruled out(1).
Causes and Risk factors
1. Causes
a. Hormonal imbalance
Menstrual bleeding that falls outside the range of normal is often a cause of great concern, before treating with hormonal interventions or blood products, PCOS, should always be ruled out with clinical signs of hyperandrogenism, obesity, or insulin resistance. Attention must also be paid to signs or a family history of a bleeding disorder, as vWD is commonly associated with excessive uterine bleeding(2). Ovulatory abnormal uterine bleeding, or menorrhagia, may be caused by thyroid dysfunction, coagulation defects (most commonly von Willebrand disease), endometrial polyps, and submucosal fibroids. Transvaginal ultrasonography or saline infusion sonohysterography may be used to evaluate menorrhagia(2a).
b. Von Willebrand disease
Von Willebrand disease is defined as a hereditary condition of coagulation abnormality. There is a report of a 17 year old woman presented with severe anaemia due to menorrhagia. On investigation, she was shown to have abnormalities of her haemostatic mechanism consistent with von Willebrand's disease Type I, although there was no family history of this disorder(3).
c. cervical cancer
In the study to determine the presentation, pathological findings, treatment, and outcome of patients with cervical sarcom, f 1804 patients in the study with cervical malignancies, 8 cervical sarcomas were identified. All patients presented with vaginal bleeding and discharge(4).
d. Birth control pill
The Pill normally is prescribed by your doctor to reduce the heavy period blood for woman as well as in treating of period pain, or for contraceptive purpose ( 21 days on and 7 days off). Oral contraception is the dominant method of contraception for women in the world wide, in Canada there is more than 43% of sexually active women use it. It is defined as medications taken by mouth to prevent unwanted pregnancy. Bleeding and spotting is normal for the first six months for women starting any oral contraceptive combination pill because our body needs time to adjust to the new medication(5).
e. Endometrial hyperplasia
Endometrial hyperplasia is a condition of over growth of endometrial cell causing too thick of the endometrium of that can lead to abnormal bleeding. Researchers at the Department of Pathology, Aarhus University Hospital found that the mean (+/-s.d.) endometrial thickness was significantly different in patients with hyperplasia 11.5 mm (+/-5.0), polyps 11.8 mm (+/-5.1), sub-mucous myomas 7.1 mm (+/-3.4) and in patients without these abnormalities(abnormal uterine bleeding) 8.37 (+/-3.9) (p<0.001)(6).
f. Intrauterine device (IUD)
Researchers at the School of Medicine, Zhejiang University, in the study of the expression of angiopoietin-1 and -2 in the endometrium of women with abnormal bleeding induced by an intra-uterine device, found that Immunohistochemical analysis showed elevated Ang-2 protein levels in secretory phase endometrium from IUD patients compared with the control women. These results suggest that the angiopoietin/Tie-2 system promotes vascular remodelling in the endometrium and that changes in the expression of Ang-1, Ang-2 and Tie-2 may contribute to abnormal uterine bleeding in some IUD users(7).
h. Miscarriage or ectopic pregnancy
h.1. Miscarriage
Miscarriage is defined as the loss of an embryo before the 20th week of pregnancy as it is incapable of surviving independently. In medical terminology, miscarriage is a type of abortion, as it refers to the pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or medically induced abortion. In US alone, over 15% of pregnancy ends in miscarriage.
Most common symptoms of miscarriage. 50% of bleeding during 20 weeks of pregnancy ends in miscarriage(8).
h.2. Ectopic pregnancy
Ectopic pregancy is defined as a condition in which the fertilized implant in somewhere else other than in the uterus. In most case, ectopic pregnancy occurrs in the one of the Fallopian tube, causinf tubal pregnancy. Ectopic pregnancy will end up in miscarriage as the fertilized can not survive outside of uterus. Bleeding occurs between 6 - 8 weeks of pregnancy may be a sign of miscariage due to the implant egg inability to survive out side of uterus(9).
i. Amenorrhea, age, PID, fibroids and ovarian masses
In the document sonographically identifiable causes of vaginal bleeding in secondarily amenorrhoeic women of child bearing age, showed that 75(73.2%) patients had pregnancy-related conditions, 14(13.7%) had normal, non-pregnant uteri while the remaining 13 (12.8%) had other gynaecological conditions namely pelvic inflammatory disease (PID), uterine fibroids and ovarian masses. Though pregnancy-related conditions are the major causes of vaginal bleeding in amenorrhoeic women of childbearing age, PID, fibroids and ovarian masses are possible findings(10).
j. Polycystic ovary syndrome
Polycystic Ovarian Syndrome is defined as endocrinologic diseases caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries as resulting of enlarged ovaries, leading to hormone imbalance( excessive androgen), resulting in male pattern hair development, acne,irregular period or absence of period, weight gain and effecting fertility. It effects over 5% of women population or 1 in 20 women(11).
h. Etc.
2. Risk factors
a. Physical, psychological and environmental factors
questionnaire survey was conducted on 14,752 women by trained doctors, when pregnant women came for the first antenatal examination, including sociodemographic characteristics, prior adverse pregnancy outcomes, diseases history, life event stress, adverse environmental exposure and detailed information on VB(12).
b. Age
The rate of postmenopausal vaginal bleeding during the study period peaks at the age of 55-59 years (25.9/1000 postmenopausal women/year) and declines thereafter(13).
c. Medical conditions and medication
People who have had medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus or taken certain medication such as steroids or blood thinnersare at incresed risk of vaginal bleeding(14)
d. Inherited bleeding disorders (IBDs)
Inherited bleeding disorders (IBDs) are by definition life-long. Women with IBDs are more likely to suffer HMB, to be symptomatic, and to present with bleeding in association with gynaecological problems. Heavy and/or abnormal menstrual bleeding increases with age due increased anovulatory cycles and gynaecological pathologies in older women(15).
d. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/22846527
(2) http://www.ncbi.nlm.nih.gov/pubmed/22764555
(2a) http://www.ncbi.nlm.nih.gov/pubmed/22230306
(3) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014910/
(4) http://www.ncbi.nlm.nih.gov/pubmed/22740005
(5) http://medicaladvisorjournals.blogspot.ca/2012/01/oral-contraception-pill-combined-oral.html
(6) http://www.ncbi.nlm.nih.gov/pubmed/11437723
(7) http://www.ncbi.nlm.nih.gov/pubmed/20233519
(8) http://medicaladvisorjournals.blogspot.ca/2012/01/miscarriage.html
(9) http://medicaladvisorjournals.blogspot.ca/2012/01/ectopic-pregnancy.html
(10) http://www.ncbi.nlm.nih.gov/pubmed/18923588
(11) http://medicaladvisorjournals.blogspot.ca/2012/01/overcome-infertility-fertility-and_13.html
(12) http://www.ncbi.nlm.nih.gov/pubmed/22584214
(13) http://www.ncbi.nlm.nih.gov/pubmed/20424279
(14) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014910/
(15) http://www.ncbi.nlm.nih.gov/pubmed/22445218
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