Acute Uterine Haemorrhage ✅
Related Subjects:
|Ectopic Pregnancy
| Ovarian Torsion
| Ruptured Ovarian Cyst
| Septic Abortion /Miscarriage
| Pelvic Abscess
| Acute Uterine Haemorrhage
| Pelvic Inflammatory Disease
🩸 Acute Uterine Haemorrhage (AUB)
⚠️ Acute uterine haemorrhage is a gynaecological emergency. Rapid recognition, resuscitation, and identification of the underlying cause are essential to prevent hypovolemic shock and maternal morbidity.
📋 Clinical Presentation
- Sudden, heavy vaginal bleeding ± clots.
- Associated symptoms: lightheadedness, syncope, fatigue, pallor.
- Signs of hypovolemic shock in severe cases: hypotension, tachycardia, cold clammy skin.
- History may suggest cause: recent delivery, miscarriage, fibroids, medications (anticoagulants, hormonal therapy).
🔬 Investigations
- 🩺 Clinical assessment: vital signs, haemodynamic stability, examination for ongoing bleeding.
- 💉 Laboratory tests:
- CBC → assess haemoglobin/haematocrit.
- Coagulation screen → PT, aPTT, INR if on anticoagulants or coagulopathy suspected.
- Blood group & crossmatch for transfusion if needed.
- 🖼 Imaging:
- Pelvic ultrasound → identify fibroids, polyps, retained products of conception, adenomyosis.
- Additional: consider pregnancy test to exclude miscarriage or ectopic pregnancy in reproductive-aged women.
⚙️ Management
- Initial Resuscitation (ABCDE approach):
- IV access with 2 large-bore cannulas
- Fluid resuscitation (crystalloids)
- Blood transfusion if Hb <7 g/dL, ongoing bleeding, or hemodynamic instability
- Monitor vitals, urine output, and serial haemoglobin
- Medical Management:
- Tranexamic acid: 1 g IV, repeat after 30–60 min if bleeding continues (max 4 g/day)
- Uterotonics:
- Oxytocin infusion (postpartum or post-miscarriage haemorrhage)
- Misoprostol or ergometrine depending on protocol
- Hormonal therapy: high-dose estrogen/progestins for non-pregnancy-related AUB (fibroids, endometrial causes)
- Surgical/Procedural Management:
- Dilation & curettage (D&C) → retained products of conception
- Uterine artery embolisation → fibroid-related bleeding
- Hysterectomy → reserved for life-threatening, refractory haemorrhage
- Monitoring & Support:
- Strict fluid balance, vitals, and repeated haemoglobin monitoring
- Multidisciplinary involvement: gynaecology, anaesthesia, critical care if shock present
📚 References
