Bleeding during pregnancy, at childbirth and in the postpartum period

Section is devoted to a very important obstetric pathology, as the bleeding during pregnancy and childbirth take in the structure of maternal mortality and currently one of the leading places. In connection with the fact that the causes of bleeding are many and varied, the section is divided into chapters corresponding to the individual types of parsing pathology. In addition to the etiology and pathogenesis of the disease, each Chapter outlines the treatment of this complication is the check of the required medications. Special attention in each Chapter is given to the role of midwives in the diagnosis of various pathological conditions that caused the bleeding, and tactics of nurses depending on conditions. In special sections provide brief information on thrombohemorrhagic syndrome, blood transfusion and blood substitutes.
The edition is intended for midwives and paramedics.
Section contains 47 figures and table.

Bleeding during pregnancy, at childbirth and in the postpartum period are frequent and life-threatening women complication. In the structure of maternal mortality they occupy one of the first places in this connection the problem of hemorrhages in obstetrics does not cease to be relevant. Although if there is bleeding in pregnant women, mothers or postpartum women and adolescent girls medical help she often has a doctor, nurse-midwife role in questions of timeliness of diagnosis of bleeding and establishment of suspected cause of his remains extremely important, as is often the first woman appeals to the midwife. In order to actively help the doctor in the fight against bleeding, midwife have to understand all the characteristics of the arisen disease. The Committee of experts of the world health organization in Geneva in October 1965 gave the following definition of responsibilities midwife: "In all cases, it (midwife) is obliged to be able to recognize the signs indicating pathology or the potential for rejection during childbirth, as she must inform the physician and be ready to provide emergency care in the absence of a doctor".
Especially important is the role of midwives working independently in obstetric departments of district hospitals, in the collective farm maternity hospitals, feldsher-midwife stations. In these conditions, the midwife must be able to understand the symptoms of the disease that caused bleeding, diagnosis and choose the right tactics of the patient. From the qualifications and experience of midwives often depends on the effectiveness of therapeutic measures in so-called obstetric bleedings, the reasons are many and varied.
Therefore, each midwife, no matter where she is now, should understand the etiology and pathogenesis of obstetric haemorrhages, be able to diagnose them, promptly call a physician, correctly and promptly organize first aid to a woman with the blood issue.
Various obstetric pathology, accompanied by bleeding (partial premature detachment normally situated placenta, placenta previa, hypotonic postpartum hemorrhage and others), may lead to a breach of blood clotting process. This state, known under the name of thrombohemorrhagic syndrome, in turn, is the cause sometimes fatal blood loss. Therefore, the problem of obstetric hemorrhages are closely related to the issues of blood coagulation and their violation. In this regard, each midwife needs to have an idea about the mechanism of development of thrombohemorrhagic syndrome in obstetrics and ways of its prevention.
The task of this section is more detailed than in the General guidelines for obstetrics, analysis of theoretical and mainly practical issues of diagnostics, treatment and prophylaxis of bleeding in pregnancy, childbirth and in the postpartum period. Clear organization of prevention and treatment of bleeding, based on knowledge of these issues will help to reduce mortality from this serious disease.