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The bleeding is usually light, often referred to as "spotting," though a few people may experience heavier bleeding. [citation needed] It is estimated that breakthrough bleeding affects around 25% of combined oral contraceptive pill (COCP) users during the initial 3 to 4 months of use, it then usually resolves on its own. [8] [9]
Tranexamic acid, a clot stabilizing medication, may also be used to reduce bleeding and blood transfusions in low-risk patients, [31] however evidence as of 2015 was not strong. [2] A 2017 trial found that it decreased the risk of death from bleeding from 1.9% to 1.5% in women with postpartum bleeding. [3]
It is thus a progesterone withdrawal bleed. As there is no progesterone in the anovulatory cycle, bleeding is caused by the inability of estrogen—which needs to be present to stimulate the endometrium in the first place—to support a growing endometrium. Anovulatory bleeding is hence termed 'estrogen breakthrough bleeding'.
Other definitions of excessive postpartum bleeding are hemodynamic instability, drop of hemoglobin of more than 10%, [12] or requiring blood transfusion. In the literature, primary postpartum hemorrhage is defined as uncontrolled bleeding that occurs in the first 24 hours after delivery while secondary hemorrhage occurs between 24 hours and six ...
Lochia serosa which persists to some weeks after birth can indicate late postpartum hemorrhaging, and should be reported to a physician. Lochia alba (or purulenta) is the name for lochia once it has turned whitish or yellowish-white. It typically lasts from the second through the third to sixth weeks after delivery.
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Severe acute bleeding, such as caused by ectopic pregnancy and post-partum hemorrhage, leads to hypovolemia (the depletion of blood from the circulation), progressing to shock. [41] This is a medical emergency and requires hospital attendance and intravenous fluids , usually followed by blood transfusion .
Bleeding in excess of this norm in a nonpregnant woman constitutes gynecologic hemorrhage. In addition, early pregnancy bleeding has sometimes been included as gynecologic hemorrhage, namely bleeding from a miscarriage or an ectopic pregnancy, while it actually represents obstetrical bleeding. However, from a practical view, early pregnancy ...