Vaginal bleeding refers to bleeding from any part of the reproductive tract, and its bleeding manifestations can be divided into menorrhagia and prolonged menstruation. Irregular bleeding or contact bleeding, etc., the amount of bleeding can be more or less. According to different reasons, vaginal bleeding can be divided into the following categories:
(1) endocrine related bleeding
The newborn, menstrual bleeding, bleeding associated with birth control pills, intermenstrual bleeding, postmenopausal uterine bleeding.
(two) bleeding related to pregnancy
Abortion, incomplete abortion, ectopic pregnancy, placenta previa, placental abruption, hydatidiform mole and choriocarcinoma.
(three) haemorrhage associated with inflammation
1. in vulva ulcer, vulva bleeding of urethral caruncle etc..
2. vaginal bleeding in vaginal ulcers, vaginitis, especially senile vaginitis, trichomonas vaginitis and so on.
3. cervical bleeding in acute cervicitis, chronic cervicitis, cervical erosion, cervical polyps and so on.
4. uterine bleeding in acute endometritis, chronic endometritis, uterine inflammation, acute pelvic inflammatory disease, chronic pelvic inflammatory disease, etc..
(four) tumor related bleeding
Irregular vaginal bleeding in 1. young girls is seen in grape like sarcoma.
2. more than middle-aged women vaginal bleeding is more common in uterine fibroids.
3. middle-aged or postmenopausal women with contact or irregular bleeding in cervical cancer, endometrial cancer, ovarian tumors, etc..
(five) trauma related bleeding
1. trauma induced bleeding.
2. bleeding after intercourse: rupture of the hymen, rupture of the vaginal wall or posterior fornix.
(six) hemorrhage associated with systemic diseases
Disseminated intravascular coagulation in patients with liver disease, aplastic anemia, thrombocytopenic purpura, leukemia and obstetrics and Gynecology diseases.
First, endocrine related vaginal bleeding
The most common disease is dysfunctional uterine bleeding, and its pathogenesis is related to the following factors.
When 1. sex hormone secretion is dysfunctional and anovulatory dysfunctional uterine bleeding, single and long-term estrogen stimulation makes endometrial hyperplasia, hyperplasia to high adenoid cystic type, adenoma type hyperplasia, and even gradually become endometrial cancer. Due to the lack of progesterone antagonism and glandular secretion, endometrial hypertrophy, glandular enlargement, glandular cavity enlargement, glandular epithelial dysplasia. Endometrial blood flow increased, spiral arterioles tortuous winding. The Department of estrogen induced acidic polysaccharide (AMPS) polymerization and gelation, the interstitial vascular permeability decrease, influence of material exchange, resulting in local endometrial tissue ischemia, necrosis and shedding caused by bleeding, while the acidic polysaccharide Department cohesion, but also hinder the uterine endometrium is detachable, the non synchronous exfoliation, caused by long-term irregular bleeding endometrium.
When ovulatory dysfunctional uterine bleeding occurs, the corpus luteum or premature degeneration leads to the short luteal phase and frequent occurrence, or atrophy and progesterone secretion, resulting in luteal phase (premenstrual) bleeding, prolonged menstruation, dripping, or both. The mechanism is that the secretion of estrogen and progesterone is insufficient, especially progesterone secretion is insufficient, in order to make the endometrium fully secretory, glands, interstitial and vascular immature development, and because of estrogen and progesterone asynchronous withdrawal, resulting in irregular endometrial exfoliation and abnormal bleeding.
The role of prostaglandin 2. known prostaglandin (PGs), especially in PGE2 (TXA2) - PGF2 suppository and prostacyclin (PGL2) for blood and blood coagulation function in a group of strong activity regulating factors, they adjusted uterine blood flow, spiral arterioles and microcirculation, muscle activity, inner membrane lysosomal function and blood coagulation. The effect of fibrinolytic activity in endometrial bleeding function.
TXA2 produces platelet and induces microvascular contraction. Platelet aggregation, thrombosis and hemostasis. But PGL2 is formed in the wall of the blood vessel, and the effect is contrary to TXA2, and it expands the microvessel strongly, resisting platelet aggregation and preventing the formation of thrombus. PGFa can induce the spiral artery contraction of endometrium, while PGE2 acts as vasodilator. So TXA2 and PGL2, PGF2a. Dysfunction of PGE2 and function may cause endometrial bleeding.
3. endometrial spiral arteries and lysosomal structure and abnormal function of spiral arteries abnormal interference endometrial microcirculation function, effect of endometrial shedding and repair function and vascular dissection surface epithelium, vasomotor function and local blood coagulation fibrinolytic function leads to abnormal uterine bleeding. From follicular phase to luteal phase, lysosomal number and enzyme activity increased. Progesterone stabilized and estrogen destroyed the stability of lysosomal membranes. Therefore, the imbalance of estrogen / progesterone before menstruation will destroy the stability of lysosomal membrane, rupture of lysosomal membrane and release and release of destructive hydrolytic enzymes, which will lead to rupture of endometrial cells, collapse, necrosis and bleeding of intima.
Reduce the coagulation factor V, VII, x, XII deficiency anemia, thrombocytopenia, often associated with blood clotting factor 4. dysfunctional uterine bleeding, iron deficiency. At the same time, the activity of plasmin increased and the plasmin was activated by plasmin. Plasmin cleaved fibrin, increased fibrin degradation products, decreased plasma fibrin, and formed the state of uterine fibrinogen, thus affecting coagulation and hemostasis in the apical arteriole and vascular lake of normal endometrium, leading to long-term massive hemorrhage.
Two. Vaginal bleeding associated with pregnancy
Vaginal bleeding associated with pregnancy is common in abortion. Most of the early aborted embryos died, necrosis and bleeding of the basal decidua caused the villi of the embryo