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Gynecologic hemorrhage represents excessive bleeding of the female reproductive system. [1] [2] Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive.
[6] [7] In children, it may be challenging to determine the source of bleeding, and "vaginal" bleeding may actually arise from the bladder or urethra, or from the rectum. [12] Vaginal bleeding in the first week of life after birth is a common observation, and pediatricians typically discuss this with new mothers at the time of hospital discharge.
The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. [4] Postcoital bleeding can be one of the first indications of cervical cancer. [5] [6] There are other reasons why vaginal bleeding may occur after intercourse. Some women will bleed after intercourse for the first time but others will not.
Symptoms include vaginal bleeding that occurs irregularly, at abnormal frequency, lasts excessively long, or is more than normal. [1] Normal frequency of periods is 22 to 38 days. [1] [3] Variation in the length of time between cycles is typically less than 21 days. [3] Bleeding typically last less than nine days and blood loss is less than 80 mL.
Others have defined the condition as blood loss of greater than 1000 mL after either delivery method, or any amount of blood loss with signs and symptoms of hypovolemia. [7] Secondary postpartum bleeding is that which occurs after the 24 hours up to 12 weeks after childbirth. [7]
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A normal menstrual cycle is 21–35 days in duration, with bleeding lasting an average of 5 days and total blood flow between 25 and 80 mL. Heavy menstrual bleeding is defined as total menstrual flow >80ml per cycle, soaking a pad/tampon at least every 2 hours, changing a pad/tampon in the middle of the night, or bleeding lasting for >7 days.