Pelvic hemorrhage

Jander HP, Russinovich NAE (1980) Transcatheter Gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage. Radiology 136 337-344... 

Vedantham S, Goodwin SC, McLucas B, et al. (1997) Uterine artery embolization an underused method of controlling pelvic hemorrhage. Am J Ohstet Gynecol 176 938-948... 

Once the suspicion of pelvic hemorrhage has been raised, one must systematically follow a protocol that will ensure injuries and sources of bleeding are addressed in order of gravity. Heetveld et al. [39] published an evidence-based algorithm for the management of hemodynamically unstable pelvic fracture patients (Table 5.2). 

Saueracker AJ, McCroskey BL et al. (1987) Intraoperative hypogastric artery embolization for life-threatening pelvic hemorrhage a preliminary report. J Trauma 27(10) 1127-9... 

Katz DS, Lane MJ, Mindelzum RE (1999) Unenhanced CT of abdominal and pelvic hemorrhage. Semin Ultrasound CT MRl 20 94-107... 

Twenty percent of patients receiving pelvic irradiation may experience hemorrhagic cystitis, especially with concurrent cyclophosphamide. Viral infections commonly associated with this condition occur most frequently in bone marrow transplant recipients who also may receive cyclophosphamide. 

Caution [C, ] Remove w/ intrautCTine PRG, increased risk of comps w/ PRG and device in place Contra Acute PID or in high-risk behavior, postpartum endometritis, cCTvicitis Disp 52 mg lUD SE PRG, ectopic PRG, pelvic Infxn immunocompromised, embedment, perforation expulsion, Wilson Dz, fainting w/ insCTt, vag bleeding, emulsion EMS Can pierce the uterus and cause severe internal hemorrhage OD Unlikely, but may cause a life-threatening t in copper level Cortisone See St oids, and Tables VI-1 and VI-2... 

Abdomen Unexplained hypotension may be the result of an internal hemorrhage. Peritoneal lavage, ultrasound, and abdominal CT may be necessary to rule out injury. Frequent reassessment is necessary as signs of abdominal injury change with time. Avoid pelvic manipulation if possible due to the potential for internal hemorrhage. 

Musculoskeletal All extremities, the pelvic ring, peripheral pulses, and thoracic and lumbar spine should be assessed. If necessary. X-rays should be obtained when the patient is stabilized. Hemorrhage from pelvic fractures is not uncommon. Hand, foot, and wrist fractures and soft tissue injuries may be missed. Frequent reevaluation should take place to identify these. 

Oxytocin is a hypothalamic nonapeptide that selectively stimulates the smooth muscle of the uterus and mammary glands. It is used in the induction or augmentation of labor and to prevent postpartum hemorrhage, and is well tolerated and effective in a wide range of infusion rates and concentrations. Contraindications to its use include placenta previa or vasa previa, a previous classical uterine incision, pelvic structural deformities, and an abnormal fetal presentation. Large fetal size and high maternal parity are relative contraindications. Prior non-classical cesarean delivery should not preclude oxytocin therapy. 

Indications Replete heat and fire toxins, exuberant heat in the three burners patterns. Septicemia, dysentery, pneumonia, acute urinary tract infections, ulcers, carbuncles, furuncles, boils, acute enteritis, acute icteric hepatitis, acute cholecystitis, encephalitis, acute conjunctivitis, acute pelvic inflammation, erysipelas, cellulitis, hemoptysis, epistaxis, urticaria, pruritus, cerebral hemorrhage, hypertension, anxiety, palpitations, insomnia, neurasthenia, and hysteria... 

Adverse events and side effects reported in association with castor oil include thrombosed hemorrhoids, precipitous labor, nausea, vomiting, diarrhea, intestinal colic, flatulence, disturbances of electrolyte balance, dehydration, hemorrhagic gastritis, hyperemia of the pelvic organs, hemolysis, and liver cell necrosis (Lippert and Mueck 2002 McFarlin et al. 1999). 

Agolini, S.F., Shah, K., Jaffe, J., Newcomb, J., Rhodes, M., Reed, J.F. 1997. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 43, 395-399. 

Concomitant venous/bone marrow hemorrhage (major venous injury, unstable pelvic fracture with marrow bleeding)... 

Coils are available in a wide variety of sizes from 2 mm to 15 mm in size and are made from either stainless steel or platinum and may have Dacron fibers placed at right angles to the long axis of the coil to increase the surface area and thereby to increase the speed and permanence of thrombosis. In practice, most coils utilized in microcatheters are platinum and those in 4- to 5-F catheters, stainless steel. It should be noted that all coils are permanent devices and should be utilized when the desired occlusion is permanent. Coils should not be used in combination with particulate embolization for the treatment of tumors, as they will occlude the access for further treatment. Coils may, on the other hand, be utilized with Gelfoam embolization in the treatment of pelvic bleedings allowing the hemorrhage to be halted quickly and permanently. 

Pisco JM, Martins JM, Correia MG (1989) Internal iliac artery embolization to control hemorrhage from pelvic neoplasms. Radiology 172 337-339... 

Lang EK (1981) Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology 140 331-339... 

Ben-Menachem Y, Coldwell DM, Young JWR, et al. (1991) Hemorrhage associated with pelvic fractures causes, diagnosis, and emergent management. AJR Am J Roentgenol 157 1005-1014... 

Collins CD, Jackson JE (1995) Pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum hemorrhage, gin Radiol 50 710-713... 

Oman D, White R, Pollack J, Tal M (2003) Pelvic embolization for intractable post partum hemorrhage long term follow-up and implication for fertility. Obstet Gynecol 102 904-10... 

Margolies MN, Ring EJ, Waltman AC, Kerr WS Jr, Baum S (1972) Arteriography in the management of hemorrhage from pelvic fractures. N Engl J Med 287 317-321... 

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