There is still bleeding after more than ten days of curettage

The body cannot recover so quickly after uterine curettage, so there will still be bleeding after uterine curettage. However, this bleeding phenomenon is generally not very serious and will stop after about a week. Of course, sometimes there are some special people, and the bleeding time may be prolonged. The longest should not exceed ten days. If bleeding continues after ten days, you should go to the hospital in time. Why is there still bleeding more than ten days after uterine curettage?

1. How long does it take for the bleeding to stop after curettage?

1. Bleeding will generally stop within a week after curettage, and no more than ten days at most. If the bleeding lasts for more than ten days, it is recommended to go to the hospital in time to check the recovery of the uterus to see if it is due to incomplete light work or endometrial infection.

2. Bleeding after uterine curettage is normal, but the bleeding should not last too long. It is normal to have a small amount of bleeding within one month after medical abortion. You should rest well after the curettage, avoid being exposed to wind and avoid contact with cold water.

3. Bleeding after incomplete abortion and curettage usually occurs within 15 days. It is normal if the amount is less than the menstrual amount, usually within 7 days, and most of the time it is 3 to 7 days. If it is not clean for half a month or the daily amount is more than the menstrual period, you need to go to the hospital for a B-ultrasound to see if another curettage is needed. After curettage, take antibiotics to prevent infection and motherwort to help the uterus recover.

2. Endometritis

Causes

1. Pregnancy and childbirth

Puerperal infection and septic abortion are common causes of acute endometritis. A small amount of fetal membrane or placenta remaining in the uterine cavity after delivery, or incomplete uterine involution at the site of placental attachment, can cause chronic endometritis.

2. Uterine surgery and intrauterine contraceptive device placement

Intrauterine surgical procedures, especially informal induced abortions, can lead to bacterial invasion and infection. Long-term stimulation from an intrauterine contraceptive device can cause chronic endometritis.

3. Not paying attention to personal hygiene

This disease is also likely to occur during sexual intercourse during menstruation and with the opposite sex who has a sexually transmitted disease.

4. Intrauterine lesions

Endometrial polyps, submucosal fibroids, or necrosis of endometrial cancer can cause endometrial infection.

5. Other gynecological inflammation

The ascending infection of cervicitis and vaginitis, and the downward spread of fallopian tube and ovarian inflammation can all lead to the occurrence of endometritis.

6. Low estrogen levels

After menopause or post-menopause, the estrogen level in the body decreases, the acidity in the vagina decreases, and the cervical mucus plug decreases. The body's physiological barrier function weakens, making it easier for bacteria to invade.

Clinical manifestations

1. Chronic endometritis

1. Symptoms

(1) Pelvic pain: Pain in the lower abdomen and lumbar pain during the menstrual interval. Some patients may not have any symptoms.

(2) Increased vaginal discharge is caused by increased secretion of endometrial glands. It is usually thin, watery, light yellow, and sometimes bloody. Senile endometritis presents as purulent leucorrhea, which often contains a small amount of blood. When there is pyometra, the discharge is purulent and has a foul odor.

(3) Menorrhagia: Menstrual periods are regular but the amount of menstrual blood doubles and the bleeding period is significantly prolonged. Irregular bleeding is less common.

(4) Dysmenorrhea is more common in nulliparous women, but severe dysmenorrhea is rare. It may be caused by excessive thickening of the endometrium, which hinders normal tissue degeneration and necrosis, and stimulates excessive spasmodic contractions of the uterus.

2. Physical signs

The uterus may be enlarged and tender; the parauterine tissue may be thickened and tender. In mild inflammation, no abnormalities may be found during bimanual examination. When uterine pyometra occurs, the uterus will be enlarged, spherical, soft and tender. Speculum examination can reveal that the cervix is ​​discharging bloody pus with a foul odor.

(ii) Acute endometritis

1. Symptoms

Mild fever, lower abdominal pain, increased leucorrhea, sometimes bloody, and with a foul odor if it is an anaerobic infection. The symptoms of acute endometritis that occurs after delivery or abortion are more severe, while endometritis caused by other reasons is mostly mild.

2. Physical signs

The uterus may be mildly tender during examination. If the condition is not controlled in time, it will further cause uterine myositis, acute salpingitis, pelvic inflammatory disease, etc. The patient's body temperature will rise significantly, reaching above 39°C, and there will be obvious tenderness in the lower abdomen.

complication

1. Pyometra

When endometritis causes cervical adhesion and blockage, the inflammatory secretions in the uterine cavity cannot flow out and accumulate in the uterine cavity, which may form intrauterine abscesses.

2. Pelvic inflammatory disease

If acute endometritis is not treated in time, it may further develop into salpingo-oophoritis, pelvic peritonitis, pelvic connective tissue inflammation, pelvic phlebitis, and even develop into sepsis.

3. Infertility

Inflammated endometrium is not conducive to the implantation of the fertilized egg, or the implantation of the fertilized egg is unstable, leading to infertility. Endometritis can also affect the fetus and cause malformations, miscarriage, premature birth, premature rupture of membranes, neonatal infection, etc.

treat

1. General treatment

(1) Nutrition and water can be supplemented intravenously, and attention should be paid to correcting electrolyte imbalance and acidosis;

(2) Patients with acute endometritis should rest in bed, preferably in a semi-recumbent position, to facilitate the limitation of inflammation and drainage of uterine secretions;

(3) Apply hot compress to the lower abdomen to promote the absorption of inflammation and relieve pain;

(4) Maintain smooth bowel movements to relieve pelvic congestion and facilitate toxin excretion;

(5) Physical cooling can be used when the fever is high;

(6) Excessive gynecological examinations should be avoided to prevent the spread of inflammation.

2. Medication

(1) Antibiotic treatment is mainly based on antibiotic treatment. The principles of antibiotic treatment are: empirical, broad-spectrum, timely and individualized. The selection of antibiotics should cover all possible pathogens, or antibiotic treatment should be selected based on the results of pathogen culture and drug sensitivity.

(2) Intrauterine drug administration: For married patients, intrauterine drug administration can be used. Before the operation, the size and position of the uterus should be determined by bimanual examination. After the vulva and vagina are disinfected and the depth of the uterine cavity is detected, a sterile urinary catheter is inserted from the cervical os into the uterine cavity. The depth should be less than 0.5 cm. The selected drug is slowly injected into the uterine cavity through the urinary catheter. After all the drug liquid has entered the uterine cavity, the urinary catheter is removed, and the patient should lie flat or in bed with the hips elevated for 1 to 2 hours. This method is repeated once a day and is discontinued during menstruation. Since this method can make the drug act directly on the lesion, it is often effective.

(3) Cleaning the uterine cavity: If endometritis occurs after delivery or abortion, if there is suspected placental tissue residue, it should be removed immediately while using antibiotics. When the antibiotics reach a certain dose and the inflammation is under control, curettage can be performed to prevent the spread of inflammation. If there is active uterine bleeding, the uterine cavity can be cleaned with the use of large amounts of antibiotics.