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Management of hemorrhage in gynecologic surgery

William H Parker, MD
Willis H Wagner, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Intraoperative hemorrhage is generally defined as blood loss exceeding 1000 mL or requiring a blood transfusion [1]. Massive hemorrhage refers to acute blood loss of more than 25 percent of a patient's blood volume or bleeding that requires emergency intervention to save the patient's life [2].

Severe postoperative anemia impacts perioperative morbidity and mortality [3]. This was illustrated in a study of hospitalized patients who refused blood transfusion for religious reasons: mortality increased as hemoglobin levels fell below 7 g/dL.

This topic review will discuss management of hemorrhage in gynecologic surgery. Surgical technique for specific procedures, incisional bleeding, and management of other complications of gynecologic surgery are reviewed separately. (See "Complications of abdominal surgical incisions" and "Complications of gynecologic surgery".) (Also see individual gynecologic surgery topic reviews).


Preoperative evaluation with a focus on preventing and preparing for perioperative hemorrhage is discussed below. Preoperative assessment for gynecologic surgery is discussed in full elsewhere. (See "Overview of preoperative evaluation and preparation for gynecologic surgery".)

Medical history — Important elements of the history are a personal or family history of prolonged bleeding, transfusion, or persistent anemia. Nongynecologic etiologies of bleeding symptoms may be present. For example, menorrhagia, a common indication for gynecologic surgery, can be a presenting symptom of von Willebrand disease (VWD). (See "Approach to the adult patient with a bleeding diathesis".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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