Gynaecological haemorrhage

Primary or recurrent neoplasms of the uterus, cervix, vagina, or vulva may present with recurrent small bleeds or with massive life-threatening haemorrhage. Haemorrhagic metastases may also cause varying degrees of bleeding. Massive haemorrhage may be the terminal event in patients with end-stage disease.

Vaginal packing can be a useful holding measure while more definitive treatment is decided. Bleeding originating from the uterus or cervix is best treated with brachytherapy. A central tube is inserted into the uterine cavity and two ovoids are inserted into the vaginal fornices. The applicators are then loaded with caesium 137. External-beam radiotherapy can be integrated at a later date if indicated.

Vaginal bleeding more commonly arises from haemorrhagic metastases. A vaginal tube can be inserted and subsequently loaded with caesium or external-beam radiotherapy can be offered, usually to a dose of 20 Gy in four or five fractions. In severe cases, surgical ligation of the branches of the internal iliac artery may be required.

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