From the Guidelines
For cervical bleeding, the most effective management approach is to apply direct pressure to the bleeding site using gauze or cotton swabs for 15-20 minutes, as this method is simple, non-invasive, and can be highly effective in controlling bleeding, thereby reducing morbidity and mortality associated with uncontrolled bleeding 1.
Management of Cervical Bleeding
The primary goal in managing cervical bleeding is to control the bleeding and prevent further complications.
- Direct pressure using gauze or cotton swabs is the first line of management.
- If bleeding persists, other methods such as silver nitrate cauterization or the application of Monsel's solution (ferric subsulfate) can be considered.
- In more severe cases, suturing with absorbable sutures or the use of vasopressin may be necessary.
Importance of Underlying Cause Identification
It is crucial to identify and treat the underlying cause of cervical bleeding, such as cervical polyps, cervicitis, or malignancy, as these conditions can significantly impact morbidity, mortality, and quality of life 1.
Screening and Prevention
Regular screening for cervical cancer, as recommended by the USPSTF, can help in the early detection and treatment of precancerous lesions and cervical cancer, thereby reducing the risk of cervical bleeding and associated complications 1.
Treatment Considerations
Treatment should be individualized based on the severity of bleeding, the underlying cause, and the patient's overall health status, with the goal of minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Menace for Cervical Bleeding
- Cervical bleeding is a common complication of surgery for cervical intra-epithelial neoplasia, and good surgical technique and other interventions can reduce immediate and long-term blood loss 2
- Vasopressin has a beneficial effect on peri-operative bleeding, and prophylactic tranexamic acid reduces haemorrhage after knife and laser cone biopsy 2
- Packing with Monsel's solution results in less peri-operative blood loss and secondary haemorrhages than routine suturing, and elective suturing increases the risk of amenorrhoea and dysmenorrhoea 2
- Topical administration of tranexamic acid reduces intraoperative and postoperative blood loss in patients undergoing posterior cervical laminectomy and fusion surgery 3
- Blood transfusions may correlate with worse survival outcomes in patients with solid cancers, but the role of blood transfusions in increasing the risk of developing recurrence in locally advanced cervical cancer patients is unclear 4
- Single-dose tranexamic acid given intravenously immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and blood transfusions 5
- Tourniquets and hemostatic dressings are associated with a decrease in mortality and a shorter time to hemostasis, respectively, in the control of severe, life-threatening external bleeding in the out-of-hospital setting 6
Interventions to Reduce Blood Loss
- Vasopressin: reduces peri-operative bleeding 2
- Tranexamic acid: reduces haemorrhage after knife and laser cone biopsy, and reduces intraoperative and postoperative blood loss in patients undergoing posterior cervical laminectomy and fusion surgery 2, 3
- Monsel's solution: results in less peri-operative blood loss and secondary haemorrhages than routine suturing 2
- Haemostatic sutures: may have an adverse effect on blood loss, cervical stenosis, and satisfactory colposcopy 2
- Tourniquets: associated with a decrease in mortality in the control of severe, life-threatening external bleeding in the out-of-hospital setting 6
- Hemostatic dressings: result in a shorter time to hemostasis than direct manual pressure using standard dressings 6