
yoniyil rakthasraavamundaakunnu.

yoniyil ninnu raktham puranthallunnathaanu yoniyile rakthasraavamennartham. garbhaashayathil ninno yoniyude mathilil ninno servixil ninno eee rakthasraavathinte uthbhavam undakam. saadhaaranayaayi, ithu oru saadhaarana aarthavachakrathinte bhagamaanu allengil hormon allengil garbhaashayathile asaadhaaranamaaya rakthasraavampolulla prathyulpaadana samvidaanathinte mattu prasnangal moolamaanu undaakunnath.
garbhaavasthayil, prathyekichu garbhaavasthayude thudakkathil, yoniyil rakthasraavamundaakunnath saadhaaranamaanu. ennirunnaalum, rakthasraavam vaidyashaasthraparamaayi abhisambodhana cheyyenda garbhakala sankeernathayeyum soochippikkaam. garbhakaalath rakthasraavam saadhaaranayaayi garbhakalavumaayi bandhappettirikkunnu, pakshe ellaayppozhum allah.
prathyulpaadana varshangalile, aarthava samayat, pathivayi prathimasa yoniyil rakthasraavamundaakunnath oru saadhaarana shaareerika prakriyayaan. prathyulpaadana varshangalil, amithamaya rakthasravavum (menorajia allengil kanatha aarthava rakthasravavum), prathimasa aarthava kaalayalavukalkidayil (aarthavaviramam) sambhavikkunnu, oro 21 divasathilum kooduthal thavana sambhavikkunnu (asaadhaarana garbhashaya rakthasravavum), valare apoorvamaayi sambhavikkunnu (oligomenoria), allengil yoniyile laingikabandhathinu sesham sambhavikkunnu (poost koyittal rakthasravavum).
asaadhaaranamaaya yoniyile rakthasraavathinte kaaranagal praayathinanusarichu vyathyaasappedunnu, atharam rakthasraavangal hormon asanthulithaavastha allengil annovulation muthal maarakathvam (servical cancer, yoniyile cancer allengil garbhashaya arbudam) vareyulla prathyeka medical avasthakalude adayaalamaakaam. mikka muthirnna sthreekalkkum rakthasraavathinte sthalam thirichariyaan kazhiyumenkilum, cheria kuttikalilum, allengil budhishoonyathayulla prayamaaya muthirnnavarilum, rakthasraavam vyakthamallayirikkaam, athu yoniyekkaal moothranaaliyilo (hematturiya) malaashayathilo aayirikkam. praayapoorthiyaakaatha kuttikalilum aarthaviraamathinu sheshamulla sthreekalilum yoniyil rakthasraavamundaakumbol, athinu ellaayppozhum vaidyasahaayam aavasyamaanu.
deferential diagnosis.
aarthava rakthasraavathinte asaadhaaranathakalkkulla padangalum nirvachanangalum lalithamaakkunnathin roopakalppana cheytha oru anthaaraashtra prakriyayude falamaayaanu saadhaarana aarthavathinulla maanadandangal nirvachichirikkunnathu. asaadhaaranamaaya yoniyile rakthasraavathinte kaaranagal praayathinanusarichu vyathyaasappedunnu.
kuttikalil.
aarthavaviramam prathekshikkunna samayathinu munbum uchithamaaya praayapoortthiyaakunna vikasanathinte abhaavathilum ithu sambhavikkukayaanenkil kuttikalil rakthasraavamundaakunnath aashankaajanakamaanu. praayapoorthiyaakunnathinna munbulla rakthasraavam vilayiruthalinu arhamaanu. ithu praadeshika kaaranangalal allengil hormon gadakangalaal undakam. kuttikalil, rakthasraavam nirnnayikkunnath budhimuttaayirikkaam, koodaathe "yoniyile" rakthasraavam yadhaarthathil moothrasanchiyil ninno moothranaaliyilo malaashayathilo ninnu undakam.
jananathinu sheshamulla jeevithathinte aadya aazhchayil yoniyil rakthasraavamundaakunnath oru saadhaarana nireekshanamaanu, ashupatri vidunna samayat pediatricianmaar saadhaaranayaayi puthiya ammamaarumaayi ithu charcha cheiyunnu. kuttikkaalathu, yoniyil oru videsha vasthuvinte saannidhyam, aaghaatham (aakasmikamo aakasmikamallaathatho), athaayath mattu saadhyamaaya kaaranagal ulppedunnu.iii. kuttikalude laingikaathikramam allengil peedanam), moothranaaliyile prolapse, yoniyile anubadha (vaaginitis), valvar alsar, lycan sclerosus polulla valvar charmma avasthakal, apoorvvamaayi tumour (haanikaramallaathatho maarakamo aaya yoniyile tumours, allengil hormon uthppaadippikkunna andashaya tumours). hormon kaaranagal central precosius pueberty, allengil peripheral precosius pueberty (mccune-aalbrait syndrome), allengil primery hypothyroidism ennivayaanu.
rogalakshanam saadhaaranayaayi maathaapithaakkalkk bhayappeduthunnathaanenkil, mikka kaaranangalum soumyamaanu, ennirunnaalum laingika durupayogamo tumoro ozhivaakkendathu pradhaanamaan. oru yoniyude forin bodyo tumeraeo ozhivakkaan anastheshyaykku (yuva) keezhilulla oru parisodhana aavashyamaayi vannekkaam, ennirunnaalum oafees hysteroscopic roopakalppana cheytha upakaranangal chilappol oafees yonikoppikkaayi topical anastheshyayulla kuttikalil upayogikkaam, ithu mayakkathinteyo general anaesthesiayudeyum ooppareshan room samayathinteyum aavasyakatha ozhivaakkunnu.
aarthavaviraamathin munbu.
pashchaathalam.
aarthavaviraamathin munbulla sthreekalil, garbhaashayathil ninno valvar allengil yoniyile murivukalil ninno servixil ninno rakthasraavamundaakam. rakthasraavam moolamaanennu nirnnayikkaan gynaecological parisodhana nadatthaam. sthreek garbhathekkurichu ariyillengilum, swaabhaavika garbhachhidram (garbhachhidram), ectopic garbham, marupillayude asaadhaarana valarcha thudangiya garbhakala sankeernathakalude falamaayum rakthasraavamundaakam. roganirnayathilum maanejmentilum eee saadhyatha manassil sookshikkanam.
saadhaaranayaayi, garbhinikalallaattha aarthavaviraamathin munbulla sthreekalil asaadhaaranamaaya garbhashaya rakthasraavathinte kaaranagal fibroidukal, polypse, poolisistik oovari syndrome (pcos) polulla hormon vaikalyangal, raktham kattapidikkal vaikalyangal, cancer ennivayaanu. servicitis allengil pelvik inflammatory disease (piedi) polulla anubadhakal yoniyil rakthasraavathinu kaaranamakum. laingikabandhathinu sesham undaakunna rakthasraavamaanu poost koyittal rakthasraavamennath. avasaanamaayi, janana niyanthranatthinte saadhaaranavum saadhaaranavumaaya paarshwafalangalil yoniyil paadukal allengil rakthasravavum ulppedunnu.
klinikkal maargganirddeshangal (figo vargeekaranam).
asaadhaaranamaaya garbhashaya rakthasraavathinte kaaranangale tharamthirikkunnathinaayi paam-koyina sisttam ennu vilikkunna kooduthal nirddishta klinikkal maargganirddesham figo (internaashanal federation oof gynaecology aandu obstetriks) vikasippicheduthittundu. eee churukkezhuthu "pii" olip "," eiii "denomyosis", ell "eomioma", emm "alainancy aandu hyperplasia", sii "oguloppathi", oo "valettari disordezhs", iii "endometrial disordezhs", aii "atrogenic kaaranagal, enn" odi classified ennivaye soochippikkunnu. figo aarthava vaikalya group, anthaaraashtra vidagtharil ninnulla inputtode, asaadhaarana rakthasraavathekkurichu lalithamaaya vivaranam shupaarsha cheythu, athu menorrhagea, metrorejiya, hypermenoria, pravarthanarahithamaaya garbhashaya raktasrava (dub) thudangiya avyakthamaaya padangal upekshichu rakthasraavam sambandhicha playin engleesh vivaranagalkk anukoolamaayi saikkil kramam, aavruthi, dairkhyam, alavu ennivayude adisthaanathil yoniyile rakthasraavathe vivarikkunnu.
eenthappanayude kaaranagal garbhaashayathinte gadanaaparamaaya, shareeraghadana, hystolopathic kaaranangalumayi bandhappettirikkunnu, avaa oru kshathatthinte histolaji kaanunnathin ultraasoundu allengil biopsy polulla imaging teknikkukal upayogichu vilayiruthaan kazhiyum. asaadhaaranamaaya rakthasraavathinte coyin kaaranagal gadanaaparamaaya kaaranangalumayi bandhappettathalla.
garbhadharanam.
garbhatthinte aadya thrimaasathil <aii. dii. 1> samayathaan yoniyil rakthasraavamundaakunnath. ithil pakuthiyum garbhachhidrathinum pakuthiyum garbhasthashishuvine garbhadhaaranathinu vidheyamaakkunnu. marupillayude sankeernathakal ulppede pala kaaranangalund, athaayath plaasantal abraption, plaasanta previa. garbhachhidram, ectopic garbham, mollar garbham, kazhivillaatha servics, garbhashaya villal, akaala prasavavadhi ennivayaanu mattu kaaranagal. garbhaavasthayude thudakkathil rakthasraavamundaakunnath garbhachhidram undaakunnathinte soochanayo apoornnamo aakam.
randaamatheyo moonnaamatheyo thrimaasathil marupillayude (bhaagikamaayo poornnamaayum servixinu mukaliloo ulla marupilla) rakthasraavam valare gurutharamaayekkaam. garbhaashayathile rakthasravavum garbhashaya vedanayumaayi palappozhum bandhappettirikkunnu.
aarthaviraamathinu sheshamulla.
aarthaviraamathinu sheshamulla yoniyile rakthasraavathinte saadhaarana kaaranangalaanu endometrial atrophy, garbhaashayathile fibroidukal, endometrial cancer enniva. ekadesham 10 sathamaanam kesukalum endometrial cancer moolamaanu. garbhaashayathinte mathililum parisaratthum sthithicheyyunna peshi koshangalum mattu tissuekalum kondu nirmmicha haanikaramallaatha tumourukalaanu garbhaashayathile fibroidukal. fibroidukal ulla sthreekalkku ellaayppozhum lakshanagal undaakilla, ennaal chilarkk aarthavangalkkidayilula yoniyile rakthasravavum laingikathaykkidayilulla vedana naduvedana anubhavappedunnu. 
diagnostic vilayiruthal.
rakthasraavam, shaareerika parisodhana, uchithamaaya mattu medical parisodhanakal ennivayude adisthaanathil rakthasraavam undakanulla kaaranam palappozhum thirichariyaan kazhiyum. yoniyile rakthasraavam vilayiruthunathinulla shaareerika parisodhanayil saadhaaranayaayi oru speculum upayogichu serviksinte drishyavalkkaranam, oru baimanuval parisodhana, oru rectovaginal parisodhana enniva ulppedunnu. rakthasraavam moolakaaranam kandethunnathilum rakthasraavam undaakkunna enthengilum asaadhaaranathakal kandethunnathilum iva shradha kendreekarikkunnu. koodaathe, rakthasraavam uthbhavasthaanath vayarilaano ennu kandethaan wier parisodhikkukayum spandikkukayum cheiyunnu. saadhaaranayaayi oru garbha parisodhanayum nadathunnu. rakthasraavam amithamo deerghakaalamo aanenkil, vilarcha parisodhikkaan oru sii. bii. sii upayogapradamaakum. asaadhaaranamaaya endometrium oru biopsy allengil dilation aandu curetteju upayogichu oru hysteroscopy vazhi anweshikkendathundu.
aarthaviraamathinu sheshamulla rakthasraavangal.
aarthaviraamathinu sheshamulla yoniyile rakthasraavathil, eathoru diagnostic vilayiruthalinteyum praadhamika lakshyam endometrial hyperplassy maarakathvavum ozhivaakkuka ennathaanu. traansvaajinal ultrasonography, endometrial sample enniva prarambha moolyanirnnayathinulla saadhaarana reethikalaanu. american koleju oof obstetrishyans aandu gynaecologistukalude (akog) maargganirddeshangal eathu rogikalkkaanu endometrial kaansarinulla saadhyatha kooduthalennu thirichariyaan uchithamaaya aadya nira nadapadikramamaayi traansvaajinal ultrasonography shupaarsha cheiyunnu. thaazhepparayunna kandethalukalum koodaathe/allengil lakshanangalum undengil endometrial sample soochippikkunnu
pipel polulla endometrium sample upakaranam upayogichu endometrial biopsy vazhiyo allengil hysteroscopy upayogicho allaatheyo dilation aandu curetteju (dii & sii) vazhiyo endometrial sample labikkum.
figo vargeekaranam.
2011-ll, internaashanal federation oof gynaecology aandu obstetriks (figo) prathyulpaadana varshangalil asaadhaarana garbhashaya rakthasraavamulla (eiii. oo. bii) sthreekalude gaveshanam, vidyaabhyaasam, klinikkal paricharanam enniva sahaayikkunnathin roopakalppana cheytha rund samvidaanangale amgeekarichu.
sankeernathakal.
ectopic garbhadharanam, prasavaananthara rakthasraavangal enniva polulla kadinamaaya rakthasraavangal hypovolamiyayilekku (rakthachamkramanathil ninnu raktham kurayunnathu) nayikkukayum njettalilekku neengukayum cheiyunnu. ithu oru medical emarjansiyaanu, ithinu ashupathriyil hajar aavasyavum intravinus draavakangalum aavasyamaanu, thudarnnu saadhaaranayaayi rakthappakarcha aavasyamaanu. rakthachamkramanathinte alavu punasthaapichukazhinjaal, rakthasraavam moolamaanennu kandethunnathinum athu pariharikkunnathinum parisodhanakal nadathunnu. aniyanthrithamaaya jeevanu bheeshaniyaakunna rakthasraavam garbhashaya damaniyude embolisation (garbhaashayathinu vitharanam cheiyunna rakthakkuzhalukalude adavu), laparotamy (adivayattile sasthrakriya) enniva aavashyamaayi vannekkaam, ithu idaykkide garbhaashayachedanathilekku (garbhaashayathinte neekkam) avasana resortaayi nayichekkaam.
neendunilkkunna yoniyile rakthakshayam moolamundaakunna oru sankeernnatha irumbinte kurravulla anaemiyayaan, ithu vanjanaaparamaayi vikasichekkaam. chila sthreekalkku anaemiya mechappeduthunnathinna irumbu supplementukaloo rakthappakarchayo aavashyamaanenkilum kaaranam illaathaakkunnathu anaemia pariharikkum.
epidemiology.
praayapoorthiyaakaathavar.
yoniyile rakthasraavathinte ettavum saadhaaranamaaya kaaranam saadhaaranayaayi yoniyile kanalilekku cherkkunna oru videsha shareeramaayi kanakkaakkappedunnu, ithu palappozhum pelvik vedana, mosham discharge allengil aavarthichulla jananendria anubadhakal ennivayumaayi bandhappettirikkunnu. eee sambhavam saadhaarana svayam paryavekshanam moolamo laingika durupayogathinte soochanayo aakam.
jananendria parikkukal oru saadhaarana kaaranamaan, palappozhum ashupathriyil praveshippikkunnathino allengil praayapoorthiyaakaatha yoniyile rakthasraavathinaayi adiyanthira vibhaagam sandarshikkunnathino ulla ettavum saadhaaranamaaya kaaranamaanith, atharam kesukalil 45 sathamaanam vare ulppedunnu. ettavum saadhaaranamaaya jananendria parikkukal stroadil parikkaanu, ithu palappozhum veezhumbol sambhavikkunnu, palappozhum moorchayulla attathu, labial madakkukalkkidayil murivukalkk kaaranamakum.
chikitsa.
pala tharatthilulla yoniyile rakthasravavum saadhaaranamaanenkilum chikitsa aavashyamillengilum mattu roopangalkku vaidyasahaayam aavasyamaanu. garbhaashayathile asaadhaaranamaaya rakthasraavathinu saadhaaranayaayi upayogikkunna aadya oopshanaanu hormon maanejment. eee hormon marunnukalil janana niyanthrana gulikakal, medroxy projastaron asattett (brand namam depo-provera), samyojitha kuthira eestrajan enniva ulppedunnu. deerghakaala chikilsakalil hormon iud insersion, janana niyanthrana gulikakal, projasttin gulikakal allengil projasttin shottukal (depo-provera) enniva ulppedunnu, koodaathe ibuprofen polulla chila marunnukal chila sthreekalkku surakshithamallayirikkaam. raktham kattapidikkunna vaikalyangalulla sthreekalkku oru hematolajistine kaanendathundu.
rakthasraavam kadinamaanengilo rogikalkku mukalil listtucheythirikkunna hormon marunnukal kazhikkaan kazhiyaathathin kaaranangalundengilo sasthrakriya chikilsakalum pariganikkaam. dilation & curetteju, endometrial ableshan, garbhaashayathe neekkam cheyyal enniva eee oopshanukalil ulppedunnu. garbhashaya vichedanam vandhyathaykk kaaranamakum, athinaal sasthrakriya theerumaanangalil saadhyamaakumbol bhaaviyile prathyulpaadanakshamathayekkulara sthreekalude mungananakal ulppedum.