VAGINAL HEMORRHAGE IN THE NEWBORN In certain otherwise healthy girls there occurs on the fifth or sixth day and sometimes later, a hemorrhage, usually very scant, from the vagina. Schukowsky found 35 such cases among 10,000 newborn girls. Blood-stained mucus or small blood-clots are found on the labia of the infant; on separating the labia it is seen that the blood conies from the vagina since small clots and strings of blood-stained mucus adhere to the visible portion of the vagina as also to the hymen. In case the hemorrhage assumes somewhat greater proportions, blood-clots mixed with mucus and clumps of blood-stained mucus are also found in the diaper. The bleeding is never severe enough to come in drops.
In many cases the bleeding stops in a day or two, in other cases it persists for a week or recurs after the pause of a day. The bleeding never disturbs the well-being of the child: the fatal cases of vaginal hemorrhage reported by Doleris must have been due to other causes.
Inasmuch as they were attended by severe constitutional disturbances, they may have been due to sepsis.
This vaginal bleeding of the newborn cannot be confused with precocious menstruation which sometimes occurs with an abnormally early development of the sexual organs. For the genuine premature menstrual bleeding (menstruatio praecox) does not occur in the first weeks of life, but later; moreover it almost always starts after months or years and at least recurs for a few months more or less regularly at monthly intervals; whereas the condition described as vaginal lilemor rhage never recurs. Besides, this precocious menstruation is accom panied by a premature development of all of the sexual organs, the ovaries, mamma', pubic hair, etc.
In rare cases girls both smaller and have irregularly recur ring lilemorrhages from the vagina, Ivhich are due to malignant neo plasms. Therefore the vagina must be carefully inspected in every case of 'vaginal hemorrhage; polypoid sarcoma of the vagina which produces no other symptoms at its beginning, may thus be discovered.
The cause of vaginal lilemorrhage of the newborn was inexplicable until recently. Asphyxia and endometritis have been advanced as the etiological factor in a few cases. Ritter attributed the genital hemor rhages of newborn girls to the same causes which produce hemorrhages in other parts of the body. Diseases of the newborn, namely, septica mia (pyamia) are so often accompanied by bleedings that the vaginal bleeding of the newborn might also be attributed to the same cause, the genital hirmorrhages being considered as local manifestations of an existing lllemophilic diathesis. Ritter concluded this from his series, which embraced 7 cases of genital haemorrhage; in 4 of these, hemor rhage of other organs (gastro-intestinal) was also present.
Later investigations show that Ritter's opinion is not correct. In the vast majority of children with vaginal lnemorrhage, septicaunia is not even to be considered. Still one must admit that according to Rit ter's observation vaginal hemorrhage may at times accompany septi cxmia. This is to be considered exceptional; for as a rule healthy children are affected.
Zappert's investigations showed that only hyperaunia and diaped esis of red corpuscles from the dilated vessels take place in the uterus and that signs of inflammation are wanting. This finding is in accord with Halban's investigations according to which newborn girls, with few exceptions, show changes in the uterus which correspond to those found in the premenstrual or menstrual condition of the uterus in the adult; these are: congestion and subepithelial hemorrhages, sometimes also haemorrhages into the cavity of the uterus. These changes are called forth in the sexually mature women by a function of the ovaries: in the fcetus and newborn, whose ovaries are functionally undeveloped, the menstrual changes in the uterus are brought about by substances, cir culating in the maternal and fatal blood during pregnancy, which arise in the placenta, probably in the chorionic epithelium (Halban). Soon after birth the mucosa of the uterus returns to its normal state and the uterus itself becomes smaller; 3 weeks post partum the puerperal invo lution of the womb is completed (Halban). The changes occurring in the prostates of newborn boys (hyperaemia, haemorrhages, infiltrations around the glands, secretion) described by Schlachta, are also classified under the reactions of pregnancy which disappear within the first 2-3 months and are attributed to the same cause as the manifestations in the uterus of newborn girls (lialban). The (edema of the vulva which is seen so commonly in newborn girls could also with probability be attributed to the active circulating substances of pregnancy.
This (edema shows itself immediately after birth or in the first days of life and gradually disappears. After this the labia majora are wrink led or thrown into folds. Similarly an of the penis and scrotum occurs in newborn boys which disappears after clays or weeks and is entirely meaningless. These wdemas have been attributed by various authors, to stasis during parturition or to compression of the veins on account of the intra-uterine position of the extremities. The fact that these occur also in children delivered by Caesarean section speaks against the first-given explanation (ITalban).