Bleeding during early pregnancy
Bleeding during pregnancy refers to a group of obstetric hemorrhages, that is, those that occur during the period of gestation and childbirth, as well as after childbirth.They are considered a serious complication, as they often cause maternal mortality.Table of contents: Bleeding during pregnancy: features Causes of bleeding during pregnancy in the first-second trimesters Symptoms and treatment of bleeding with ectopic pregnancy Causes and symptoms of bleeding during early miscarriage
Bleeding during pregnancy: features
The woman's period of life is characterized by certain criteria:
- sudden appearance of bleeding;
- massiveness of blood loss;
- is primarily affected by the fetus( therefore, an emergency delivery is often practiced);
- except in some cases, blood loss is accompanied by severe pain;
- bleeding during pregnancy forms a rapid depletion of the defenses and compensatory reactions of the woman's body;
- a sharp decrease in BCC( circulating blood volume) with cardiac dysfunction;
- at times increases the risk of DIC-syndrome( disseminated intravascular coagulation).
Causes of bleeding during pregnancy in the first-second trimesters
Factors that can provoke the development of bleeding during this period of pregnancy are quite a lot.The reason directly depends on which trimester it occurred in.
Early-onset bleeding occurs due to the following reasons:
- ectopic pregnancy;
- spontaneous abortion;
- bladder skid;
- Implantation bleeding;
- frozen pregnancy;
- gynecological diseases.
The doctor's tactics, algorithm and treatment scheme depend on the cause, which triggered bleeding at the term of up to 20 weeks of pregnancy.
Symptoms and treatment of bleeding with ectopic pregnancy
It is also called an ectopic pregnancy, in which the egg is implanted after fertilization and begins to develop outside the uterine cavity.Typical places of its localization are pipes, abdominal cavity, ovaries, cervix, rudimentary horn( unicorn uterus).
An ectopic pregnancy is formed as a result of such pathologies in the history of :
- genital infantilism;
- operative interventions on the internal genitalia;
- hormonal imbalance.
It can be progressive and impaired due to rupture of the tube or ovary.In some cases, this condition is completed by tubal abortion.
The main symptom in this case is spotting during pregnancy, which "smear", the women have a delay in menstruation, she complains of pains in the lower abdomen.Ectopic pregnancy can also cause an acute abdomen, a condition requiring emergency medical attention due to rupture of the fallopian tube.This type of pregnancy can develop up to a maximum of 8 weeks, and then comes the rupture of the tube and opens bleeding( internal and external).
A gynecological examination and ultrasound should be performed in order to correctly verify the diagnosis.
Further treatment tactics next :
- assessment of a woman's condition;
- determination of the degree of blood loss;
- collection and refinement of anamnesis( gynecological and obstetrical);
- admission to the gynecological department as a matter of urgency;
- the transportation of the woman must be carried out in a horizontal position, the head end must be lowered;
- it is important to maintain BP numbers at the optimal level;
- in case of massive blood loss, the patient is hospitalized by a resuscitative and surgical team;
- all further measures are developed and undertaken already in the hospital.
Causes and symptoms of bleeding during early miscarriage
The correct name for this condition is spontaneous abortion, which is considered to be abortion for up to 28 weeks.With it, the woman opens the cervix, and the fetal egg is partially or completely expelled from the uterine cavity.
Reasons that can provoke an early miscarriage are the following :
- genetic disorders in the fetus;
- hormonal imbalance in the body of the mother( progesterone deficiency, testosterone excess);
- Rh-conflict between mother and child( when mother R-, and father R +);
- reception of medicines;
- severe stress;
- the wrong way of life;Injury, fall,
This pathology is accompanied by pains with localization in the lower abdomen, increased tone of the uterus, bleeding, turning into bleeding.The condition of a woman directly depends on the amount of blood loss, the period, the presence of her anemia and other diseases.
Important : for spontaneous abortion, it is necessary to stop bleeding in time to avoid hemorrhagic shock that occurs when a large volume of blood is lost( individually for each patient).If pregnancy can not be maintained, resort to curettage.
Bleeding during pregnancy 12 weeks is regarded as an early abortion, and it often occurs for an unclear reason.From 13 to 28 weeks it is a question of late abortion.2-8 pregnancies out of 100 result in spontaneous miscarriage for different causative factors.
Bloody discharge has a different characteristic( from smearing to profuse), as well as pain syndrome( from aching to blunt pain in the lower abdomen).Preserve pregnancy in case of a threatening and beginning abortion, but the more blood is lost, the worse the prognosis.
Spontaneous abortion has a staged course:
- Threatening miscarriage.This condition can be accompanied by very scarce bloody secretions, the pain is weak and has a dull aching character with localization in the lower abdomen.
- The abortion started . With it, the discharge of blood will also be uneventful, and the pains are cramping.This stage of spontaneous miscarriage usually proceeds with a satisfactory state of health.A woman should be taken to a gynecological hospital to decide the issue of the appropriateness of maintaining a pregnancy.The prognosis in this case may be favorable, but it all depends on the amount of blood loss.
- Abortion in the course.The patient has massive bleeding and cramping pain in the lower abdomen.This condition requires immediate hospitalization and appropriate measures( scraping of the uterus, blood transfusion to recover lost blood).
- Partial abortion.Blood is secreted by clots and has a darker shade, it can be a lot.There must be pain syndrome.Pregnancy can not be preserved in this case, therefore, resort to curettage of the uterine cavity.
- Complete spontaneous abortion of . Most often it occurs at very early stages of pregnancy.The clinical picture is as follows: contraction of the uterus, opening of the cervical canal, removal of the fetal egg from the uterine cavity with some blood, closing the cervical pharynx and stopping bleeding.Complete spontaneous abortion does not require emergency care, but the woman is still hospitalized.In a hospital, she is diagnosed with scraping.This procedure allows you to make sure that there are no fetal eggs left in the uterine cavity.
Treatment measures for spontaneous early miscarriage
The outcome of the treatment of bleeding during pregnancy largely depends on the timely treatment of a woman in a medical facility and clear compliance with all of the doctor's prescriptions.
The complex therapy for such conditions includes:
- The first and main rule for a woman who has a threat of an early miscarriage is a strict bed rest.
- Complete emotional rest.
- If necessary, hormonal therapy is prescribed( Progesteron, Duphaston, Utrozestan).
- Infusion therapy( IV infusion of solutions according to prescriber's instructions) is also performed.
Treatment should take place in a hospital under the supervision of a treating gynecologist.If the cause can be eliminated and, at the same time, the current pregnancy is preserved, the woman should be under medical supervision before delivery.
Bleeding early in clots: causes, symptoms, prognosis
Presence of clots in bloody discharge during pregnancy is, most likely, the isolation of fragments of embryonic tissue.Often, the woman sees the clots when you visit the toilet or after lifting weights.The process itself is accompanied by spasmodic pain( similar to contractions).Such bleeding is a miscarriage at an early age, which very often happens during the first 12 weeks.Doctors will not keep such a pregnancy, especially if the blood is scarlet and there are clots.
Note: is a kind of blood clots( brown, red, red), as well as suggested symptomatology, can be symptoms of not only miscarriage, but also of such pathologies:
- frozen pregnancy;
- detachment of the fetal egg;
- Cervical or tubal pregnancy.
These conditions are very dangerous for the life and health of a woman, therefore they require urgent care and hospitalization.
Early Bleeding Hemorrhages with Pulmonary Drift
This pathology is a kind of trophoblastic disease that is formed from derivatives of female and male germ cells.Bubble skidding can develop both during physiological and ectopic pregnancy, after childbirth, artificial abortion, with inflammatory processes of the reproductive system, hormonal disorders.This disease is characterized by the presence of modifications in the chorion: there are increased sizes of villi with the formation of bubble-shaped elements on them.It affects mostly women at a young age of 20 to 30 years.
Symptomatic of bladder skidding :
- Delay of menstruation up to 2-4 months( a woman considers herself pregnant);
- bloody discharge( they appear as a result of the rejection of the vesicles) with the presence of the same vesicles in them;
- the uterus at a gynecological examination does not correspond to the expected duration of pregnancy;
- when performing ultrasound at week 20 the fetus in the uterus is not visualized, but the picture of the "snow storm" is visible;
- is very strongly marked clinic of early toxicosis;
- titer of chorionic gonadotropin in the blood above the norm of 1000 times;
- bleeding can only be cured by scraping the uterine cavity.
Note: this pathology is an indication for continuous monitoring in a female consultation for 2 years with systematic delivery of analyzes for chorionic gonadotropin.Repeated pregnancy is only allowed after 2 years with negative results of studies.
Implantation bleeding in the first trimester
It is considered a variant of the norm, since it does not carry a danger to the embryo.The mechanism of its development is as follows: a fetal egg is implanted into the uterine mucosa, during this process a vessel can be touched, which causes the women to have minor bloody discharge in the early pregnancy period.This occurs usually in those days when the expected next menstrual cycle was to begin.Therefore, women often take implantation bleeding for regular menstruation, as they simply do not know about pregnancy.
The clinical picture in this case will be the following :
- meager secretions;
- Duration of excretions from several hours to 2 days maximum;
- bleeding does not increase.
Note: if the discharge is more abundant and accompanied by pain, then these are signs of a different pathology, rather than implantation bleeding .
Early-onset bleeding due to frozen pregnancy
With this pathology, the fetus freezes in the early stages of up to 12 weeks.The reason is usually found in genetic disorders of the embryo, hormonal deficiency, acute infectious pathologies, which can be determined by a diagnostic route.Sometimes this condition is asymptomatic for a woman.
In other cases, there are such symptoms of :
- scant blood-bearing;
- absence of signs of fetal life on ultrasound;
- pain in the lower abdomen;
- abrupt disappearance of signs of pregnancy;
- mammary gland softening;Discrepancy between the size of the uterus and the duration of pregnancy.
The therapeutic tactics for a stiffened pregnancy and accompanying bleeding is reduced to hospitalization of a woman and curettage of the uterus.
Bleeding early in pregnancy: what to do?
Given that the causes of bleeding may be different, when they occur, you should immediately consult a doctor.
- If blood allocation is insignificant, there are no pains and before the women's consultation is near, you can ask for help there yourself.
- When the blood is bright or the bleeding is severe - you need to call an ambulance and wait for it.
- Before arrival, the doctor should take a horizontal position, give the legs an elevated position, do not take any medication so as not to erase the symptoms.
- If bleeding is accompanied by loss of consciousness, severe pain, cold sweat, this may indicate ectopic pregnancy and tube rupture.In this case, every minute is important.
Viktorova Julia, obstetrician-gynecologist