Bleeding during pregnancy in early and late periods - Causes, symptoms and treatment. MF.

Bleeding during pregnancy is the most common pathology. And this is not just a pathology, but also a serious complication, which is not realized by every pregnant woman. This is primarily due to the common misconception that during pregnancy can be monthly. But in fact, there is no blood discharge in the norm during pregnancy. Very rarely( in 3% of cases out of 100), some pregnant women have slight bleeding at the very beginning of pregnancy, when a woman does not know about her pregnancy. This occurs at the time of attachment of the fetal egg to the uterus, and, as a rule, corresponds to the period of the expected menstruation. Only in this case, bleeding is the norm. In other cases, any bloody discharge is regarded as a pathology

Causes of bleeding during pregnancy

Bleeding can occur both at an early and late pregnancy. Depending on the timing of bleeding, early or late, it is possible to suggest a pathology that caused bleeding.

Bleeding early in pregnancy( before 12 weeks of pregnancy), may indicate:

- about the beginning of miscarriage;
- about ectopic pregnancy;
- about undeveloped "frozen" pregnancy;
- about a bubble drift.

Bleeding late in pregnancy( after 12 weeks) may be due to abruption or presentation of the placenta.

It should be noted that if bleeding occurred during pregnancy, this does not mean that it is associated with the pathology of the fetus. The reason for this may be exacerbations of gynecological diseases in a future mother - cervical erosion, uterine fibroids, polyps of the cervical canal and so on. Bleeding can also be caused by a banal trauma to the genitals.

Bleeding during pregnancy can be of different intensity - smearing, mild, or plentiful with clots. Quite often, bloody discharge is accompanied by painful sensations. The pain can be intense and sharp, spreading throughout the abdomen. Often resemble fights, as happens, for example, with miscarriage. Or there may be slightly palpable pain in the lower abdomen. In addition to pain and blood discharge, the pregnancy reduces the pressure, the pulse becomes faster, there is weakness. But the nature and intensity of pain and hemorrhage can not be diagnosed, since in one pathology in different women these indicators differ.

If blood allocation is insignificant - this does not mean that you need to lie at home and wait until they pass. Any bleeding during pregnancy is a reason for emergency treatment in a gynecologist. Such conditions can be dangerous both for the life of the fetus and for the mother.

Diagnosis of the cause of bleeding during pregnancy

In order to identify the exact cause of bleeding, it is necessary to examine the gynecologist and a number of diagnostic studies in a hospital or maternity hospital.

The doctor takes a swab from the vagina when examined. The pregnant woman gives a general and biochemical blood test, a coagulogram, a blood test for HIV, hepatitis, syphilis;general urine analysis. She is determined by the blood group and Rh factor. Mandatory ultrasound of the organs of the small pelvis and fetus.

Further, depending on the revealed pathology, additional studies can be assigned. Thus, with a miscarriage, an undeveloped pregnancy, the blood is additionally examined for hCG( human chorionic gonadotropin), hormones, tests for TORCH infections( herpes, rubella, cytomegalovirus, toxoplasmosis);A smear for sexually transmitted infections. If there is a suspicion of an ectopic pregnancy, diagnostic laparoscopy is done. In case of pancreataneous skipping, the level of hCG is also examined.

To diagnose the cause of bleeding at a late pregnancy, additional studies are usually not required, due to the high information content of ultrasound.

Treatment of bleeding during pregnancy

Treatment is prescribed depending on the pathology and stage of the disease. At the beginning of miscarriage, activities should be aimed at maintaining pregnancy and stopping bleeding. If the fetus is viable according to the results of the ultrasound, in the early stages of pregnancy, hemostatic drugs are prescribed( Dicinon), antispasmodics for lowering the tone of the uterus( no-shpa, suppositories with papaverine), hormonal preparations - gestagens( Duphaston or Utrozhestan) up to 16 weeks of pregnancy to maintain progesterone level- "pregnancy hormone", vitamins and trace elements( vitamin E, iodomarin, folic acid, Magne6).If the effect is good, the discharge stops and the pregnancy persists. If the miscarriage still occurred and the discharge abundant - produce scraping of the uterine cavity with the removal of the remains of the fetal egg.

When confirming the diagnosis, a "frozen" pregnancy or a bladder drift, as in the case of a miscarriage, a scraping of the uterine cavity is shown. After curettage for contraction of the uterus, the hormone Oxytocin and haemostatic drugs are prescribed. Bloody discharge after curettage discontinue after a week.

With ectopic pregnancy treatment is prompt. Do laparoscopy or laparotomy and remove the affected uterine tube or squeeze the fetal egg out of the tube.

With placenta previa, if the discharge is insignificant, spasmolytics, droppers with magnesia, beta-adrenomimetics( Ginipral), disaggregants( Trental or Curantil) and vitamins are prescribed to maintain pregnancy. With placenta previa, bleeding can continue until delivery. All this time the woman is laid in the hospital. When reaching a full term( 38 weeks of pregnancy), a cesarean section is performed. If the bleeding is abundant, the caesarean section is performed urgently even if the fetus is premature. To fill blood loss, infusion therapy is performed( transfusion of freshly frozen plasma and erythrocyte mass).

If suspicion of detachment of the placenta is urgently performed by cesarean section, regardless of the gestational age and viability of the fetus. In parallel, the infusion therapy is performed.

All women with Rh-negative blood immediately after scraping, surgeries for ectopic pregnancy and cesarean section are injected with antiresus D-immunoglobulin for the prevention of Rh-conflict between mother and fetus when fetal blood flows into the mother's bloodstream.

All pregnant women who have had bleeding and pregnancy managed to keep it is recommended sexual abstinence and emotional rest. Many drugs that are prescribed in the hospital, it is necessary to apply and after discharge, even if there are no blood secretions to protect themselves from the repeated threat of termination of pregnancy. With the re-occurrence of blood discharge, the pregnant woman should also immediately contact the gynecologist.

In the rehabilitation period after stopping bleeding, sedatives are used - tinctures of motherwort or valerian. Recommend non-pharmacological and physiotherapy treatment - acupuncture, endonasal galvanization and so on.

As for folk medicine, apart from tinctures of motherwort and valerian, which have been used for a long time in obstetrics, it is better not to use other herbs for bleeding, as in most cases they are ineffective, and in the worst case harmful in pregnancy and may further exacerbate the situation.

Complications of bleeding during pregnancy:

- miscarriage that can not be treated;
- antenatal fetal death;
- infectious complications, septic shock, which occurs due to the presence of dead tissue remains in the uterine cavity;
- with great blood loss, development of hemorrhagic shock is possible, which can lead to death;
- choriocarcinoma is a rare malignant cancer that can occur after scraping for a bubble drift.

Prevention of bleeding:

- natural family planning - non-abortion;
- restriction of physical and sexual activity during pregnancy;
- timely treatment of chronic gynecological diseases( especially sexual infections) prior to pregnancy;
- reproductive function up to 35 years.

Doctor's consultation on bleeding during pregnancy

1. Can I use any medications to stop bleeding at home?
You can not, urgently need to see a doctor.

2. How soon can I get pregnant again after scraping?
After 3-6 months, after examination and appropriate hormonal treatment.

3. Can menstruation occur during pregnancy?
Not happen.

4. Can bleeding occur during pregnancy due to sex?
Can.

5. Lay down for preservation in 5 weeks. Bleeding and did not pass and a miscarriage occurred, although she drank hormones. Tell me, maybe the dose of hormones was not enough?
Maybe, but hardly. It is necessary to find out for what reason you had a miscarriage after the examination. The doctor probably prescribed hormones to compensate for the lack of progesterone in the body, which is often the case with miscarriages. But miscarriage can occur due to genetic defects of the fetus( in 75% of cases) and then the hormones have nothing to do with it.

6. How to understand the nature of blood discharge - is it a miscarriage or a frozen pregnancy?
No, just be able to install only a doctor after examination and ultrasound.

7. I have a placenta previa. There are no bloody excretions anymore. Is it possible to have sex?
You can not. It is necessary to abstain from sexual intercourse before delivery.

8. I got macular bleeding after a month's delay for a week. What is it?
Take a pregnancy test and contact your gynecologist. Either this pregnancy or dysfunction of the ovaries.

9. Can there be bleeding due to a bath?
Maybe all thermal procedures are undesirable in pregnancy, especially on short terms.