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孕期出血常见原因及应对
作者:home99
发表时间:2010-04-13
更新时间:2010-04-15
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写给准妈妈1
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除了早孕(孕吐)反应,孕期出血可能要算准妈妈最常见的一个问题了,说是四分之一的准妈妈可能都碰到过,只是程度不同,阶段不同,原因可能不同。有些可能是正常现象,有些可能是危险信号。孕晚期可能是早产或临产征兆,孕早期少量出血多属正常现象,在英文里有时以spotting与bleeding相区分,不同原因、不同孕期出现的出血要区别对待。

因为孕期出血关系到宝宝的安危,可能也是让准妈妈最最担心的一个问题,无论哪种原因或哪个阶段出现出血现象,准妈妈还是应引起高度警惕和重视,建议及早打电话问OB,采取恰当的应对措施,所以单独写个贴子,将我看到的资料贴出来供JMs参考啊!祝JMs好孕&好运!

●少量出血和阴道出血有什么不同?
●关于孕期出血常见原因和应急措施
●孕期出血是常见症状是否保胎需分原因对待
●孕期出血的N种原因
●孕期出血的7种可能
●孕期出血非小事
●准妈妈应高度警惕孕期出血现象
●孕妇出血时如何进行急救
●Bleeding During Pregnancy
●Bleeding And Spotting During Pregnancy
●Bleeding During Pregnancy

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少量出血和阴道出血有什么不同?

点滴出血是轻微的阴道出血,类似于月经初期或末期的出血量。出血的颜色可能呈粉色、红色或褐色(血干了后之的颜色)。而阴道出血则是比较多的出血,甚至大量出血。

造成少量出血或阴道出血的原因是什么?

孕期发生少量出血或阴道出血情况的原因不太容易确定。因为在这一阶段,你的子宫颈和骨盆区域的供血量都增加了。在你接受宫颈涂片检查、阴道检查,或性生活后出现滴血状况并不奇怪。其他可能的出血原因还包括:

1、植入性出血
受精卵在你的子宫壁上着床时,你可能会在一两天里有轻微的出血现象。受精卵着床发生在受精之后6~7天,乃至10天左右,所以这时你可能甚至还不知道自己已经怀孕了呢。

2、流产或宫外孕(异位妊娠)
少量出血或阴道出血有可能是流产 或宫外孕的先兆,尤其是在伴有腹部疼痛或痉挛性疼痛等情况时。阴道出血也可能是葡萄胎的征兆。葡萄胎是一种相对较为罕见的情况,它是指由于受精卵畸形使胚胎无法发育或存活而发生绒毛水肿。

大概有1/4的孕妇会在孕早期有不同程度的出血现象,她们中约有一半人最终会流产。不过,如果你在怀孕7~11周期间的B超检查中显示出宝宝有正常的心跳,那么你可以继续妊娠的机会就会高于90%。

3、感染
少量出血也可能是由与怀孕毫不相干的情况造成的。阴道感染(比如酵母菌感染俗称霉菌或细菌性阴道炎),或性传播感染疾病(比如阴道毛滴虫病、淋病、衣原体,或疱疹),都会使你的阴道、子宫颈感染并发炎。发炎的组织在接受宫颈涂片检查,或阴道检查或性生活之后,就容易出现少量出血的现象。如果你有子宫颈息肉(良性的),那么你在接受宫颈涂片检查、性生活或排便之后,也有可能会出现少量出血或阴道出血。

4、胎盘问题或早产
到孕中期或孕晚期,少量出血或阴道出血则有可能是一些较为严重的情况的征兆,比如前置胎盘、胎盘早剥(胎盘在胎儿娩出前从子宫壁剥离)、晚期流产(孕13~28周前),或早产(孕28~37周前)。

即使是发生在孕早期的阴道出血也有可能是胎盘潜在问题的征兆。研究表明,孕早期的阴道出血与之后并发症的高风险间存在联系,包括早产或胎盘早剥,特别是在出血症状严重的情况下。

5、正常分娩先兆——见红
这是指怀孕37周后白带呈黏性并带有血丝,通常是子宫颈黏液栓塞脱落的征兆,这时子宫颈为了分娩而开始变柔软或扩张。这时,你还是应该将其他少量出血或阴道出血的情况告知医生。

注意: 如果你的血型为Rh阴性,那么在你出现出血情况时,就需要注射RhD免疫球蛋白,除非你能够确定宝宝爸爸的血型也是Rh阴性,或者确定不是子宫出血。

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关于孕期出血常见原因和应急措施

孕期出血的原因和状况因人而异,危险程度也各不相同。虽然有80%的出血不会影响正常的妊娠,但是也不能忽视另外的20%。为谨慎起见,避免发生大出血等危及生命的情况,还是要去医院。

一、孕期出血原因及对策

毫无疑问,出血是孕期最令人恐慌的一个现象。而实际上,出血是相当常见的,少量流血或轻度出血往往只是流产的先兆,而最终并不一定会导致流产,但也有些出血会威胁母体与胎儿的安全,孕妈咪应该对各种可能导致出血的情况有所了解。

二、不同原因引起的出血及应急措施

1、生理性出血

受孕后,有的孕妈咪会在当月月经期仍有少量月经样出血,一般无其他伴随症状(如腹痛、经期不适感),这可能只是孕卵着床的一种生理反应。

措施:这种情况不需治疗,只要保持外阴清洁即可。

2、流产

胎盘和子宫壁分离,并刺激子宫,会使子宫收缩,子宫颈扩张,血液从子宫中流出。这种流血多伴有下腹疼痛,流血量由少到多,色由暗到红,腹痛由隐痛逐渐发展到较剧烈疼痛。

措施:阴道流血量不多(少于月经量),且确诊先兆流产的,宜保胎治疗。原则:绝对卧床休息;应用镇静剂;内分泌治疗用黄体酮;维生素E治疗,严密观察。

但如果阴道大量出血(超过月经量),阵缩变剧,腹部剧痛有块物排出,出血不停,诊为难免流产或不定流产保留块物,即刻入院处理以防大出血引起休克,危及生命。

3、宫外孕

当受精卵发育到一定程度,会使输卵管壁发生破裂而出血。由于这种出血是流在腹腔内,经阴道流的出血可能并不多,但常伴有剧烈绞痛。

措施:在停经后有阴道出血伴下腹痛,要高度重视,必须去医院就诊排除宫外孕。如在家发生下腹剧痛,拨打120,在救护车来到之前,应当头低、脚高,保持安静,防止出血,因为出血会引起贫血和休克。用毛毯等物保温也很重要。

4、葡萄胎

葡萄胎流产一般开始于闭经后的2-3个月。流血多为断断续续少量出血,但有的会反复多次大量流血。

措施:孕早期要做子宫B超监测胚胎发育,可早发现葡萄胎。如早期妊娠反应厉害,也要及时检查排除葡萄胎,一旦出血多应赶紧送医院急救,短期延误就有可能造成更多的失血,危害孕妈咪。

5、劳累太过

孕妈咪怀孕早期如果过于劳累、工作压力大,也可能引起阴道少量出血。

措施:保持安静、足够的休息和心情舒畅,必要时做保胎治疗。

6、阴道与宫颈病变

常表现为有不规则的阴道出血或有血性分泌物,易发生在阴道检查或性交后,但无腹痛。常见的病变有阴道或宫颈炎症、宫颈糜烂、子宫颈息肉、子宫黏膜下肌瘤脱出宫颈口或宫颈癌等。一般还附带腹痛等症状,这种情况,不会直接引发流产。

措施:做好孕前检查,配合医生治疗,做好保养,可以继续妊娠。

7、前置胎盘

主要特征是妊娠晚期(孕28-38周)无痛性反复阴道流血,常无任何诱因突然发生。阴道流血时间的早晚、反复发作的次数、流血量的多少与前置胎盘的类型有关。

完全性前置胎盘约在孕28周左右出血,偶有发生于孕20周者,次数频繁,量较多,有时一次大量流血即可使病人陷入休克状态。边缘性前置胎盘初次出血发生较晚,甚至临产方有流血,量也较少。部分性前置胎盘的出血情况介于两者之间。

措施:绝对卧床休息,给予镇静、止血、补血药物,如利眠宁、维生素K、硫酸亚铁等,出血完全停止后酌情安排下地轻微活动。如孕妈咪出现头晕、腹痛、宫缩、血压或血色素下降、胎心变化等,需及时与医生联系。

8、胎盘早期剥离

可能大量出血,也可能微量甚至不出血。腹部持续有触压疼痛现象,胎动减少或消失。

措施:立即入院让胎儿娩出或进行剖宫产。

9、早产

在怀孕中晚期,出现阴道见红,或者腹部胀痛、破水,子宫强烈收缩并引起下坠感,肚子明显变硬,这些都是早产的迹象。

措施:如未到足月,已经出现不规则子宫收缩或少量阴道流血,医生会指导孕妈咪用药以抑制宫缩,尽可能使妊娠继续维持。如宫缩变规则,且经检查发现宫颈管张开,此时早产已不可避免,医生会采取措施来提高早产儿的存活率。

三、妈妈记者说

面对孕期出血,几乎每个孕妈咪都会吓得六神无主,不要慌,可能问题并没有你想象的那么糟,我们来看看三位《时尚育儿》妈妈记者经历的“出血意外”吧。

1、出血后最好做B超检查陈秀岚|长沙|广告总监|儿子7个月

怀宝宝四个多月的时候,我也发生过出血现象,因为一直保持着裸睡的习惯,有天早上发现床单上有一块硬币大小的血迹,颜色暗红。为保安全,立刻去了医院,医生说最好做个B超,结果检查出来一点事都没有。最后遵医嘱卧床休息了两天,后来宝宝出生,健康又活泼。看来像我这样的出血并不用太担心。

2、错位胎盘应入院安胎艾静|青岛|编导|儿子5个月

我的宝宝是提前了一个月来到人世的,因为怀他7个月多一点的时候,就发现少量的出血,颜色鲜红,而且持续不断,肚子倒也不疼,到医院一检查,就发现是异位胎盘,需要住院,幸亏听了医生的,立刻办了住院手续,在医院安胎观察。

进院的第十天,就因为出血大增不得不做了剖宫,还好,宝宝经过半个多月的保温箱养育,健康地出院了,我自己也避过了一次大难。所以,如果像我这样有持续出血情况,一定要去医院。

3、因宫颈靡烂而出血者宜休息保胎夏玲|南昌|美容顾问|女儿2个月

从一个多月开始我有阴道出血的症状,在半个月的时间内出现了三四次,每次出血量不多,只有一点,是淡红色的。去医院检查,医生说我有三度的宫颈糜烂,可能是导致出血的原因,之后我一直在家休息保胎。现在宝宝已经两个月了,健康又漂亮。偶尔听到周围怀孕朋友也有出血的情况,我都会安慰她们。

育儿提醒

孕期出血的原因和状况因人而异,危险程度也各不相同。虽然有80%的出血不会影响正常的妊娠,但是也不能忽视另外的20%。为谨慎起见,避免发生大出血等危及生命的情况,还是要去医院。

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孕期出血是常见症状是否保胎需分原因对待

怀孕是一个正常的生理过程,但在孕期可能出现一些异常情况。准妈妈最担心的事情就是不明原因的出血。从点滴出血到大量出血,出血是怀孕期间很常见的症状,可以发生在怀孕的各个时期。

“在怀孕期间一旦出现出血症状,千万不要惊慌失措,应当尽快到医院就诊,配合医生进行检查和治疗,并尽可能保留出血的护垫,以便让医生估计出血量。”北京协和医院妇产科主治医师戚劢莉指出,出血能否保胎,还需要根据出血原因具体分析。

一、早孕期出血50%不影响妊娠

在所有准妈妈中,大约20%-30%有过早孕期出血的症状,其中50%最终可以顺利地产下健康的宝宝。戚劢莉归纳了早孕期出血的原因:

先兆流产出血量少:所谓先兆流产是指有流产的征兆,并不一定会发生流产,表现通常是阴道的少量出血。孕酮不足是可能的原因。如果通过检查后胎儿位于子宫内,宫颈没有活跃的出血,这时孕妇应该注意休息,减少活动,避免同房、便秘、精神压力,必要的情况下,可以遵循医生的意见适当补充孕激素保胎。

难免流产大多是自然选择的结果:如果先兆流产进一步发展,流产无法避免,我们叫做难免流产。难免流产的原因,其中很大一部分可能与宝宝本身的发育异常有关,可以认为是自然选择的结果。难免流产通常出血量会比较大,与月经量相当或者更多,大多会伴有腹痛。如果阴道排出肉样的组织,那可能就是流产的胚胎,应该收集起来带到医院进行必要的检查。

胚胎停育容易大出血:宫腔里的宝宝停止发育,常常会出现阴道出血,大多依靠超声诊断。在怀孕8周后没有胎心搏动,常常意味着胚胎停育。一部分停育的胚胎可能会自然流产;但也有一部分会一直停留在宫腔里,这种情况也需要清宫,否则可能会引起感染、大出血。

异位妊娠危及生命:当胚胎生长在子宫腔以外的部位,称为异位妊娠,俗称宫外孕,最常见的是输卵管妊娠。随着胚胎的生长,可能会引起局部破裂大出血,危及生命。除了出血以外,腹痛也是常见的表现。

除了这些常见的原因,还有一些可能引起出血的原因,例如着床期的出血、宫颈糜烂、宫颈息肉等。

二、中晚孕期出血应减少活动多观察

如果中晚孕期,尤其是怀孕28周后出现阴道出血,孕妇应该尽快到医院就诊,其间应该减少活动,观察出血量、宝宝胎动变化以及有无腹痛等症状。中晚孕期的出血,除了宫颈的炎症和病变,还可能出现以下三个原因:

前置胎盘可致反复出血:正常胎盘应该附着在子宫体部,如果怀孕28周后,胎盘附着的部位过低,接近或者覆盖了宫颈口,就称为前置胎盘。前置胎盘可导致反复出血,大多(70%)不伴有腹痛,一次出血量可能很大。

胎盘早剥必须马上剖宫:也就是胎盘在宝宝出生前就从子宫壁剥离,可能与外伤、高血压、吸烟等有关。如果胎盘提前剥离,对于宝宝和妈妈来说都是非常危险的情况。孕妇常常会出现严重腹痛,可以伴有腰痛和宫缩,阴道出血有时并不严重。如果剥离的面积较大,宝宝可以在短期内失去血供而危及生命,医生必须马上进行剖宫产手术。

晚期流产/先兆早产可用药物抑制:除了会有少量阴道流血、血性分泌物,还可能伴有腹部一阵阵的发紧发硬,甚至出现规律的下腹阵痛和下坠感。如果每半个小时内这种发紧发硬、阵痛的感觉超过了3次,医生就需要用药来抑制宫缩。

三、B超是孕期出血常用的检查手段

在早孕期,如果患者出现阴道出血症状,到医院就诊时,一般会被建议行超声检查。这时,B超的目的首先是确定胚胎位于宫内而非异位妊娠,其次是确定宫内发育的胚胎是否与停经的周数相符合,也就是有没有胚胎停育的情况发生。

“正常情况下,停经7-8周时B超能够看到胎心搏动,如果看不到,医生就需要再次核对受孕的时间。如果B超的结果没有发现胚胎的异常情况,就需要血液激素水平。”

戚劢莉表示,像孕早期的难免流产,如果出血量逐渐减少,可以通过超声检查看宫腔内是否有残留物,如果没有大多不需要进一步处理;但是如果出血不止或者血停后又再次出血,并且通过超声检查宫腔内仍残留组织,这种情况大多需要进行清宫手术。

四、保胎不能盲目进行

在孕期,准妈妈们出现阴道出血时,都会询问医生是否需要保胎,但是,能否保胎受到患者身体状况和胎儿自身发育是否异常有关系。

早孕期出血,如果B超没有发现胚胎的异常情况,就要参考患者的血液激素水平,孕酮水平如果减低,才会给予保胎治疗。如果孕酮的水平是正常的,那么还要寻找其他可能引起出血的原因。

“保胎不能盲目进行,如果没有确定胚胎是否位于子宫内就使用保胎药的话,可能会延误异位妊娠的治疗,而是病情恶化。”

戚劢莉指出,保胎药会根据孕妇的情况选择注射针剂或者是口服药。目前这类药物主要是天然黄体酮,对于宝宝来说是比较安全的。不过在中晚孕期需要使用保胎药物时,往往要先从输液开始,待病情稳定,可以继续服用口服药物。

“除了使用保胎药,孕妇也应当适当休息,减少剧烈运动和紧张情绪。很多孕妇认为,保胎就需要绝对卧床,不能下地。其实不是这样的,象日常生活、散步这样的活动还是可以继续的。”(缪炜)

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孕期出血的N种原因

在孕期的不同阶段发生阴道出血都是什么原因?你该如何应对?

在怀孕过程中发生阴道出血可能会把你吓一大跳。是的,发生这种情况多属于不正常现象。据调查,大约有10%~15%的准妈妈经历过阴道出血。当然,很多时候,它并没有你想得那么糟糕,其中一部分准妈妈经过保胎治疗或很好的休息以后可以继续妊娠下去。对此专家表示:在怀孕过程中发生阴道出血一定要重视,不要不以为然,不管在孕期的哪个阶段,只要发生阴道出血的症状,你都要及时去医院看医生,检查阴道出血的原因,同时给予正确的治疗和指导。

一、孕早期阴道出血
在孕期的阴道出血当中,孕早期阴道出血占有比较高的比例,约占10%左右。称为早期流产。早期流产中包含了先兆流产、难免流产、不全流产及完全流产,其中先兆流产最多见。若在孕早期发现阴道出血就能够及时看医生,给予休息及治疗,出血即可停止并可以继续妊娠下去。若阴道出血量增多、伴有阵发性腹痛加剧同时有组织物堵塞宫颈口,此时流产就不可避免要发生。所以,我们有必要分清哪些出血是可以继续怀孕下去的,而哪些出血是怀孕即将终止的。

二、你不必担心的出血:

1、着床“出血”:通常在受孕后,胚胎进入血管丰富的子宫内膜着床后的24周内发生。有时,你会误认为这是月经刚开始的表现,尤其是当你的月经周期不规律时。

2、月经出血:在怀孕后,持续生长的胎盘会释放出激素以抑制月经的发生。但是由于在怀孕前几周所释放出的激素的量,尚不足以抑制即将到来的月经,所以,准妈妈在怀孕的前两个月可能还会有少量、短暂的月经出现。

三、这些时候,你需要警惕:

如果你在出血时伴随着疼痛、痉挛,或者出现大量、持续的出血,血色较深,或有凝结的血块等现象,就要马上去医院就医。因为这些现象有可能是流产或者宫外孕的征兆。

1、孕中期、孕晚期阴道出血
在怀孕13周以后发生阴道出血的几率会大大降低,同时也不一定就意味着流产或者早产。但此时的出血是病理性的,是要引起所有准妈妈高度重视的。下面就为你列举了这一时期出现阴道出血的常见原因:

2、胎盘前置
在怀孕中、晚期出血通常是由于胎盘位置异常引起的。前置胎盘是指胎盘在子宫中位置过低(正常情况下应附着在子宫底部、宫体的后壁、前壁及侧壁),甚至将宫颈口部分或者全部覆盖。

不过,如果在孕中期发现胎盘位置过低不必太惊慌。大部分情况下,随着胎儿的生长和子宫的扩大,胎盘也会受到牵拉而上移,此时,我们称之为“胎盘低置状态”。但是,也有一部分准妈妈,直到孕28周以后,胎盘仍然位于子宫的下段,甚至胎盘下缘达到或覆盖宫颈内口,位置低于胎儿先露部,这种情况,我们称之为“前置胎盘”。通常,大约有1/10胎盘低置状态的孕妇到孕晚期会出现前置胎盘。而前置胎盘是妊娠晚期的严重并发症,也是妊娠晚期出血最常见的原因。

3、胎盘早剥
正常情况下,当胎儿分娩以后,胎盘自子宫壁剥离娩出。胎盘早期剥离指的是正常位置的胎盘在胎儿娩出前,部分或全部从子宫壁剥离的现象。胎盘早剥多发生在妊娠20周以后的任何时期,由于外伤和特定的疾病引起。在分娩前,子宫壁与胎盘附着处产生出血现象,合并腹部疼痛,出现不能缓解的子宫收缩。一部分出血可自阴道流出,称为显性剥离;一部分出血积聚在胎盘与子宫壁之间,称为隐性剥离。胎盘早剥是妊娠晚期严重并发症,有起病急、发展快的特点,若处理不及时可危及母儿生命。所以,如果准妈妈在怀孕中、晚期出现高血压病或突如其来的外力撞击或挤压腹部,随之出现持续性腹痛,伴有或不伴有阴道出血,都需要立即就医,及时得到医生的治疗。

4、见红
随着预产期的临近,由于子宫收缩,宝宝的头开始下坠入盆,胎膜和子宫壁逐渐分离摩擦就会引起小血管破裂而出血,则就是俗称的见红。通常是粉红色或是褐色的黏稠液体,或是分泌物中的血丝。一般见红在阵痛前的24小时出现,但也有在分娩几天前甚至1周前就反复出现见红。

如果只是淡淡的血丝,量也不多,没有出现规律性阵痛,孕妈咪可以留在家里观察,平时注意不要太过操劳,避免剧烈运动就可以了。如果流出鲜血,超过生理期的出血量,或者伴有腹痛的感觉,就要马上入院就诊。

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孕期出血的7种可能

在早孕期,阴道不正常出血是一个常见的问题,大约有1/4的孕妇会有此经历;到了怀孕中期和后期,仍有一些危险因素会导致不正常出血。孕期出血的原因和状况因人而异,危险程度也各不相同。为了确保母儿的安全,孕妈妈应该对各种可能导致出血的因素有所了解。一般来说,临床上根据孕期出血发生的时间将其分为两类,即怀孕初期出血和怀孕中后期出血。

一、初期(怀孕1~3个月)

1、子宫颈息肉、子宫颈糜烂或子宫颈病变

【危险因子】性生活复杂、卫生习惯不好、生活作息不正常、身体抵抗力较差等。

【医师叮咛】对于早孕期出血,很多人往往会忽略子宫颈的问题。子宫颈严重发炎导致糜烂,或原本已有子宫颈息肉,很容易因为怀孕后激素的改变而造成表面毛细血管破裂出血。

近年来子宫颈癌最常发生的年龄段已经悄悄下降至30~40岁,已经怀孕并不代表子宫颈一定没问题,在怀孕前后都应该定期做子宫颈抹片检查;如果孕初期有阴道出血现象,也应该检查子宫颈是否有问题。

2、流产

【危险因子】胎儿染色体异常、母体激素分泌失调、子宫先天发育异常或后天缺陷、免疫系统问题、病毒感染、孕妇患有慢性疾病(如心脏病、肾脏病及血液疾病)、过度操劳、压力过大、性生活太剧烈、外力撞击、环境污染、用药不当、吸烟、喝酒、摄取过量咖啡因或者会其他促进子宫收缩的食物等。

【医师叮咛】在胎盘完全形成之前,胚胎着床并不稳定,因此很多因素都可造成流产。当流产发生时,胚胎与子宫壁会发生不同程度的分离,分离面的血管一旦破裂,就会造成阴道出血症状。

根据一项医学研究统计,超过50的孕妇可以安然度过怀孕初期出血这一关,成功地继续妊娠;约30的孕妇可能会发生流产;另外有近10的孕妇可能是宫外孕或其他问题。

有些孕妇担心,早期怀孕时有不正常阴道出血,保胎成功后宝宝会不健康。许多研究显示,有一半以上的流产是胚胎本身异常所导致,这是一种自然淘汰,如果能够继续妊娠,胎儿一般都是正常的。

3、宫外孕

【危险因子】曾经有过骨盆腔发炎、骨盆腔黏连病史或做过输卵管手术或前次怀孕曾发生宫外孕等。

【医师叮咛】受精卵着床在子宫以外的地方便称为宫外孕,发生率大约是1,而其中95的宫外孕都是发生在输卵管。由于输卵管的管壁非常薄,无法供给胚胎足够的营养,而且逐渐发育的受精卵使输卵管壁膨胀,会导致管壁破裂,在怀孕7~8周时便会产生不正常阴道出血,甚至有严重腹痛或因腹内大量出血而导致休克。

在确定怀孕的初期,如果超声波检查未能发现子宫内有胚胎的迹象,就必须尽早检测血液中的绒毛膜促性腺激素(β-hcg),可诊断出有无宫外孕的可能,并适时做出适当的处理。

4、葡萄胎

【危险因子】母亲年龄小于20岁或高于40岁、食物中缺乏胡萝卜素和动物性脂肪、曾有流产的病史、曾有葡萄胎病史、吸烟等。

【医师叮咛】葡萄胎是一种良性绒毛膜疾病,发生率大约是1‰,亚洲国家的发生率较高一些。因为胎盘绒毛滋养细胞异常增生,末端绒毛转变成水泡,水泡间相连成串,状似葡萄,因而称为“葡萄胎”。在怀孕初期会有不正常阴道出血、严重孕吐甚至心悸等症状。

通常利用超声波和抽血检测绒毛膜促性腺激素便可诊断,治疗方式是利用子宫内膜真空吸引术把葡萄胎清除,然后持续追踪绒毛膜促性腺激素的指数,直到连续3周都正常,之后每个月再追踪一次,连续半年正常为止,如果绒毛膜促性腺激素指数下降不理想,就要考虑用化学药物治疗。在追踪期间必须严格避孕,治愈两年后才可计划怀孕。

二、中后期(怀孕4个月至生产)

5、前置胎盘

【危险因子】孕妇曾做过流产手术、子宫肌瘤、子宫畸形、前胎剖宫产、曾接受子宫手术、有前置胎盘史、吸烟等。

【医师叮咛】正常怀孕时,胎盘是附着在子宫壁的前壁、后壁或顶部,如果胎盘附着于子宫的部位过低,遮住了子宫颈内口,阻塞了胎儿先露部,即称为前置胎盘。

前置胎盘的发生率约为1/200,临床上依据胎盘覆盖子宫内口的程度,分为4种类型:完全性、部分性、边缘性及低位性。由于子宫会随着怀孕周数增加而变大,胎盘位置也会随之向上提升。如果在孕8个月之后,仍有完全性或部分性前置胎盘,则阴道出血的几率大为提高。

由于妊娠晚期或临产后子宫下段逐渐伸展,而位于子宫内口的胎盘不能相应地伸展,导致前置部分的胎盘从其附着处剥离,使血窦破裂而出血。

初次流血量通常不多,剥离处血液凝固后,出血可暂时停止,偶尔有第一次出血量就很多的情况。随着子宫下段不断伸展,出血往往会反复发生,并且量越来越多。

前置胎盘的类型不同,出血的特点也不一样。完全性前置胎盘初次出血时间早,多在妊娠28周左右,称为“警戒性出血”;边缘性前置胎盘出血多发生在妊娠晚期或临产后,出血量较少;部分性前置胎盘的初次出血时间、出血量及反复出血次数介于两者之间。

由于反复多次或大量阴道流血,孕妇可出现贫血,出血量越多则贫血程度越重。出血严重者可发生休克,还能导致胎儿缺氧、窘迫,甚至死亡。

6、早产

【危险因子】孕妇年龄小于18岁或大于38岁、孕妇本身有某些疾病(如妊高征)、工作繁忙、压力过大、前胎有早产史、多胞胎、有子宫肌瘤、双角子宫、吸烟、用药不当等。

【医师叮咛】从怀孕4个月开始,子宫每天会不定时收缩几秒钟,医学上称为“无痛性收缩”,属正常现象。如果在怀孕37周以前子宫收缩的频率增加,下腹有强烈的下坠感或疼痛感,阴道出血,腰酸,阴唇抽痛,这些都是早产的症状,要马上就医。只要充分休息,配合药物治疗(严重者需要住院治疗),大多数孕妇都可以顺利妊娠至足月生产。

7、胎盘早期剥离

【危险因子】妊高征、高龄产妇、妊娠糖尿病、外力撞击、多胞胎、脐带过短、曾有胎盘早期剥离病史。

【医师叮咛】正常情况下,胎盘在胎儿产出后才剥离;胎儿娩出前,胎盘部分或完全地与子宫壁分离,则称为胎盘早期剥离。胎盘早期剥离是妊娠晚期的一种严重并发症,进展相当快,如果处理不及时,可能危及母亲和胎儿的生命。

临床上主要分为两种类型:外出血型及内出血型。外出血型胎盘早期剥离的主要症状为阴道出血,出血量一般较多,颜色暗红,会伴有轻度腹痛。

内出血型胎盘早期剥离的情况较严重,多发生在重度妊娠高血压孕妇身上,症状为突然发生的持续性腹痛或腰酸,阴道可能仅有少量流血或完全没有流血,其程度因剥离面积大小及胎盘后积血多少而异,积血越多疼痛越剧烈。

一旦发生胎盘早期剥离,胎儿即处于极度危险的情况,必须及时终止妊娠,尽快施行剖宫产手术,以挽救孕妇和胎儿的生命。

如果您有妇产科方面疾病的疑问,请拨打我院妇产科咨询电话:0731-82288163,有专业的妇产科医生为您解答。也可电话预约看诊专家。

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孕期出血非小事

怀孕是一个正常的生理过程,但在孕期可能出现一些异常情况。准妈妈最担心的事情就是不明原因的出血。事实上,只要弄清楚出血的原因,找出相应的对策,出血也并不是件可怕的事情。

我们就此问题采访了郑大一附院妇产科主任医师史惠荣。她介绍说,孕期出血的时间不同,出血的原因也不同,有些情况不必太担心,只要认真对待便可止血,对腹中的小宝宝也没有危险,但有些情况却应该及时就医。

妊娠早期最常见的异常情况是阴道出血,出血量大,带有血块,并伴随着阵阵腹痛。引起妊娠早期出血的原因主要有:流产、异位妊娠、葡萄胎等。

★流产
导致流产的原因较多,主要有:遗传基因缺陷使胚胎不能正常发育;过多接触有害的化学物质(如砷、苯、甲醛、氧化乙烯等)和物理因素(如放射线、噪音及高温等)而引起流产;母亲罹患严重的全身性疾病、生殖器官畸形或肿瘤、内分泌失调等也可导致流产。

流产的主要表现是在妊娠早期出现阴道出血和腹痛。根据流产发展的不同阶段,流产可以分为先兆流产、难免流产、不全流产和完全流产。一般在先兆流产阶段,阴道出血较少,腹痛轻。如果没有胚胎发育异常,经过保胎治疗,出血就会停止,可以继续妊娠。如果出血量多于月经,伴有较重的腹痛,则流产势必发生,需要进一步治疗。

★异位妊娠
也称宫外孕,就是指受精卵未能正常进入子宫内,在子宫腔其他位置(输卵管、宫角、腹腔或卵巢)着床。通俗地讲,就是受精卵在子宫外“露宿”。而这些部位壁薄、狭窄,当受精卵逐渐长大就会穿过壁管,破坏血管造成大出血。

发生异位妊娠时,一般在停经40天左右出现阴道流血,多伴有下腹部的隐痛、胀痛、坠痛等。此时进行尿妊娠检查可为阳性,而超声检查宫腔内见不到妊娠的胚囊,往往在输卵管的部位可以发现异常的肿物。长到一定程度,着床周围的组织会被破坏从而出血。若异位妊娠已经破裂,则可发生一侧下腹部的撕裂样疼痛,同时伴有头晕、恶心、呕吐,严重的还会危及准妈妈的生命。

★葡萄胎
是畸形胎的一种。在胚胎发育的初期,孕妇的胎盘绒毛滋养细胞异常增生,转变成水泡相连成串,外观上看去有点类似葡萄一样的形状,所以称为葡萄胎。但直到现在,医学界还不清楚引起葡萄胎的原因。

患葡萄胎出现阴道流血的时间晚于流产和异位妊娠,多发生在3个月左右。出血量开始较少,以后逐渐增多,甚至反复大量出血,此时在血液中可见到水泡样组织。

葡萄胎患者的子宫增长速度一般大于相应的怀孕时间。如在妊娠后出现此类异常情况,应及时到医院就诊。

妊娠中期是腹中小宝宝生长趋于成熟的重要阶段。当没有任何前兆,只有剧痛和出血时,如果不及时治疗,可危及准妈妈和宝宝的生命。这段时间出血常见的疾病主要有前置胎盘和胎盘早期剥离。

★前置胎盘
正常情况下胎盘附着在子宫体部,发生前置胎盘时,胎盘位置下移,附着于子宫颈口附近。患者在妊娠晚期或分娩前发生无诱因无痛性反复阴道流血,开始出血量少,随着出血的反复发生,出血量越来越多。由于反复多次或大量阴道出血,患者可出现贫血,严重者发生休克,还能导致胎儿缺氧甚至死亡。

前置胎盘的诊断并不困难,对于孕晚期出血的患者,通过B超检查可以明确胎盘的位置。如果确诊为前置胎盘,医生将根据前置胎盘的类型采取适当的治疗方式,以尽快使准妈妈和宝宝脱离危险。

★胎盘早期剥离
指正常位置的胎盘在胎儿娩出前,部分或全部从子宫壁剥离。胎盘可以说是胎儿的命根子,胎盘一旦剥离,就有可能造成胎儿死亡。

轻型胎盘早期剥离阴道出血量较少,腹痛轻,对孕妇和胎儿威胁较小。重型胎盘早期剥离在阴道出血的同时多伴有内出血和持续性腹痛,患者病情危重,可在短时间内休克,胎儿因缺氧而死亡。

胎盘早期剥离患者多有明显的诱因。根据病史(如重度妊娠高血压综合证、腹部重力撞击)、阴道出血伴有腹痛、患者子宫增大有压痛、胎心率改变等表现,结合B超检查可以明确诊断。胎盘早期剥离病情紧急且后果严重,一旦发生上述情况,应立即到医院进行诊治。

最后史主任介绍说,孕期的任何时候都有可能出血,掌握出血的原因,才能做好止血的工作。

其中,宫颈糜烂和痔疮引起的出血较为常见。但是因为这两种情况出血少极容易忽视治疗,一旦病情加重,出血量大就会造成孕妇贫血,影响小宝宝的正常发育。

★宫颈糜烂
宫颈糜烂可能会造成整个孕期都或多或少出血,却不间断。这种出血与自然流产时子宫收缩,使胎盘与子宫分离造成的流血不同。它不会直接影响胎儿的发育,只要及时止血,妊娠仍可正常进展。如果不及时止血,则影响正常妊娠,最终导致流产。

随着孕期时间的增加,准妈妈体内雌激素与孕激素水平不断提高,原本就宫颈糜烂的准妈妈会感到症状明显加重,这时就容易阴道出血。另外,过度的性生活,过量食入巧克力、辣椒、桂圆等热性、刺激性食物也会加重出血症状。

★痔疮
准妈妈更容易便秘,便秘严重了就形成痔疮,排便时就会出血。这是因为随着胎儿一天天长大,盆腔内的血液供应增加,子宫也随之胀大继而压迫静脉,造成血液回流受阻;再加上妊娠期间盆腔组织松弛,更促使了痔疮的发生和加重;另外,由于直肠肛门部位受到子宫压迫而血行淤滞,也会促使痔疮的发生。遇到这种情况,准妈妈可以通过改变日常生活习惯和加强饮食调理来达到改善和治疗的效果。

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准妈妈应高度警惕孕期出血现象

当孕妇出现出血且合并持续腹痛,经产科医师确诊为胎盘早期剥离时,应紧急剖宫产,以维护母亲及胎儿的生命安全。

“出血”是孕妈妈最害怕的事,怀孕期间出血一定是体内有状况而发出的警讯,孕妈妈可别认为量少就不用担心,只要有出血现象,一定要尽快就医,确定原因!

受孕后,为了让受精卵顺利着床,子宫内膜不再剥落,女性自然能享受10个月没有经期来临的日子。若在怀孕期间发现出血情况,可要提高警觉了。各孕期导致出血的原因不尽相同,提醒孕妈妈立即就医查找出血原因,好让自己安心度过孕期,胎儿也才能健康地出生!

一、怀孕前期1~3个月

怀孕前3个月是众所周知的不稳定阶段,常有出血的情况发生。此阶段的出血常会被视为先兆流产的征兆,但也不完全是,以下几种情况都有可能是出血的原因,因此,及时就医查找原因很重要。

1、先兆流产

孕妇因阴道出血就医后,医生一般会要求孕妇做B超检查和妇科检查,以查找出血的原因。如果发现胚胎尚存活,妇科检查也无异常,那么先兆流产通常被认为是出血原因。

【多休息】导致先兆流产的原因很多,治疗方法也因人而异,作为孕激素的黄体酮只对黄体分泌不足及孕酮缺乏引起的先兆流产有作用。此外,卧床休息很重要,孕妇若发生出血,一定要尽量卧床休息且遵医嘱,才能稳定情况。

【不正常的胚胎】不健全的胚胎无法正常发育,也会造成出血的现象。若经安胎后仍无法缓解出血情况,最后可能会导致流产,这属于一种自然淘汰现象,孕妈妈不必太难过。

2、宫颈息肉

宫颈息肉是慢性子宫颈炎的一种临床表征。它是因为慢性炎症刺激使子宫颈管粘膜组织局部增生,而由于子宫自身有排异的倾向,致使增生的粘膜逐渐自基底部向宫颈外口突出而形成的息肉样改变。

性行为可能会引起出血,因此,在未怀孕时也可能发生出血的情形。如果在怀孕各期有性行为的话,便可能因此引起出血,但宫颈息肉的出血不影响胎儿。

【避免性生活】如果经医生诊断确定为子宫颈息肉,医生可依严重程度决定是否施行子宫颈息肉切除术。而怀孕期间若有子宫颈息肉,需避免性生活,以免造成过度刺激。

3、宫颈糜烂

宫颈糜烂其实就是子宫颈较严重的发炎,在怀孕前中后期都可能发生,子宫颈受细菌或霉菌的感染引起发炎后会造成出血。怀孕后抵抗力降低,且分泌物增多,容易引起生殖道或泌尿道感染,进一步造成细菌、霉菌逆行向上而导致子宫颈发炎。

【轻中度可不必治疗】一般来说,宫颈糜烂对胎宝宝基本没有什么影响,而且孕期不宜治疗,所以妊娠期轻中度宫颈糜烂一般可不必治疗。重度宫颈糜烂要做医生的指导下适当使用药物治疗,但要充分考虑这些药物对胚胎发育的影响。

4、宫外孕

宫外孕是指受精卵并未顺利着床在子宫腔内,而是着床在子宫腔之外的地方,如卵巢、输卵管、腹腔或子宫颈,其中最常见的是输卵管外孕。宫外孕除了有出血征兆外,有时还会合并有下腹疼痛的症状,严重者会因内出血而导致休克。如果孕妇有内出血且合并腹痛情形,B超检查未能在子宫腔内找到胚胎,且人类绒毛膜促性腺激素仍为怀孕反应,就可怀疑宫外孕。

【手术切除胚胎】由于宫外孕属非正常的怀孕,必须终止妊娠。通常会采用腹腔镜手术予以切除,另外,也可能投予药物,使胚胎自然萎缩。

5、葡萄胎

葡萄胎是胚胎未正常发育,其细胞异常增生,造成绒毛极度水肿的一种情况。怀有葡萄胎的孕妈妈,其人类绒毛膜性腺激素会异常的高,有些会合并严重的呕吐症状,经超声波检查时,子宫腔内看起来就像是充满着“雪花”一般。

【清除异常胚胎】胚胎不正常当然得终止妊娠,终止葡萄胎的妊娠通常会用子宫搔刮术清除异常的胚胎组织。因有时亦有侵犯性葡萄胎或绒毛膜癌的可能,术后必须持续追踪。

【假性月经】尚未验孕的女性在怀孕初期有出血状况时,常误以为是月经来潮而未加留意,而这可能会使孕妈妈错失保住胎儿的机会。通常怀孕初期的出血和平常的月经有些许不同,出血量不会像月经那么多,颜色也偏暗,因此如果发现月经的状态和往常不一样,要考虑到是否为怀孕的出血,建议尽快就医确诊。

二、怀孕中期4~6个月

怀孕中期是整个孕期最稳定也最舒适的阶段,若是怀孕前期的状况良好,通常进入中期后不会出现出血的现象,但有时仍会因为其他原因而有出血情况发生。

【出血原因】子宫颈机能不全

正常情况下,分娩发动后,强力的宫颈收缩才会引起子宫颈扩张,但子宫颈机能不全者,因其子宫颈长度较短,在15~20周时容易因为轻微的宫缩或压力就造成子宫颈扩张,从而导致流产。子宫颈长度小于2厘米者较容易发生这种情况。

【视情况进行子宫颈环扎术】未怀孕时,通常不容易发现子宫颈机能不全的现象,而怀孕后症状出现时常为时已晚。若在怀孕期间发现子宫颈机能不全,一般可在怀孕满3个月后进行子宫颈环扎术,将子宫颈缝合,以承受日渐长大的胎儿压力,日后解开缝线就可进行自然生产。但如果症状出现时,子宫颈已扩张至5厘米以上,就可能无法避免流产的发生。

三、怀孕后期7~10个月

怀孕后期如果出现出血现象,较常见的原因是早产、前置胎盘和胎盘早剥。

1、早产征兆

怀孕后期,特别容易因为劳累或压力引起子宫收缩,子宫收缩后会刺激子宫颈的扩张,当子宫颈扩张时,其上的毛细血管及黏膜会剥落而形成出血,这是早产的重要征兆。

【安胎】发现早产征兆后,孕妇必须尽快就医,医师会视情况给予安胎药物,抑制子宫收缩,进而改善子宫颈的扩张情况,并且请孕妇卧床休息,在情况未稳定前,尽量不要下床走动。

2、前置胎盘

前置胎盘是指胎盘的位置很低,甚至可能盖住子宫颈口,导致无法自然生产。有前置胎盘情况者,也容易在怀孕后期出现出血的情况。前置胎盘的出血一般不会合并疼痛,但有时出血过多,可能会危急胎儿及母亲的生命。

【多休息】经超声波确认为前置胎盘的孕妇,医生会视情况判断是否需住院安胎,即使不用住院安胎,孕妈妈平常也必须多休息,并且避免剧烈运动和行房。

3、胎盘早期剥离

正常情况下,胎盘在胎儿娩出后才随着脐带拖出,但如果胎盘提早剥离,便会严重影响胎儿的氧气和营养供给,可能造成胎儿窘迫,甚至胎死宫内;另外,还会造成母体下腹部疼痛及严重出血。

【紧急剖宫产】当孕妇出现出血且合并持续腹痛,经产科医师确诊为胎盘早期剥离时,应紧急剖宫产,以维护母亲及胎儿的生命安全。

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孕妇出血时如何进行急救

人们把怀孕叫“有喜”,可见孕育生命是件高兴的事。但如果孕妇出现阴道出血的情况,特别是离预产期还早,则属于异常,需要紧急处理,否则会影响母婴的安危。一般来说,不同时期发生出血的原因不同,急救方法也不同。

在12周以前的早孕阶段发生少量阴道出血,不要惊慌失措。如果B超已证实为宫内妊娠的,先兆流产的可能性较大,可以暂时卧床休息并注意观察出血的情况。如果阴道出血严重,血量多于月经量,有血块,伴有腹痛,表明先兆流产发展了,应马上到医院看急诊,由医护人员处理。

有一点很重要,如果出血时排出一些烂肉样组织物,千万不要将其丢弃,可用白酒或酒精浸泡,带到医院鉴定是否为妊娠物。这对于诊断和处理非常重要,可避免不必要的刮宫。未确定为宫内妊娠的少量阴道出血者,应先除外宫外孕和胎停育后再进行保胎治疗。

孕中晚期的出血原因较多,有可能是晚期流产和早产的先兆、胎盘位置较低、胎盘边缘血窦破裂或胎盘早剥等,不论何种原因造成的出血,都应该立即到医院进行治疗。因为即使是先兆晚期流产或早产,因孕周较大,一旦病情发展,随时有大出血的可能。如果是胎盘因素造成的出血就更严重,可危及孕妇和胎儿的生命。

孕妇就诊时有几点需要注意:1、选择医院本着就近、有输血条件、有急诊B超检查的原则;2、应选择宽松易脱换的衣物,就诊途中以平卧位为宜,座位要松软,避免腹部受压和路途颠簸;3、孕妇本人在关注出血量多少的同时要注意胎动的情况;4、其家人在护送的途中要观察孕妇的精神状态、肤色、脉搏等;5、有合并症的孕妇,如妊娠高血压患者易发生胎盘早剥,而出血多少不能反映病情的严重程度,最好由急救车护送孕妇,便于医护人员及时处理紧急情况。

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Bleeding During Pregnancy

Vaginal bleeding can occur frequently in the first trimester of pregnancy and may not be a sign of problems. But bleeding that occurs in the second and third trimester of pregnancy can often be a sign of a possible complication. Bleeding can be caused by a number of reasons.

Some basic things to know about bleeding are:
● If you are bleeding, you should always wear a pad or panty liner so that you can monitor how much you are bleeding and what type of bleeding you are experiencing.
● You should never wear a tampon or introduce anything else into the vaginal area such as douche or sexual intercourse if you are currently experiencing bleeding.
● If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your health care provider immediately.

First Half of Pregnancy:

1、Miscarriage:

Bleeding can be a sign of miscarriage but does not mean that miscarriage is imminent. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy. Approximately half of pregnant women who bleed do not have miscarriages. Approximately 15-20% of all pregnancies result in a miscarriage, and the majority occur during the first 12 weeks.

Signs of Miscarriage include:
● Vaginal bleeding
● Cramping pain felt low in the stomach (stronger than menstrual cramps)
● Tissue passing through the vagina

Most miscarriages cannot be prevented. They are often the body's way of dealing with an unhealthy pregnancy that was not developing. A miscarriage does not mean that you cannot have a future healthy pregnancy or that you yourself are not healthy.

2、Ectopic Pregnancies:

Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The fallopian tube accounts for the majority of ectopic pregnancies. Ectopic pregnancies are less common than miscarriages, occurring in 1 of 60 pregnancies.

Signs of Ectopic Pregnancies:
● Cramping pain felt low in the stomach (usually stronger than menstrual cramps)
● Sharp pain in the abdominal area
● Low levels of hCG
● Vaginal bleeding

Women are at a higher risk if they have had:
● An infection in the tubes
● A previous ectopic pregnancy
● Previous pelvic surgery

3、Molar Pregnancies:

Molar pregnancies are a rare cause of early bleeding. Often referred to as a "mole", a molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).

Signs of a Molar Pregnancy:
● Vaginal bleeding
● Blood tests reveal unusually high hCG levels
● Absent fetal heart tones
● Grape-like clusters are seen in the uterus by an ultrasound

What are common reasons for bleeding in the first half of pregnancy?

Since bleeding that occurs in the first half of pregnancy is so common (20-30%), many wonder what the causes are besides some of the complications already mentioned. Bleeding can occur in early pregnancy due to the following factors, aside from the above mentioned complications:
● Implantation bleeding can occur anywhere from 6-12 days after possible conception. Every woman will experience implantation bleeding differently—some will lightly spot for a few hours, while others may have some light spotting for a couple of days.
● Some type of infection in the pelvic cavity or urinary tract may cause bleeding.
● After intercourse some women may bleed because the cervix is very tender and sensitive. You should discontinue intercourse until you have been seen by your doctor. This is to prevent any further irritation—having normal sexual intercourse does not cause a miscarriage.

Second Half of Pregnancy:

Common conditions of minor bleeding include an inflamed cervix or growths on the cervix. Late bleeding may pose a threat to the health of the woman or the fetus. Contact your health care provider if you experience any type of bleeding in the second or third trimester of your pregnancy.

4、Placental Abruption:

Vaginal bleeding may be caused by the placenta detaching from the uterine wall before or during labor. Only 1% of pregnant women have this problem, and it usually occurs during the last 12 weeks of pregnancy.

Signs of Placental Abruption:
● Bleeding
● Stomach pain

Women who are at higher risks for this condition include:
● Having already had children
● Are age 35 or older
● Have had abruption before
● Have sickle cell anemia
● High blood pressure
● Trauma or injuries to the stomach
● Cocaine use

5、Placenta Previa:

Placenta previa occurs when the placenta lies low in the uterus partly or completely covering the cervix. It is serious and requires immediate care. It occurs in 1 in 200 pregnancies. Bleeding usually occurs without pain.

Women who are at higher risks for this condition include:
● Having already had children
● Previous cesarean birth
● Other surgery on the uterus
● Carrying twins or triplets

6、Preterm Labor:

Vaginal bleeding may be a sign of labor. Up to a few weeks before labor begins, the mucus plug may pass. This is normally made up of a small amount of mucus and blood. If it occurs earlier, you could be entering preterm labor and should see your physician immediately.

Signs of Preterm Labor include these symptoms that occur before the 37th week of pregnancy:
● Vaginal discharge (watery, mucus, or bloody)
● Pelvic or lower abdominal pressure
● Low, dull backache
● Stomach cramps, with or without diarrhea
● Regular contractions or uterine tightening

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Bleeding And Spotting During Pregnancy

While bleeding or spotting during early pregnancy may be a common pregnancy symptom, it will no doubt cause some concern to anyone who may be pregnant. There are a number of possible causes for this to being 'normal' - such as when your fertilized egg implants itself into the wall of your uterus - commonly referred to as implantation bleeding. This alone can cause a day or two of bleeding.

Of course if you are still in the early stages of pregnancy you may experience some bleeding similar to what you may expect if you were about to start your normal monthly cycle. Although your hormones will prevent your normal cycle from occurring while you are pregnant, it is not uncommon that some women may experience some bleeding around the same time as they would normally have had their period.

Did you know that a quarter of all pregnant women will experience bleeding or spotting at some point in their pregnancy?

1、What is the difference between spotting and bleeding?

Spotting is very light bleeding, similar to what you may experience during the very beginning or the end of your normal period cycle and it can vary in color from pink to red or brown. Bleeding would be what you would normally experience during a normal monthly cycle.

If the spotting you are experiencing is in conjunction with either bright red blood, fevers, chills or cramping then you will want to contact your health care provider as soon as possible.

2、What are the other causes of spotting?

●Infections
Spotting may also be a result of conditions which are not pregnancy related. A vaginal infection, such as a yeast infection or bacterial vaginosis or even a sexually transmitted infection can cause your cervix to become irritated or inflamed. An inflamed cervix is particularly susceptible to spotting after sex or after a Pap smear.

●Miscarriage or Ectopic Pregnancy
Spotting is one of the early signs of a possible miscarriage or an ectopic pregnancy, especially if accompanied by abdominal pain or any cramping. There are of course other signs of both of these complications, and you should read through the articles if you are concerned about the health of your baby.

●Placental Problems or Premature Labor
Spotting or bleeding during the second or third trimester of your pregnancy can be a sign of a complication such as:
*placenta previa
*placental abruption
*a late miscarriage
*premature labor

●Normal Labor
A vaginal discharge that's tinged with blood after 37 weeks is most likely just a sign that the mucous plug has dislodged and the cervix is beginning to soften or dilate in preparation for labor. You should still report any other bleeding or spotting at this point to your healthcare provider.

●Unknown Causes
In some cases, the cause of the spotting will remain a mystery. There have been hundreds upon hundreds of cases where women have had bleeding or spotting during pregnancy, and have carried full term and had healthy babies.

The important thing is that the moment you experience any type of bleeding or spotting that you inform your healthcare provider ASAP.

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Bleeding During Pregnancy

1、Overview

Because bleeding during all phases of pregnancy may be dangerous, you should call your health care provider if you have any signs of vaginal bleeding during your pregnancy.

Vaginal bleeding is any blood coming from your vagina (the canal leading from the uterus to the external genitals). This usually refers to abnormal bleeding not associated with a regular menstrual period.

● First trimester bleeding is any vaginal bleeding during the first 3 months of pregnancy. Vaginal bleeding may vary from light spotting to severe bleeding with clots. Vaginal bleeding is a common problem in early pregnancy, complicating 20-30% of all pregnancies.

● Any vaginal bleeding during the second and third trimesters of pregnancy (the last 6 months of a 9-month pregnancy) involves concerns different from bleeding in the first 3 months of your pregnancy. Any bleeding during the second and third trimesters is abnormal.

● Bleeding from the vagina after the 28th week of pregnancy is a true emergency. The bleeding can range from very mild to extremely brisk and may or may not be accompanied by abdominal pain. Hemorrhage (another word for bleeding) is the most common cause of death of the mother in the United States. It complicates about 4% of all pregnancies.

2、Causes

First trimester bleeding

Vaginal bleeding in the first trimester of pregnancy can be caused by several different factors. Bleeding affects 20-30% of all pregnancies. Up to 50% of those who bleed may go on to have a miscarriage (lose the baby). Of even more concern, however, is that about 3% of all pregnancies are ectopic in location (the fetus is not inside the uterus). An ectopic pregnancy may be life threatening to the mother. All bleeding associated with early pregnancy should prompt a call to your health care provider for immediate evaluation.

● Implantation bleeding: There can be a small amount of spotting associated with the normal implantation of the embryo into the uterine wall, called implantation bleeding. This is usually very minimal, but frequently occurs on or about the same day as your period was due. This can be very confusing if you mistake it for simply a mild period and don't realize you are pregnant. This is a normal part of pregnancy and no cause for concern.
● Threatened miscarriage: You may be told you have a threatened miscarriage if you are having some bleeding or cramping. The fetus is definitely still inside the uterus (based usually on an exam using ultrasound), but the outcome of your pregnancy is still in question. This may occur if you have an infection, such as a urinary tract infection, get dehydrated, use some drugs or medications, are involved in physical trauma, if the developing fetus is abnormal in some way, or for no apparent reason at all. Other than these reasons, threatened miscarriages are generally not caused by things you do, such as heavy lifting or having sex, or by emotional stress.
● Completed miscarriage: You may have a completed miscarriage (also called a spontaneous abortion) if your bleeding and cramping have slowed down and the uterus appears to be empty based on ultrasound evaluation. This means you have lost the pregnancy. The causes of this are the same as those for a threatened miscarriage. This is the most common cause of first trimester bleeding.
● Incomplete miscarriage: You may have an incomplete miscarriage (or a miscarriage in progress) if the pelvic exam shows your cervix is open and you are still passing blood, clots, or tissue. The cervix should not remain open for very long. If it does, it indicates the miscarriage is not completed. This may occur if the uterus begins to clamp down before all the tissue has passed, or if there is infection.
● Blighted ovum: You may have a blighted ovum (also called embryonic failure). An ultrasound would show evidence of an intrauterine pregnancy, but the embryo has failed to develop as it should in the proper location. This may occur if the fetus were abnormal in some way and not generally due to anything you did or didn't do.
● Intrauterine fetal demise: You may have an intrauterine fetal demise (also called IUFD, missed abortion, or embryonic demise) if the developing baby dies inside the uterus. This diagnosis would be based on ultrasound results and can occur at any time during pregnancy. This may occur for any of the same reasons a threatened miscarriage occurs during the early stages of pregnancy. It is very uncommon for this to occur during the second and third trimesters of pregnancy. If it does, the causes also include separation of the placenta from the uterine wall (called placental abruption) or because the placenta didn't get sufficient blood flow.
● Ectopic pregnancy: You may have an ectopic pregnancy (also called tubal pregnancy). This would be based on your medical history and ultrasound, and in some cases laboratory results. Bleeding from an ectopic pregnancy is the most dangerous cause of first trimester bleeding. An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, most often in the fallopian tube. As the fertilized egg grows, it can rupture the fallopian tube and cause life-threatening bleeding. Symptoms are often variable and may include pain, bleeding, or lightheadedness. Most ectopic pregnancies will cause pain before the tenth week of pregnancy. The fetus is not going to develop and will die because of lack of supply of nutrients. This condition occurs in about 3% of all pregnancies.

There are risk factors for ectopic pregnancy. These include a history of prior ectopic pregnancy, history of pelvic inflammatory disease, history of fallopian tube surgery or ligation, history of infertility for more than 2 years, having an IUD (birth control device placed in the uterus) in place, smoking, or frequent (daily) douching. Only about 50% of women who have an ectopic pregnancy have any risk factors, however.

●Molar pregnancy: You may have a molar pregnancy (technically called gestational trophoblastic disease). Your ultrasound results may show the developing fetus is not actually a baby but is abnormal tissue. This is actually a type of cancer that occurs as a result of the hormones of pregnancy and is usually not life-threatening to you. However, in rare cases the abnormal tissue is cancerous. It can invade the uterine wall and spread throughout the body. The cause of this is generally unknown.

●Postcoital bleeding is vaginal bleeding after sexual intercourse. It may be normal during pregnancy.

●Bleeding may also be caused by reasons unrelated to pregnancy. For example, trauma or tears to the vaginal wall may bleed, and some infections may cause bleeding.

Late-pregnancy bleeding

The most common cause of late-pregnancy bleeding is problems with the placenta. Some bleeding can also be due to an abnormal cervix or vagina.

● Placenta previa: The placenta, which is a structure that connects the baby to the wall of your womb, can partially or completely cover the opening of your womb. When you bleed because of this, it is called placenta previa. Late in pregnancy as the opening of your womb, called the cervix, thins and dilates (widens) in preparation for labor, some blood vessels of the placenta stretch and rupture. This causes about 20% of third-trimester bleeding and happens in about 1 in 200 pregnancies. Risk factors for placenta previa include these conditions:

* Multiple pregnancies
* Prior placenta previa
* Prior Cesarean delivery

● Placental abruption: This condition occurs when a normal placenta separates from the wall of the womb (uterus) prematurely and blood collects between the placenta and the uterus. Such separation occurs in 1 in 200 of all pregnancies. The cause is unknown. Risk factors for placental abruption include these conditions:
* High blood pressure (140/90 or greater)
* Trauma (usually a car accident or maternal battering)
* Cocaine use
* Tobacco use
* Abruption in prior pregnancies (you have a 10% risk it will happen again)

● Uterine rupture: This is an abnormal splitting open of the uterus, causing the baby to be partially or completely expelled into the abdomen. Uterine rupture is rare but very dangerous for both mother and baby. About 40% of women who have uterine rupture had prior surgery of their uterus, including Cesarean delivery. The rupture may occur before or during labor or at the time of delivery. Other risk factors for uterine rupture are these conditions:
* More than 4 pregnancies
* Trauma
* Excessive use of oxytocin (Pitocin), a medicine that helps strengthen contractions
* A baby in any position other than head down
* Having the baby's shoulder get caught on the pubic bone during labor
* Certain types of forceps deliveries

● Fetal vessel rupture: This condition occurs in about 1 of every 1,000 pregnancies. The baby's blood vessels from the umbilical cord may attach to the membranes instead of the placenta. The baby's blood vessels pass over the entrance to the birth canal. This is called vasa previa and occurs in 1 in 5,000 pregnancies.

● Less common causes of late-pregnancy bleeding include injuries or lesions of the cervix and vagina, including polyps, cancer, and varicose veins.

● Inherited bleeding problems, such as hemophilia, are very rare, occurring in 1 in 10,000 women. If you have one of these conditions, such as von Willebrand disease, tell your doctor.

3、Symptoms

It is helpful for your health care provider to know the amount and the quality of the bleeding that you have. Keep track of the number of pads used and passage of clots and tissue. If you pass a clump of tissue and are going to see your doctor, bring the tissue with you for examination.

● Other symptoms you may experience are increased fatigue, excessive thirst, dizziness, or fainting. Any of these may be signs of significant blood loss. You may notice a fast pulse rate that increases when you stand up from lying down or sitting. Dizziness may increase when you stand up as well.

● With late-pregnancy bleeding, you may have these specific symptoms:
* Placenta previa: About 70% of women have painless bright red blood from the vagina. Another 20% have some cramping with the bleeding, and 10% have no symptoms.
* Placental abruption: About 80% of women have dark blood or clots from the vagina, but 20% have no external bleeding. More than one-third have a tender uterus. About two-thirds of women with placental abruption have the classic "pain and bleeding." Over half of the time the baby shows signs of distress. Most abruptions occur before labor starts.
* Uterine rupture: Symptoms are highly variable. Classic uterine rupture is described as intense abdominal pain, heavy vaginal bleeding, and a "pulling back" from the birth canal of the baby's head. The pain may initially be intense, then get better with rupture, only to worsen as the lining of the abdomen is irritated. Bleeding can range from spotting to severe hemorrhage.
* Fetal bleeding: This condition may show up as vaginal bleeding. The baby's heart rate on the monitor will first be very fast, then slow, as the baby loses blood.
* Lower genital tract injury: This condition usually causes only mild spotting. Cervical cancer is very rare in women of childbearing age. A yeast infection may cause a white or pink discharge and can be itchy. A ruptured vaginal varicose vein can cause heavy bleeding.

4、When to Seek Medical Care

Bleeding is not normal at any time during pregnancy. Report any abnormal vaginal bleeding during pregnancy to your health care provider. Be prepared to give information about the amount of blood lost and a description of how you are feeling overall. If your bleeding is light and you have no pain, your evaluation may be in the doctor's office.

Go to a hospital's Emergency Department if the following conditions develop:
● If you have severe bleeding or cramps and contractions (call 911)
● If vaginal bleeding in pregnancy lasts for more than 24 hours and you are unable to get in touch with your health care provider or you don't have one
● If you faint (pass out) or feel very dizzy
● If you are bleeding and develop a fever over 100.5°F
● If you have pain worse than a normal period, or severe localized pain in your abdomen, pelvis, or back
● If you have undergone an abortion and develop a fever, abdominal or pelvic pain, or increased bleeding
● If you have been given medical treatment for ectopic pregnancy with methotrexate, and you develop increased abdominal or pelvic pain within the first week after the injection

5、Exams and Tests

The medical evaluation begins with a thorough history and physical exam. Depending on the setting (medical office or hospital) and the seriousness of your symptoms, laboratory and ultrasound tests may be performed. For bleeding in the early part of pregnancy, the doctor's main goal will be to make sure you don't have an ectopic pregnancy. That is what the evaluation will focus on. For late-pregnancy bleeding, the doctor first will make sure you are stable.

Medical history: Your health care provider will ask you a lot of questions:
● If early in pregnancy, your pregnancy history will be reviewed regarding the certainty of the dates of your pregnancy. If you think you are pregnant, you usually are. Although, in many cases, women who don't think they are pregnant, often can be.
● You may be asked about recent trauma or sexual intercourse and whether you have abdominal pain or contractions.
● Your medical history will be reviewed, with emphasis on bleeding disorders or liver problems and drug or tobacco use.
● You will be asked about prior Cesarean deliveries, preterm labor, placenta previa, or placental abruptions.

Physical exam: Regardless of where you are being treated, the first thing that should be established is how sick you are as a result of the bleeding. This is done by evaluating vital signs (pulse and blood pressure), and by a quick physical assessment of volume of blood loss by looking to see if you are pale or if you have abdominal tenderness. If you have lost a significant amount of blood, you will be treated with IV fluids and you may need an operation.

● Your abdomen will be examined to see if you are tender and to check the size of your uterus.
● You will be checked for bleeding from other sites, such as nose or rectum.
● The results of the pelvic exam may or may not be very helpful in differentiating between ectopic pregnancy and threatened miscarriage: 10% of women with an ectopic pregnancy will have a completely normal pelvic exam. How enlarged the uterus is on examination may help, because in less than 3% of ectopic pregnancies is the uterus enlarged to greater than 10 cm.
● Quantity and quality of abdominal pain and vaginal bleeding is important for the doctor to know. Pain is seen in most women with ectopic pregnancy (up to 90%) and vaginal bleeding (50-80%).
● Late in pregnancy, you will have an abdominal ultrasound prior to a vaginal exam to see if you have a placenta previa. If ultrasound does not show previa, you will have a sterile speculum vaginal exam to evaluate you for injury to the lower genital tract. If the vaginal exam is normal, you will have a digital exam to check for cervical dilation. You will have monitors attached to your abdomen to check for contractions and for the baby's heart rate.
● Symptoms and physical examination diagnose uterine rupture. The symptoms that suggest rupture are sudden onset of severe abdominal pain, abnormality of the size and shape of the uterine contour, and regression of the baby's head up the birth canal.

Lab tests: Several lab tests are routinely obtained. They include a urine pregnancy test, a urinalysis, a blood type and Rh, and a complete blood count (CBC). Serum quantitative bhCG, which is a blood hormone marker of pregnancy, is also frequently obtained.
● The urine pregnancy test is extremely sensitive for diagnosing pregnancy at or about the same time you miss your period, or possibly a few days before. A urinalysis can diagnose urinary tract infections, regardless of whether you have symptoms of this type of infection. This is because infections, specifically of the urinary tract, are a cause of miscarriage. Also, a urinary tract infection with no symptoms is relatively common in pregnancy, occurring in 2-11% of pregnant women. Up to a fourth of these women will go on to have kidney infections.
● Your blood type will be checked. You are being screened for whether your type is Rh negative or positive. If you are negative and the father of the baby is positive, your body may make antibodies against the baby. If this occurs without treatment, the next time you are pregnant, these antibodies will appear again and harm that baby. If this is discovered during the first pregnancy and treatment with an injection called RhoGAM is given, this prevents the antibodies from forming.
● A blood count is routinely obtained to have an estimate of how much bleeding has already occurred.
● The bhCG level is a measure of the volume of living tissue associated with the developing pregnancy. Both ectopic and intrauterine pregnancies (IUP) produce bhCG, although there is usually a difference in the rate at which the quantitative bhCG level increases. Although a single value of bhCG isn't useful for differentiating between a normal or abnormal pregnancy or an ectopic pregnancy, a variation in the expected rate of rise of the bhCG level can be helpful. A falling bhCG does not exclude the possibility of tubal rupture. The real value of the quantitative bhCG for diagnosis of ectopic pregnancy is when it is used in correlation with the results of a pelvic ultrasound.

Ultrasound: Ultrasound can often determine if the fetus is healthy and growing inside the uterus. Ultrasound is a form of imaging using sound waves, not x-rays. It is a test that is often able to identify a pregnancy and estimate the age of the fetus. However, a pregnancy may be too early to be seen on ultrasound.
● Ultrasound may be able to find an ectopic pregnancy growing outside of the uterus. It also may be used to look for blood in the pelvis-a very serious complication that can occur when the ectopic pregnancy has ruptured the fallopian tube.
● Late in pregnancy, placenta previa is diagnosed almost exclusively by abdominal ultrasound, which can detect it 95% of the time.
● Placental abruption is diagnosed by excluding other causes. It often cannot be confirmed until after delivery when the placenta is found to have a blood clot attached to it. An ultrasound is performed to make certain that the bleeding is not from a placenta previa. Ultrasound at best is only able to detect about half of placental abruptions.
● Fetal bleeding can be distinguished from maternal bleeding by performing a special test on the blood present in the vagina. Also, a special type of ultrasound (Doppler) may be used to see the blood flow within the blood vessels.
● Lower genital tract problems can easily be diagnosed with a speculum examination. It is important that an ultrasound rule out placenta previa prior to any vaginal exam.

6、Treatment

The treatment options for vaginal bleeding during pregnancy depend on the diagnosis and the certainty of that diagnosis.

7、Self-Care at Home

If you begin to bleed during early pregnancy, until your doctor has seen you and given different instructions, you should take it easy. Rest and relax and no heavy lifting, strenuous exercise, sex, tampons, or douching. Drink plenty of water and try to guard against dehydration. Remember to keep track of the number of pads used and if the bleeding is increasing or decreasing.

There is no home care for late-pregnancy bleeding. You must see a health care professional immediately.

8、Medical Treatment

Early pregnancy bleeding

● Ectopic pregnancy: If you have been diagnosed with an ectopic pregnancy by ultrasound, you may be given medication or taken into surgery.
* Medical management is with methotrexate, a drug that kills rapidly developing tissue.
* Surgery is reserved for those women who do not meet certain criteria for receiving medical treatment with methotrexate, and for those who are too sick to wait for the methotrexate to work. Also, if you choose not to have methotrexate therapy, then surgery would be the only other option. Surgery is usually a laparoscopic procedure (small incisions in your abdomen for tiny instruments) into the fallopian tube and removal of the ectopic pregnancy, while attempting to save as much of the tube as possible. This may not be possible, however, if there has been much damage to the tube by the ectopic pregnancy itself or from significant bleeding.

● Threatened miscarriage: If you are diagnosed with a threatened miscarriage, your health care provider will give you instructions about activities, what to watch for, and when to return for follow-up. Home care for threatened miscarriages: Rest until any pain or bleeding stops. Avoid sexual intercourse for 3 weeks. Do not douche or use tampons.

● Incomplete/inevitable abortion: You will be admitted to the hospital for a procedure to remove any remaining fetal tissue in your uterus. This is called uterine evacuation (D & C) to prevent any further complications such as hemorrhage or infection.

● Missed abortion: In this case, you may either be admitted to the hospital for uterine evacuation (D & C) or monitored at home with the possibility of passing the tissue without surgery. This decision is made by you and your doctor after a discussion of the risks and benefits of both choices. The age and size of the fetus may be important when deciding which course of action to pursue.

● Complete abortion: You may be sent home after complete passage of fetal tissue is ensured or if an ultrasound shows no remaining tissue.

● Molar pregnancy: Immediate uterine evacuation (D & C) is necessary. Follow-up blood B-hCG levels should be obtained to check for chorionic carcinoma (a type of cancer).

Late pregnancy bleeding

With late-pregnancy bleeding, you will be monitored for blood loss and signs of shock. You will receive IV fluids and possibly blood. Your baby will be monitored closely for signs of distress. Your treatment will be guided by the cause of your bleeding, your condition, and the age of the baby.

● Placenta previa
* Cesarean delivery (the baby is delivered surgically) is the preferred route of delivery.
* If you or your baby is in danger from severe bleeding, you will have an emergency Cesarean delivery.
* If you are having contractions, you may get IV medicine to slow them or stop them.
* If your pregnancy is fewer than 36 weeks and your bleeding is not severe, you will be admitted to the hospital for observation, monitoring of your baby's heart rate, and repeated blood counts to check for anemia. You will get a medicine to help your baby's lungs mature. When you are 36 weeks pregnant, the doctor will check your baby's lungs, and, if they are mature, you will have a Cesarean delivery.
* Almost all deliveries will be Cesarean deliveries because of the high risk of severe bleeding and danger to the baby by a vaginal delivery. In very rare cases, when the placenta is next to but not covering the cervix, a vaginal delivery may be attempted.
* Even with a Cesarean deliveries, you can lose up to 3 pints of blood.

● Placental abruption
* Vaginal delivery is the preferred delivery. Cesarean delivery is reserved for emergencies.
* If you have massive bleeding and you or your baby are in danger, then an emergency Cesarean delivery will be performed.
* If your baby is more than 36 weeks, you will have a rapid but controlled vaginal delivery. You may be given some IV medication to make your contractions more effective.
* If your pregnancy is fewer than 36 weeks and your bleeding is not severe, you will be admitted to the hospital for observation, monitoring of your baby's heart rate, and repeated blood counts to check for anemia. You will get a medicine to help your baby's lungs mature. When you are 36 weeks pregnant, the doctor will check your baby's lungs, and, if they are mature, you will have a Cesarean delivery.

● Uterine rupture
* If there is a high suspicion for rupture of the uterus, you will have an immediate Cesarean delivery.
* Your uterus may have to be removed.
* If you are stable and want to have more children, the surgeon may be able to repair your uterus.
* You will probably need to be transfused with several units of blood.

● Fetal bleeding is treated by performing an immediate Cesarean delivery.

9、Next Steps

If you have any complications including bleeding, abdominal pain, or fever, you should return to the doctor for reexamination.

10、Follow-up

If you have been treated for ectopic pregnancy and have increased pain or any weakness or dizziness, you should call an ambulance or have someone take you to a hospital's emergency department immediately.

● You may be placed on bed rest with instructions to place nothing into the vagina.

● Do not douche, use tampons, or have sexual intercourse until the bleeding stops.

● Follow-up care with your gynecologist should be arranged within 1-2 days.

● Women who have had a molar pregnancy need regular, long-term follow-up and repeat measurements of beta-hCG to ensure that no cancer will develop.

11、Prevention

The best way to prevent any complication in pregnancy is to have a good relationship with your health care provider and to maintain close contact throughout your pregnancy. This is especially important if you have had prior pregnancies complicated by third-trimester bleeding.

Avoid bleeding in pregnancy by controlling your risk factors, especially the use of tobacco and cocaine. If you have high blood pressure, work closely with your health care provider to keep it controlled.

12、Outlook

The effects of bleeding during your pregnancy depend on many factors. The cause of the bleeding and whether it is treatable is the most important issue.

Early pregnancy bleeding

● If a normal appearing pregnancy with a normal beating heart is seen by ultrasound inside the uterus and you are younger than 40 years, the pregnancy has a less than 3% chance of being a miscarriage. If you are older than 40 years, then there is an 8% chance of miscarrying. If there is not a definite pregnancy seen within the uterus, then the likelihood of miscarrying is really unknown but could be up to 50%.

● For bleeding in early pregnancy caused by ectopic pregnancy, the pregnancy will not survive. If you have such a pregnancy, the possibilities of future ectopic pregnancies depend on the location, timing, and management of the condition. About 50% of women with ectopic pregnancies later have successful pregnancies.

● Threatened abortion: You will have an entirely normal pregnancy and birth 50% of the time. Alternatively, you may progress to have a spontaneous abortion or miscarriage. If you have an ultrasound at the time of your evaluation, which shows a fetus with a heartbeat in the uterus, there is a 75-90% chance of having a normal pregnancy.

● Complete abortion or miscarriage: For women with recurrent miscarriages, the possibility of having a successful pregnancy is still high. Even after 2 or more miscarriages, your chances for delivering a child are still high.

● Molar pregnancy: After having a molar pregnancy, the risk of molar pregnancy in a later conception is about 1%. In addition, the overall risk of a certain form of cancer in women who have had a prior molar pregnancy has been estimated at 1,000 times higher than that of women who have not had a molar pregnancy.

Late pregnancy bleeding

● Placenta previa: The risk of maternal death is less than 1%, but other complications, such as massive hemorrhage requiring transfusion of blood or a hysterectomy, can also occur.
* Rarely, the placenta attaches abnormally deep into the uterus. This is called a placenta accreta, increta, or percreta, depending on the depth. Many women who have this condition have such massive bleeding that a hysterectomy (removal of the uterus) is required to save the woman's life.
* Up to 8 of every 100 babies with placenta previa die, usually because of premature delivery and lack of lung maturity. Other problems for the baby include size smaller than expected, birth defects, breathing difficulties, and anemia requiring blood transfusion.

● Placental abruption: The risk of maternal death is low, but major blood loss may require transfusions.
* The risk of death for the baby with placental abruption is about 1 in 500. This accounts for 15% of all newborn deaths.
* If the baby survives, about 15% have neurological and behavioral problems as a result of decreased oxygen to the brain. This occurs because placental blood vessels spasm and reduce the flow of oxygen to the baby before delivery.
* As the placenta separates from the womb, amniotic fluid and some placental tissue may enter the woman's bloodstream and cause a reaction. Her blood may become very thin and not clot well, which worsens the hemorrhage. She may require additional blood products to help her clot.

● Uterine rupture: This is a very dangerous condition for both the woman and the baby.
* The greatest risks to the woman are hemorrhage and shock.
* An increased rate of transfusion occurs with uterine rupture, and 58% of women require more than 5 units of blood transfused.
* The risk of death for the woman is less than 1%. However, if left untreated, the woman will die.
* The risk to the fetus is extremely high. The death rate is about 1 in 3.

● Fetal bleeding is extremely dangerous for the baby. The risk of death for the baby is 50% and is increased to 75% if the membranes rupture (water breaks).

● Congenital bleeding disorders: The risk of complications for the woman is quite low. The most concerning is hemorrhage. The risk to the infant is very low. The largest risk to the baby, especially if it is a male, is inheritance of the bleeding disorder.

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