Bleeding in Pregnancy

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 The causes of bleeding in early pregnancy are broadly divided into two groups: 
I. Related to the pregnant state: 
 Abo...

Abortion 
Ectopic pregnancy 
Hydatidiform mole 
Bleeding In Early Pregnanct - Suliman Alrajhi Colleges 10/14/2014 4

Bleeding In Early Pregnanct - Suliman Alrajhi Colleges 10/14/2014 5

Bleeding In First Trimester Of Pregnancy

Vaginal bleeding during pregnancy first trimester can be caused by various factors. Nearly 20 to 30% of pregnancies will be affected with bleeding during this phase.

1. Ectopic Pregnancy:

In an ectopic pregnancy, the fertilized egg implants outside the uterus, that is usually in the fallopian tube. You will usually notice cramping and a sharp pain in the lower abdominal region accompanied by dizziness, weakness and nausea. It can be life threatening to mother and requires immediate medical attention. Statistically, only 3% of pregnancies experience it.
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

2. Molar Pregnancy:

Molar pregnancy is a rare condition that results when the placenta becomes a cystic mass from a malformed embryo. This is a type of tumor that occurs because of pregnancy hormones and is not life threatening at all. It happens within a few weeks of conception. In some cases, it can turn out to be abnormal and can spread throughout the body, the condition being diagnosed as gestational trophoblastic disease. You can observe vaginal bleeding within few weeks of conception if you happen to suffer from molar pregnancy.
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

3. Miscarriage:

One of the major concerns with bleeding during first trimester of pregnancy is that it can be a miscarriage as well. It is common to occur during the initial 12 weeks of pregnancy. If bleeding accompanies symptoms like cramping, lower abdominal pain and passage of tissue through the vagina, then there is a higher chance of miscarrying the baby. About 50% pregnant women who experience the symptoms along with vaginal bleeding, miscarry a baby.

Bleeding In Second And Third Trimesters Of Pregnancy

The common cause of bleeding during late pregnancy is due to placenta problems. Also, abnormal cervix or vagina can cause bleeding.

4. Placenta Previa:

This is the most common cause of bleeding during late pregnancy. In this condition, the placenta that usually connects the fetus to the womb will cover a part of the cervical opening. As a result, bleeding takes place. Later in pregnancy, the cervix becomes thin and dilates to prepare for labor. At this stage, the placenta stretches and ruptures causing heavy bleeding. The risk factors for this placenta previa condition include prior placenta previa, multiple pregnancies and prior cesarean delivery.

5. Placenta Abruption:

This condition occurs in the second half of pregnancy or the third trimester. It is an early separation of placenta from the uterus and it leads to blood collection in the region between the placenta and uterus. It is accompanied by cramps, pains in the abdominal region, tenderness in the uterus and back pain. If the separation is too little, it is not lethal for the baby. But, it will pose severe risks if the separation is large. The risk factors for this cause of vaginal bleeding include trauma, hypertension, usage of tobacco, cocaine and prior placenta abruption.

6. Uterine Rupture:

In rare conditions there will be an abnormal splitting of the uterus due to a scar from a prior C-section. It makes the fetus expel into the abdomen that can be quite dangerous for both the baby and the mother. The uterine rupture can occur before or during the labor time. There are certain other risk factors that include trauma, multiple pregnancies, using excess amounts of oxytocin medicine (strengthens contractions) and deliveries through forceps.

7. Fetal Vesssel Rupture:

The developing blood vessels of the fetus may cross the opening of the birth canal. These are known to be vasa previa and can be lethal to the baby as blood vessels can tear open and bleed severely. This condition is also accompanied by abnormal fetal heart rate. It is a very rare condition that happens in 1 out of 5000 pregnancies.

8. Pre-term Labor:

If the delivery time falls between week 20 to week 37, it is considered a pre-term labor. It is accompanied by cramping, regular contractions, built-in pelvic pressure and back pain. A few days before your body prepares for labor, you will pass your mucus plug where bleeding starts. This is termed as a bloody show that requires an immediate contact with your health care provider.
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
Some other causes of bleeding in late pregnancy include:
  • Injury to vagina or cervical region
  • Cancer
  • Polyps
  • Varicose veins (abnormal veins with full of twists and turns)

HOW TO DIAGNOSE

Lab Test

Full blood count

Urine Pregnancy Test

Serum b-hCG level

Imaging

Ultrasound

Chest X ray - in case of Molar Pregnancy

Light Bleeding      Vaginal Bleeding expulsion of Severe pain , uterine size                 Mild pain H/O ( before 20Mild...
Heavy Bleeding    h/o Expulsion of POC , Uterine size < period of    gestation , Os may be open   Diagnosis --- Incomple...
Any bleeding with----H/o passage of vesicles                   Pain , fever , abdominal distension , H/o                  ...



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