Is bleeding and clotting normal in early pregnancy. Vaginal Bleeding and Blood Clots During Early Pregnancy: What’s Normal and What’s Not

22.11.197626.10.2021 by alexxlab

Is bleeding and clotting normal in early pregnancy. What are the types of bleeding during pregnancy. How much bleeding is considered normal in the first trimester. When should you be concerned about bleeding during pregnancy. What causes vaginal bleeding in early pregnancy.

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Understanding Vaginal Bleeding in Early Pregnancy

Vaginal bleeding during pregnancy, especially in the early stages, can be a source of concern for many expectant mothers. However, it’s important to understand that bleeding is relatively common, particularly in the first 20 weeks of pregnancy. In fact, studies show that 25-40% of women experience some form of vaginal bleeding during this period. While this statistic may provide some reassurance, it’s crucial to take any bleeding seriously and consult with a healthcare provider to rule out potential complications.

How common is bleeding in early pregnancy?

Bleeding during the first trimester is more common than many people realize. Approximately one in four women experience some form of vaginal bleeding in early pregnancy. While this doesn’t necessarily indicate a problem, it’s always best to err on the side of caution and seek medical advice.

Types of Bleeding During Pregnancy

When assessing the severity of vaginal bleeding during pregnancy, it’s important to consider both the amount and color of the blood. Healthcare providers typically categorize bleeding into three main types:

Spotting: A few drops of blood that don’t fully cover a panty liner
Light bleeding: Requires the use of feminine hygiene products but is less than a typical menstrual flow
Heavy bleeding: Resembles or exceeds a normal menstrual period, sometimes accompanied by blood clots

Is bright red blood more concerning than brown blood?

Generally, bright red blood is considered more concerning than brown blood during pregnancy. Bright red blood typically indicates fresh bleeding, while brown blood may be older and less worrisome. However, any bleeding should be reported to your healthcare provider for proper evaluation.

Causes of Bleeding in the First Trimester

There are several potential causes of vaginal bleeding during the first 12 weeks of pregnancy. Understanding these can help alleviate some anxiety, but it’s important to remember that only a healthcare professional can accurately diagnose the cause.

What is implantation bleeding?

Implantation bleeding is one of the earliest signs of pregnancy, occurring about 6 to 12 days after conception. It happens when the fertilized egg attaches to the lining of the uterus. This type of bleeding is usually light and may be mistaken for a light period.

Can hormonal changes cause bleeding in early pregnancy?

Yes, hormonal fluctuations during pregnancy can cause changes to the cervix, making it more sensitive and prone to bleeding. This can result in light bleeding or spotting, especially after activities such as sexual intercourse or a pelvic exam.

Potential Complications Associated with First Trimester Bleeding

While many instances of first-trimester bleeding are not indicative of serious problems, there are some potential complications that may be associated with vaginal bleeding:

Miscarriage
Ectopic pregnancy
Molar pregnancy
Subchorionic hematoma

It’s important to note that experiencing bleeding does not necessarily mean you’re having one of these complications. However, prompt medical evaluation is crucial to rule out these possibilities and ensure both maternal and fetal health.

How is a threatened miscarriage diagnosed?

A threatened miscarriage is typically diagnosed when there is vaginal bleeding with or without abdominal pain, but an ultrasound shows that the pregnancy is developing normally. Many women who experience a threatened miscarriage go on to have healthy pregnancies, but close monitoring is usually recommended.

Bleeding in the Second Half of Pregnancy

While bleeding can occur at any stage of pregnancy, it’s generally considered more concerning when it happens in the latter half. After the 20th week of pregnancy, bleeding can be indicative of more serious complications.

What are the potential causes of bleeding after 20 weeks?

Potential causes of bleeding in the second half of pregnancy include:

Placenta previa: A condition where the placenta partially or completely covers the cervix
Placental abruption: When the placenta separates from the uterine wall before delivery
Preterm labor: Labor that begins before 37 weeks of pregnancy

These conditions often come with additional symptoms such as abdominal pain, back pain, contractions, or fever. Any bleeding in the second half of pregnancy warrants immediate medical attention.

When to Seek Medical Attention for Pregnancy Bleeding

While some light spotting or bleeding can be normal during pregnancy, it’s always best to err on the side of caution. Contacting your healthcare provider allows for proper evaluation of your individual risks and appropriate monitoring of your condition.

Should you use tampons if you’re experiencing pregnancy bleeding?

No, it’s not advisable to use tampons during pregnancy, especially if you’re experiencing bleeding. Tampons can introduce bacteria into the vagina and potentially increase the risk of infection. Instead, use sanitary pads to monitor the amount and type of bleeding you’re experiencing.

Preventive Measures and Self-Care During Pregnancy

While not all causes of vaginal bleeding during pregnancy are preventable, there are some steps you can take to promote a healthy pregnancy:

Attend all prenatal appointments
Follow a healthy diet and take prenatal vitamins as recommended
Avoid smoking, alcohol, and illicit drugs
Practice safe sex to prevent infections
Manage stress through relaxation techniques

Remember, every pregnancy is unique, and what’s normal for one woman may not be for another. Always consult with your healthcare provider about any concerns you have during your pregnancy.

Can stress cause bleeding in early pregnancy?

While stress itself doesn’t directly cause bleeding, high levels of stress can potentially lead to behaviors or physical changes that might increase the risk of bleeding. For example, stress might cause changes in hormone levels or lead to high blood pressure, which could potentially affect the pregnancy. However, it’s important to note that many women experience stress during pregnancy without any bleeding or complications.

Diagnostic Procedures for Pregnancy Bleeding

When you report vaginal bleeding to your healthcare provider, they may recommend several diagnostic procedures to determine the cause and ensure the health of both you and your baby.

What tests might be performed if you experience bleeding during pregnancy?

Depending on your symptoms and stage of pregnancy, your healthcare provider may recommend:

Physical examination
Ultrasound scan
Blood tests to check hormone levels
Genetic testing if a miscarriage is suspected

These tests can help identify the cause of bleeding and guide appropriate treatment or monitoring strategies.

Treatment Options for Pregnancy-Related Bleeding

Treatment for vaginal bleeding during pregnancy depends on the underlying cause and the stage of pregnancy. In many cases, especially with light spotting in early pregnancy, no specific treatment is necessary beyond careful monitoring.

How is a threatened miscarriage typically managed?

If you’re diagnosed with a threatened miscarriage, your healthcare provider may recommend:

Rest and limiting physical activity
Avoiding sexual intercourse until the bleeding stops
Regular monitoring with ultrasounds and hormone level checks
In some cases, progesterone supplementation may be suggested, although its effectiveness is still debated

It’s important to follow your healthcare provider’s recommendations closely and report any changes in your symptoms promptly.

Can bed rest help prevent miscarriage in cases of early pregnancy bleeding?

While bed rest is often recommended for women experiencing bleeding in early pregnancy, there’s limited scientific evidence to support its effectiveness in preventing miscarriage. However, reducing physical activity may help alleviate symptoms and provide peace of mind. Your healthcare provider will advise you on the best course of action based on your individual situation.

Emotional Support During Pregnancy Complications

Experiencing bleeding or other complications during pregnancy can be emotionally challenging. It’s important to acknowledge these feelings and seek support when needed.

Where can you find emotional support if you’re experiencing pregnancy complications?

Consider the following sources of support:

Your healthcare provider or a mental health professional
Support groups for women experiencing high-risk pregnancies
Online forums and communities (ensure they’re moderated and reputable)
Family and friends
Pregnancy counseling services

Remember, it’s normal to feel anxious or worried, and seeking support can help you manage these emotions more effectively.

Future Pregnancies After Experiencing Bleeding

If you’ve experienced bleeding in a previous pregnancy, you may have concerns about future pregnancies. While having bleeding in one pregnancy doesn’t necessarily mean you’ll have it in subsequent pregnancies, it’s natural to feel anxious.

Does bleeding in one pregnancy increase the risk of bleeding in future pregnancies?

Having experienced bleeding in one pregnancy doesn’t automatically mean you’ll have bleeding in future pregnancies. Each pregnancy is unique, and many women who have had bleeding in one pregnancy go on to have uncomplicated subsequent pregnancies. However, if the bleeding was due to a specific condition, such as a uterine fibroid or cervical polyp, there might be an increased risk in future pregnancies if the underlying condition persists.

If you’re planning another pregnancy after experiencing bleeding in a previous one, it’s important to discuss your concerns with your healthcare provider. They can provide personalized advice and may recommend additional monitoring in your next pregnancy for your peace of mind.

What precautions can be taken in future pregnancies if you’ve previously experienced bleeding?

If you’ve had bleeding in a previous pregnancy, consider these precautions for future pregnancies:

Schedule a preconception appointment with your healthcare provider
Start prenatal care early in your pregnancy
Follow all recommended prenatal care guidelines closely
Report any bleeding or spotting immediately to your healthcare provider
Manage any underlying health conditions that might contribute to pregnancy complications
Maintain a healthy lifestyle, including proper nutrition and appropriate exercise

Remember, many women who have experienced bleeding in one pregnancy go on to have healthy, uncomplicated subsequent pregnancies. Your healthcare provider can offer personalized advice based on your medical history and individual risk factors.

Bleeding During Pregnancy: What’s Normal and What’s Not?: The Women’s Specialists of Fayette: Obstetricians & Gynecologists

Many women associate bleeding while pregnant with miscarriage. But it’s actually a common issue, especially in the first 20 weeks when 25-40% of women have vaginal bleeding. Even so, bleeding should still be taken seriously to rule out any potential pregnancy complications.

At Women’s Specialists of Fayette our team offers personalized obstetrics and gynecological services — including high-risk pregnancy care — to women in Fayette, Georgia.

If you have bleeding, several factors can indicate whether it’s cause for concern, including the type and amount of blood you pass and where you are in your pregnancy. To be safe, contact us if you notice any sign of blood so we can evaluate your personal risks of pregnancy complications.

Types of bleeding during pregnancy

If you’re pregnant and bleeding, it’s important to find out how much blood you’re passing and what it looks like. In most cases, bright red blood is more concerning than any that’s brownish.

To determine the amount of blood you’re passing, you should wear a panty liner or pad — don’t use tampons in your vagina when you’re pregnant. If you’re “spotting,” you might notice a few drops of blood that don’t fully cover your panty liner or pad. When you have light vaginal bleeding, you have to use feminine hygiene products to avoid staining or soiling your clothes.

Heavy vaginal bleeding during pregnancy usually describes flow resembling a menstrual period, and you might also notice other tissue on your pad, like blood clots.

Bleeding during the first half of pregnancy

A full-term pregnancy lasts approximately 40 weeks and is broken into three trimesters averaging three month each. When you experience light bleeding or spotting in the first half of your pregnancy, it’s usually not a sign of a serious problem.

It’s common for women to have a small amount of bleeding for a week or two after conception, known as implantation bleeding. You can also have minor bleeding from vaginal infections.

Hormonal production during pregnancy also causes changes in your cervix, which can make it softer and more prone to bleeding or spotting. These changes increase your chances of vaginal bleeding from routine activities, like internal exams or sexual intercourse. In fact, internal exams and sexual intercourse can trigger bleeding throughout your entire pregnancy because of these cervical changes.

If you have heavy vaginal bleeding or additional symptoms like abdominal pain or cramping, this can indicate a more serious issue, like ectopic pregnancy, molar pregnancy, miscarriage, or the threat of miscarriage.

Bleeding in the second half of pregnancy

Any bleeding during your pregnancy can indicate a potential issue, but it’s usually most concerning during the second half of your pregnancy.

Certain pregnancy complications, like miscarriages and ectopic or molar pregnancies, are no longer an issue after the first 20 weeks of your pregnancy. However, as your pregnancy advances, bleeding can indicate a more serious problem, such as:

Placenta previa: the placenta partially or completely covers your cervix
Placenta abruption: your placenta tears away from your uterine wall
Preterm labor: childbirth beginning before 36 weeks

These types of issues often have additional symptoms, such as fever, pelvic pressure, back or abdominal pain, cramping, diarrhea, or contractions.

No matter how light your vaginal bleeding may be, it’s essential to call us as soon as possible so we can evaluate your personal risks and monitor your condition.

To learn more about vaginal bleeding during pregnancy, call us at Women’s Specialists of Fayette or schedule an appointment online today.

Warning signs during pregnancy – Bleeding from the vagina during pregnancy

Causes of vaginal bleeding in the first trimester

The causes of bleeding from your vagina during the first trimester (0 to 12 weeks) include:

Implantation bleeding

This is light bleeding (also known as ‘spotting’). It happens very early on in your pregnancy (after 6 to 10 days), around the time that your period would have been due. It is caused by the fertilised egg attaching to the inner lining of your womb.

Hormonal changes

The hormones of pregnancy can cause changes to your cervix (the neck of the womb). These changes may mean that you bleed more easily, for example after sex.

Threatened miscarriage

If you have bleeding with or without tummy pain in the first trimester, you will often be referred for an ultrasound scan.

You may be diagnosed with a ‘threatened miscarriage’ if the pregnancy is developing normally and no other cause is found. Many women who have a threatened miscarriage go on to have a healthy baby. You may be offered a follow-up scan.

Miscarriage

Unfortunately sometimes bleeding in pregnancy may mean that you are having a miscarriage. During the first trimester, this is sometimes called ‘an early miscarriage’. This means the loss of a pregnancy during the first 12 weeks.

Signs of miscarriage

Ectopic pregnancy

Occasionally bleeding from the vagina can be a sign that you have an ectopic pregnancy. This means that the pregnancy is developing outside the womb.

Ectopic pregnancy symptoms

A molar pregnancy or hydatiform mole

This is a rare condition where the placenta is not normal and the pregnancy does not develop as it should. Abnormal cells develop in your womb.

A molar pregnancy is usually treated by a simple procedure. This removes the abnormal cells from your womb. You may have appointments afterwards with your obstetrician for blood tests and/or ultrasound scans. These are to make sure all the cells have been removed.

Molar pregnancy

Causes of vaginal bleeding in second and third trimesters

Many women have vaginal bleeding during the second (13 to 26 weeks) and third trimester (26 to 40 weeks).

This does not always mean that there is something wrong. But it can be a sign that there is a problem with your pregnancy. You should always contact your GP, midwife or obstetrician urgently if you experience any bleeding.

Possible causes of bleeding in the second and third trimesters include:

‘Late’ miscarriage

In the second trimester, bleeding from the vagina can be a sign of a late miscarriage. This is the term used to describe the loss of a pregnancy between 12 and 23 weeks.

Problems with the cervix or neck of the womb

This includes infection or inflammation.

Placenta praevia

This is a condition where the placenta or afterbirth is located lower in the womb than normal. This partially or completely blocks the birth canal.

Placenta praevia can cause bleeding which may be severe at times. If you have placenta praevia you will be advised to have a caesarean birth if the placenta does not move up the womb.

Placental abruption

This is a rare and very serious condition. The afterbirth separates from the inner lining of the womb. It can cause bleeding and severe tummy pain and can be dangerous for you and for your baby.

A ‘show’

Bleeding from your vagina can be a sign that you are going into labour, particularly if you also have tightenings or pains in your lower tummy. If you are less than 37 weeks pregnant, this could be a sign of preterm or premature labour.

Bleeding in Early Pregnancy

Med J Armed Forces India. 2007 Jan; 63(1): 64–66.

S Vardhan

^*Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

TK Bhattacharyya

⁺Professor & HOD, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

SPS Kochar

^#Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

B Sodhi

^**Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

^*Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

^#Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

^**Associate Professors, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

⁺Professor & HOD, Department of Obstetrics & Gynaecology, AFMC, Pune 411 040

Received 2006 Sep 22; Accepted 2006 Dec 4.

Key Words: Ectopic pregnancy, Abortion, Vesicular mole

Bleeding in early pregnancy may be life threatening. A small amount of bleeding or spotting per vaginum which may be dismissed as trivial can be catastrophic. Hence, it is mandatory for all health care providers to understand the condition and aim at an early diagnosis.

There are three important causes of bleeding in early pregnancy namely abortion, ectopic pregnancy and hydatidiform mole in the order of frequency of their occurrence. However of the three, ectopic pregnancy keeps best of the clinicians perplexed and may prove fatal earlier and more often than abortion and hydatidiform mole.

Ectopic Pregnancy

Ectopic pregnancy occurs in about 1% of all pregnancies and the incidence tends to rise with increasing incidence of pelvic inflammatory disease (PID) and use of Copper T, although in certain regions a decline in the incidence has been reported [1]. The first differential diagnosis in any lady of reproductive age group with history of amenorrhoea, pain abdomen and bleeding per vaginum should be ectopic pregnancy. Although abortion may have similar presentation, but the blood loss is visible externally and the patient’s general condition is commensurate with the visible blood loss. In contrast, external visible bleeding is scanty in ectopic pregnancy and the diagnosis is often late, which increases the mortality rate [2].

Predisposing factors for ectopic pregnancy

The index of suspicion for ectopic pregnancy should be high if there is history of pelvic inflammatory disease, previous ectopic pregnancy, repeated spontaneous or induced abortion, failed Copper T ie. pregnancy with Copper T in situ, failed tubectomy, pregnancy following tuboplasty operation and assisted reproductive techniques (ART).

Clinical features

Amenorrhea is present in about 75% of the cases and the history of missing periods is not elicited in the remaining, because some vaginal bleeding appears at the expected time of menses in cases of ectopic pregnancy which the lady mistakes as her normal periods. Thus, in a patient without history of amenorrhea, the possibility of pregnancy is often not entertained leading to a delay in the diagnosis of ectopic pregnancy. Pain abdomen is variable from colicky, dull aching to piercing and is located usually in the lower abdomen. It is the most consistent symptom of ectopic and is present in all the cases.

Bleeding per vaginum (PV) is usually scanty, brownish and altered which occurs due to withdrawal of hormonal support on rupture or total abortion of ectopic pregnancy. The classical triad in a case of ectopic pregnancy consists of amenorrhoa, pain abdomen and bleeding per vaginum. However, one or more of them may be absent. Bleeding is uterine in origin. The decidual changes occur although to a lesser extent in ectopic pregnancy as they occur in an intrauterine pregnancy. Rarely the bleeding may be excessive when duration of amenorrhoea is more and the entire decidua may be shed as a mould or decidual cast.

Dyspepsia, vomiting and loose motions (which may be due to pelvic hematocele pressing on the rectum) may often lead to an erroneous diagnosis. It is not unusual to find these patients being treated for gastroenteritis and the possibility of ectopic was not even considered in a significant number of cases.

Syncopal attacks with sudden unexplained episodes of fainting followed by spontaneous recovery should raise a strong suspicion of ectopic pregnancy. The mechanism is probably vagally mediated.

The pelvic findings include severe tenderness in one of the fornices and it may not be possible to palpate an adnexal mass in majority due to tenderness. Cervical motion tenderness is present in most. However, it is also present in cases of pelvic inflammatory disease (PID). A boggy mass in the Pouch of Douglas may be suggestive of a pelvic haematocele.

Diagnosis

The aim of most clinicians should be to pick up these cases early. If patients with high risk factors are kept under observation, all efforts should be made to establish or exclude the diagnosis of ectopic pregnancy. The pregnancy can be confirmed by various biochemical tests including urine pregnancy tests, usually positive within 2 to 5 days of missing the periods and serum beta hCG which can detect pregnancy at 7th post fertilization day ie. around 21^st day of the cycle when serum beta hCG levels reach 5 mIU/ml.

Ultrasonography (USG), especially transvaginal sonography (TVS) may be useful, by locating an irregular heterogenous adnexal mass which may show a gestation sac with a fetal pole and cardiac activity within the tube. USG can also be usefully combined with serum beta hCG levels for an early diagnosis:

(i)
At serum beta hCG levels of 1500 mIU/ml, an intrauterine sac must be visualized by TVS.
(ii)
At serum beta hCG levels of 4500 mIU/ml, an intrauterine sac must be visualised by transabdominal sonography (TAS).

If an intrauterine sac is not visualized with serum beta hCG levels as mentioned above, the diagnosis of an ectopic pregnancy is confirmed. Additionally, in a normal intrauterine pregnancy serum beta hCG levels usually double in 48 hours and minimum acceptable rise is 66% in 48 hours. The possibility of ectopic or missed abortion should be considered, otherwise.

Laparoscopy can be usefully employed for diagnostic as well as therapeutic purpose. Conservative surgery for ectopic pregnancy can be effectively performed in unruptured ectopic pregnancy in the form of salpingostomy and salpingotomy.

Management

Immediate resuscitative measures in the form of intravenous (IV) fluids and blood transfusion are important in case of ruptured ectopic pregnancy, where the patient is likely to be in hypovolemic shock. Urinary output can be measured to guide the requirement of IV fluids with monitoring of vital parameters.

Surgical management can be radical in the form of salpingectomy or conservative with salpingostomy, salpingotomy or resection and end to end anastomosis.

Conservative surgery offers the advantage of improved fertility [3], although there is a marginal increase in recurrence of ectopic pregnancy. Both these procedures can be performed by laparotomy or laparoscopy. Laparoscopic surgery should be avoided in hemodynamically unstable patients, but it has the advantage of being less invasive, facilitating early return to routine activity.

Medical management can be offered in early unruptured ectopic pregnancy, the most common agent being used is methotrexate. The criteria for medical management are gestation period of less than 6 weeks, tubal mass of less than 3.5 cm in diameter, no cardiac activity, serum beta hCG level should be less than 15,000 mIU/ ml and the patient hemodynamically stable. A single dose of injection methotrexate 50 mg/sq m intra muscularly proves to be effective in most [4, 5] but it may be repeated in few cases[6]. The advantage is avoiding surgical intervention and the disadvantages include the requirement of follow up and the toxicity of the cytotoxic drug used.

Abortion

Abortion is the commonest cause of bleeding in early pregnancy, in about 10-15% of all pregnancies. All patients present with amenorrhoea and bleeding PV. Some peculiarities of the different types of abortion are discussed below:

Threatened Abortion

There is a minimal detachment of the placenta within the decidua, resulting in vaginal bleeding in the form of spotting or scanty bleed without pain abdomen or risk to the life of the mother. However, poor pregnancy outcome especially intrauterine growth restriction (IUGR) has been reported [7]. Majority of the cases respond well to expectant management [8, 9] with bed rest, sedation and progesterone support in early pregnancy in the form of micronised progesterone 100 mg intravaginally twice daily upto 10 – 12 weeks of pregnancy.

Incomplete Abortion

Patient gives history of vaginal bleeding, often with clots with or without a fleshy mass and complains of lower abdominal pain which is mild as compared to pain in an ectopic pregnancy. This should be dealt with as an emergency because bleeding tends to continue and may be severe, along with the risk of infection unless the products of conception are removed by suction and evacuation. Following evacuation administration of injection methyl ergometrine 0.2 mg IV reduces the amount of blood loss. The use of broad spectrum antibiotics reduces the risk of post abortal infection.

Complete Abortion

In these patients the entire products of conception are expelled spontaneously and the bleeding stops after the uterus contracts. In cases of excessive bleeding, IV fluids and blood transfusion may be required.

Missed Abortion

The fetus is dead but the products are retained within the uterine cavity. It is not an emergency and should be managed by suction and evacuation.

Septic Abortion

Usually occurs following illegal abortion by quacks and unqualified persons. It should be suspected in ill looking patients with bleeding and foul smelling discharge per vaginum, pain lower abdomen with high fever. The management should be aggressive with IV fluids, broad spectrum parenteral antibiotics, evacuation of products of conception. Laparotomy may be required in cases where peritonitis has developed indicating uterine perforation and gut injury.

Vesicular Mole

It is the least common of the three important causes of bleeding in early pregnancy occurring in about 0.1% of all pregnancies. Usually it is not life threatening except for rare instances of excessive uterine bleeding spontaneously or during evacuation. Rarely, a perforating mole may lead to intraperitoneal haemorrhage, necessitating exploratory laparotomy.

It presents with excessive nausea and vomiting in the first trimester, scanty vaginal bleeding and occasional passage of grape like vesicles per vaginum. On examination uterus may be larger than the period of gestation with anemia and preeclampsia. The features of thyrotoxicosis may be seen rarely [10]. Ultrasonography shows absence of fetus and “Snow Storm Appearance” due to multiple fluid filled vesicles, which is diagnostic.

Management includes suction and evacuation and follow up to detect persistent trophoblastic disease and malignant conversion into gestational trophoblastic tumor (GTT). If the beta hCG level fail to fall to normal, plateau above normal, rise after initial fall or there is evidence of local metastasis to vagina or distant metastasis to liver, and brain, chemotherapy in the form of methotrexate is instituted.

Conflicts of Interest

None identified

References

1. Copte J, Bouyer J, Germain E. Recent declining trend in ectopic pregnancy in France; evidence of two clinico epidemiologic entities. Fertil Steril. 2000;74:881–883. [PubMed] [Google Scholar]2. Barnhart KT, Katz I, Hummel A. Presumed diagnosis of ectopic pregnancy. Obstet Gynaecol. 2002;100:505–508. [Google Scholar]3. Bangsgaard N, Lund C, Ottesen B. Improved fertility following conservative surgical treatment of ectopic pregnancy. BJOG. 2003;110:765–766. [PubMed] [Google Scholar]4. Morlock RJ, Lafata JE, Eisenstein D. Cost effectiveness of single dose methotrexate compared with laparoscopic treatment of ectopic pregnancy. Obstet Gynaecol. 2000;95:407–409. [PubMed] [Google Scholar]5. Lipscomb GH, Puckett KJ, Bran D. Management of separation pain after single dose methotrexate therapy for ectopic pregnancy. Obstet Gynaecol. 1999;93:590–592. [PubMed] [Google Scholar]6. Lipscomb GH, Meyer NL, Flynn DE. Oral Methotrexate for treatment of ectopic pregnancy. Am J Obstet Gynaecol. 2002;186:1192–1195. [PubMed] [Google Scholar]7. Weiss JL, Malone FD, VIdaver J. Threatened abortion: A risk factor for poor pregnancy outcome, a population based screening study. Am J Obstet Gynaecol. 2004;190:745–748. [PubMed] [Google Scholar]8. Blohm F, Friden B. Expectant management of first trimester miscarriage in clinical practice. Acta Obstet Gynaecol Scand. 2003;82:654–656. [PubMed] [Google Scholar]9. Luise C, Jermy K, May C. Outcome of expectant management of spontaneous first trimester miscarriage; observational study. BMJ. 2002;324:873–876. [PMC free article] [PubMed] [Google Scholar]10. American College of Obstetricians & Gynaecologists Bulletin # 53 Diagnosis and treatment of gestational trophoblastic disease. Obstet Gynaecol. 2004;103:1365–1367. [PubMed] [Google Scholar]

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7 Potential Causes for Large Blood Clots During Your Period

Passing blood clots during your menstrual cycle is often a normal occurrence during the heaviest days of your period. In fact, most women experience clots at some point in their lives; however, heavy bleeding and passing large clots can sometimes be a cause for concern.

Are huge blood clots normal during your period? What other symptoms can you look out for to ensure that more worrisome health conditions aren’t occurring?

Menorrhagia is defined as menstrual bleeding that can be heavier than usual. If you’re changing your tampon every two hours or sooner, or are passing blood clots the size of a quarter or larger, you may be suffering from heavy periods. This is uncomfortable and often painful, and many women suffer from the debilitating symptoms that come from heavy periods.

There are numerous potential reasons that your period is getting heavier and you’re passing abnormal period clots, and the good news is that many of the conditions and reasons for these symptoms are both common and treatable.

Here are seven reasons why you may be passing big blood clots and experiencing heavier-than-normal periods:

1. Thyroid Conditions

Your thyroid is the gland in your neck responsible for hormone production and distribution. If it’s not functioning properly, it can wreak havoc on your cycle. Conditions like hypothyroid (producing too little thyroid hormone) or hyperthyroid (producing too much thyroid hormone) can impact the flow and severity of your menstrual cycle. In order to properly diagnose a thyroid condition, your doctor should run a thyroid panel, often called a TSH panel, to assess your thyroid’s health. Doctors can also test to see your levels of T3 and T4 hormone and run anti-thyroid antibody panels to see if you have an underlying autoimmune thyroid disease like Hashimoto’s Thyroiditis or Grave’s disease.

2. Polyps and Fibroids

Growths like polyps and fibroids can settle in the uterus and its lining and can cause your period to become heavier and longer than usual. There are many types of benign fibroids, but submucosal fibroids (fibroids that grow inside the uterine cavity) are the most likely to cause heavy bleeding and large clotting. Uterine polyps that grow on the cervix or in the lining of the uterus can also be a factor in heavy clotting. If you’re experiencing heavy bleeding, large blood clots during your period or lower back pain, it could be a uterine obstruction like a fibroid.

3. Birth Control

If you recently started a new form of birth control and are passing large blood clots during periods, your method of birth control could be a contributing factor. Some forms of birth control, like non-hormonal IUDs, can cause heavier-than-normal periods and clots in some women. If you have an IUD and are experiencing heavy clotting and bleeding, talk to your doctor about your symptoms to find out if this is the right form of birth control for you.

4. Medications

Like birth control, there are many over-the-counter and prescribed medications that can contribute to heavy periods with clots. Anti-inflammatory medications, hormonal medications (like estrogen and progestins) and anticoagulants can contribute to abnormal menstrual flow and bleeding. If you’re passing giant blood clots during periods, try to take inventory of the medications you’re taking and ask your doctor about their potential side effects.

5. Miscarriage

In the initial stages of pregnancy, if there is a miscarriage or ectopic pregnancy (which is when a fetus begins to form outside of the uterus), it can oftentimes be confused for a heavier-than-usual period clot. An early loss of a pregnancy can lead to larger-than-usual blood clots as well.

6. Endometriosis

Endometriosis results when tissues that normally grow inside of your uterus develop outside of the uterine cavity. This can cause heavy clotting and bleeding during your cycle, abdominal pain and severe cramps. It can be very painful and hard to diagnose, but several treatments can make this chronic illness more manageable.

7. Polycystic Ovarian Syndrome (PCOS)

Another condition that can cause heavy clots and bleeding during your cycle, PCOS, is a common hormone imbalance. Follicles form on the ovaries, which fail to release eggs regularly, resulting in irregular periods.

Other Chronic Conditions

There are plenty of less-common chronic conditions that can affect your period and make it heavier than it should be: various thyroid diseases, adenomyosis, blood disorders like Von Willebrand disease, certain types of cancers and Pelvic Inflammatory Disease (or PID).

If you are worried that your period may be heavier than normal, filling out a period tracking chart as it’s happening may be helpful for your doctor to diagnose your symptoms.

It’s important to talk to an experienced specialist about your concerns so that you can get the relief you deserve. At Advanced Gynecology our physicians are experts in menorrhagia, and we’re here to help.

I have a blood clot under the placenta.

What does this mean?

Midwife sonographer and BabyCenter’s expert on scans.

The blood clot found during your scan may have been caused by an area of bleeding. What the blood clot means depends on the stage of your pregnancy, and how heavy the bleeding was.

It may be nothing to worry about, as it’s common to have light bleeding in the first three months of pregnancy. About one in four women have some blood loss in their first trimester.

Light spotting, or discharge that is brown or pink, is not usually serious. Any bleeding in pregnancy can leave behind a blood clot. If the area of bleeding is small, the blood clot should gradually be absorbed, and it won’t affect your baby.

A large area of bleeding can be more of a worry. If the bleeding is heavy, a scan may show small pockets of clots under the developing placenta. This will show on the scan as a dark, thickened area behind the placenta. Unfortunately, this may mean that you have an increased chance of miscarriage.

If bleeding is found, you will probably be offered another scan in a week or so, to check that all is well. Though this is bound to be an anxious time, be reassured that most blood clots that are picked up by scans don’t cause problems.

However, sometimes a blood clot is a signal that you and your baby need extra care. A blood clot in your first trimester may mean that you have a higher risk of having pregnancy complications, such as high blood pressure or pre-eclampsia. These conditions affect how the blood flows between the placenta and your baby, which can affect your baby’s wellbeing. You may also be more likely to need a caesarean or an assisted birth.

Blood clots are more difficult to see later on in your pregnancy, as the area of bleeding looks very similar to the placenta itself. If you have any bleeding in late pregnancy, it’s important that you see a doctor.

Bleeding from behind the placenta in late pregnancy may mean that you have a low-lying placenta, perhaps covering your cervix (placenta praevia). If the placenta is found to be low at your 20-week anomaly scan, a follow-up scan should be arranged at 32 weeks. If the placenta remains low, you will have another scan at 36 weeks. At this stage, your obstetrician will discuss a plan of care with you about the birth of your baby.

Another complication linked to heavy bleeding in late pregnancy is when the placenta becomes detached from the lining of your uterus (placental abruption).

If you are found to have placenta praevia, placental abruption, or problems with the blood flowing to your baby, it can be serious. You and your baby will get extra support from your doctor. She will monitor you closely to keep you safe and well.

Reviewed by Dr Ashwini Nabar, BabyCenter India’s expert obstetrician and gynaecologist.

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Implantation Bleed

Implantation bleeding is considered to be an early sign of pregnancy and it occurs around the time of the following menstruation cycle. Mood swings, cramping, headaches, and brown or pinkish spotting or discharge are common signs that accompany implantation bleeding. Generally, one-third of women may encounter implantation bleeding during their pregnancy process.

Credit: Africa Studio/ Shutterstock.com

When the women become pregnant, the fertilized egg that is attached to the uterus lining will begin to grow resulting in implantation bleeding. Implantation bleeding is a normal process and may not need medical attention.

Fertilization process

During the ovulation process in women, the ovum is released from the ovary. This ovum is picked up by the fallopian tube. The ovum stays in the fallopian tube for about 12–24 hours. During this time, the ovum is fully functional and stays alive. When sperm is deposited in the vagina, it swims into the uterus through the opening of the cervix and moves further into the fallopian tubes.

Of the many sperms that may travel, only one will fuse with the ovum. The sperm penetrates the cell membrane and deposits the male genetic material into the ovum and the two nuclei undergo fusion. The ovum is fertilized in the fallopian tube; now termed as the fertilized ovum or zygote, it stays for around 72 hours in the fallopian tube.

During this 72-hour period, the zygote develops rapidly. Initially, it divides into two cells. Then the divided cells again subdivide into four cells. This cell division process happens many times and at the end of the 72-hour period, the cells resemble a solid ball called morula. Now, the cells in the morula divide further, which makes the cells to move toward the outer edge of morula, making the morula resemble a hollow ball. After fertilization, this hollow ball-like structure of the cell (now termed as blastocyst) is formed in about 5 days.

The blastocyst may take about 5–7 days to reach the uterus. Upon reaching the uterus, the blastocyst gets attached to the lining of the uterus which is termed as implantation. This stage is termed as the beginning stage of pregnancy, provided the embryo survives in the uterus.

During this cell movement process, some blood vessels present in the wall of the uterus may break and cause bleeding. Followed by ovulation, it may take about 10 days to 2 weeks for the complete movement and bleeding to occur.

Upon successful implantation of the blastocysts, the cells will multiply further aiding in the growth of the fetal membranes and the placenta.

When the embryo cannot get implanted, the survival period is just a few days, after which it gets detached from the uterus and moves out of the vagina along with menstrual fluid.

Occasionally, the blastocysts get attached to the fallopian tube and implantation may happen in the tube. As the embryo grows, it may rupture the fallopian tube and may result in severe pain and blood loss for the woman.

Implantation bleed versus menstruation bleed

After ovulation, menstruation will happen after 14 days. So there is confusion about the bleeding—whether it is due to menstruation or implantation and some women may think that they are late for their periods. Somewhere around the 22nd or 25th day, light pink color spots may be seen, a few days prior to the regular menstruation signal. When the egg moves, light bleeding may happen. The bleeding may resemble menstruation bleeding; however, there are differences between the two.

Blood color: Blood flow during the menstruation period varies in women. Some women may have heavy blood flow while some others may have a lesser flow. In any case, the color of the spotting is the same across all women as the bleeding location is the same every time. On the other hand, in implantation, the blood is dark brown (rust color) or more pinkish, and the blood seems to appear aged.

Blood consistency: During menstruation, some women may have thick blood clots during blood flow. In case of implantation bleeding, the consistency of the rust color or pink color blood will be the same throughout.

Bleeding flow pattern: Implantation bleeding starts with light spotting and heavy flow may follow after a few days of light spotting. Whether the women are lightweight or overweight, the implantation bleeding pattern is the same.

Bleed duration: In the case of menstruation, most women have their period lasting between 2 and 7 days. Implantation bleeding may last for a few hours or even up to 2 days. Bleeding may be more in women experiencing their first pregnancy compared with women who have had egg attachment earlier.

When the bleeding is less, it is not a matter of concern during the initial stages of pregnancy as there is no risk involved in the development of the baby; bleeding could also be due to vaginal infections, cervix irritations, or sexual intercourse. Extended bleeding is a sign of concern, particularly during pregnancy.

“In a pregnant woman, the infection develops differently.”

– The coronavirus affects all women equally.But portability is different. Compared to the average woman, the infection develops in a pregnant woman differently. In the first trimester, the disease can manifest itself in a mild course, like ARVI. If it is too late to start treatment, there are complications. But in the second and third trimesters, the disease is often more severe. Due to the fact that the abdomen is enlarged, it presses on the diaphragm, and therefore the excursion of the lungs decreases (the difference between the girth of the chest during inhalation and exhalation is , – ed. ).

As you know, the coronavirus causes hypercoagulability (increased blood clotting , – approx.ed. ). And in the third trimester, a woman also experiences physiological hypercoagulation – this is by nature itself laid down so that there is no bleeding during childbirth. Accordingly, these phenomena are superimposed on each other – and the woman is harder to carry the coronavirus.

– There is a widespread belief that many viral diseases severely affect the fetus in the first trimester of pregnancy, at the stage of laying organs and tissues. Is it so with the coronavirus?

– As with any infection, if there is a massive damage to the mother’s body, the fetus can be affected in the early stages.No one excludes such a possibility, but since broad statistics on this disease have not yet been collected, we cannot speak about it unequivocally.

So far, of course, we are talking about the fact that the most massive complications occur precisely at long periods of time, and it is in the mother.

– What are the main dangers for the expectant mother?

– Hypercoagulation causes a lot of severe disorders. These can be complications from all organs – heart, kidneys, liver… Everyone suffers, because thrombosis occurs not only in the lungs (namely, we see them on CT). Multiple blood clots of large and small vessels can form, for example, in the kidneys.

Of course, women who have extragenital pathology, that is, concomitant diseases: hypertension, diabetes mellitus, kidney problems, and large overweight, are more affected. Even without coronavirus, they complicate the course of pregnancy, which means that with covid, such patients are at risk of complications more often.

– Is there a higher risk for a mother with coronavirus in multiple pregnancies?

– Certainly. Multiple pregnancies are more difficult in themselves. And with coronavirus, firstly, the belly is larger than if the fetus was alone. This means that the pressure on the diaphragm is stronger, and the excursion of the lungs is even less. And the risks of hypercoagulability are increasing. There were no such cases in our consultation – but mothers who are expecting twins are better taken care of. It is physically difficult for them to run on recreational activities and communicate with everyone.

Coronavirus affects all women equally. But portability is different. Compared to an ordinary woman, a pregnant woman develops the infection differently

“The child suffers in the womb while the mother is sick”

– What are the risks of coronavirus for the unborn baby?

– Here we also start from the main formidable manifestation of coronavirus – hypercoagulation. Placental thrombosis can cause intrauterine growth retardation, because in this case, the baby receives less oxygen and nutrients, respectively, it develops more slowly. And thrombosis in the umbilical cord can even cause intrauterine fetal death.

Another danger is placental abruption, which begins with hypercoagulation. There is also such a nuance: when blood clotting increases, the body tries to start the process of its liquefaction – and this state can go to the other extreme, hypocoagulation. And this is a process when, on the contrary, the blood does not clot. The result is bleeding, which can lead to the loss of pregnancy.

And finally, the coronavirus during pregnancy can lead to premature birth (if the pregnancy is terminated before 22 weeks – this is a miscarriage, if after that it is already premature birth – approx.ed. ).

The fact is that the body, being in serious danger, tries to reduce it as much as possible – which means it rejects the fetus as a source of increased risk. So with severe complications, he gets rid of the danger through premature birth.

– In case of premature birth as a result of coronavirus, what are the chances of a child surviving?

– Each case is individual. The forecast here is also based on the general case – much depends on how long the baby was born.If it is 22-28 weeks, then this is an extreme premature birth, when the baby’s weight does not exceed 900 grams. Of course, it is more difficult to take care of such children, but in a maternity hospital of the 3rd level – like, for example, the RCH perinatal center – there are opportunities for this. But here no one will give any predictions. We do not know the compensatory capabilities of the fetus. One child survives, and the other cannot cope with being born so early.

We now have 4 such children in nursing, who were born prematurely due to their mother’s covid.They, thank God, are alive, like their mothers.

– In addition to prematurity, what other consequences can the baby have after childbirth if the mother was sick with coronavirus during pregnancy?

– Even if the mother’s course of covid was not the most severe, and even if the baby was born at a safe enough time, he still often has certain problems. He suffers in the womb while his mother is ill: he does not have enough oxygen, and the child is often born with hypoxia. Its immunity is weakened, and the placenta of a pregnant woman can miss other infections (not necessarily coronavirus).

We do not know the compensatory capabilities of the fetus. One child survives, and the other cannot cope with the fact that he was born so early

– Is the mother sent for a caesarean section if she has a severe course of coronavirus? Or should it resolve itself?

– To begin with, we cannot stimulate natural childbirth, even if it is necessary to do so. Because we do not yet know how the body of a patient with coronavirus will react to such stimulation.Therefore, in a severe course of covid, when the mother is in a very serious condition, she, of course, undergoes a cesarean section. And if the course of the coronavirus is mild, it is better to let the child be born independently. At least so that he, passing through the birth canal, receives a primary immune complex and so that he develops a pulmonary surfactant.

– Can a baby be infected with covid in utero from a mother?

– There are no such statistics yet. It is too early to draw clear conclusions – we know too little of this disease, it is too changeable and insidious.

“With coronavirus, the saying does not work that houses and walls help”

– How many pregnant women with coronavirus infection are now under your supervision?

– There has been a large increase since July. And today in our consultation there are only 19 pregnant women with ARVI symptoms, and 9 of them with confirmed covid.

Two weeks ago, the number of confirmed cases of coronavirus in pregnant women, according to our consultation, rose to 15. And more than half of them are in the hospital with a moderate to severe course of the disease.

– In your antenatal clinic, were there any cases of late intrauterine death of a child due to coronavirus in the mother?

– According to our consultation, there were no such tragedies. We managed to recognize the danger in time. There were three cases when there were premature births – the babies survived there.

– How to do it on time? How is the tracking of Covid cases in pregnant women in the antenatal clinic carried out?

– We conduct a very careful monitoring, every woman is always on the phone with her midwife.As soon as the expectant mother informs us that she has a sore throat, we call a therapist to her. He comes to her home, examines her, takes tests at home. And these are not only PCR smears (which may not show a positive result), but also blood tests. From them we see what the picture is, and a decision is made on how to proceed. If we see a coronavirus blood picture, then an unambiguous hospitalization is shown here.

And detailed symptoms are already being determined in the hospital.If the course of the coronavirus is mild, the woman is discharged home and closely monitored for her condition. If it is moderate or severe, she remains hospitalized. This happens, depending on the period and severity, either in the RCH, or in the city hospital No. 7, or in the RKIB. This year we are already coping with this and are on time. And in these hospitals, everything is prepared to treat pregnant women from coronavirus, they know all the features.

The most difficult cases get to the RCH, doctors there keep constant contact with Moscow for each patient.And the use of this or that drug or method of treatment is decided by a council with the participation of metropolitan doctors.

The insidiousness of this disease is that even with good health, lung damage can already be critical. Therefore, we act through our husbands if we cannot “reach out” to the very future mother

– What if a woman categorically refuses to go to the hospital?

– There are, of course, women who are not aware of the dangers and refuse to be hospitalized: “I feel good, and I will not go anywhere, I feel better at home.”But the insidiousness of this disease is that even with good health, lung damage can already be critical. Therefore, we act through our husbands if we cannot “reach out” to the expectant mother herself. And they, as a rule, understand the danger, do not want to risk the lives of their loved ones, and somehow they still manage to persuade the patient. Because this is all very serious.

Unfortunately, the saying “Houses and walls help” does not work with coronavirus.

– How are expectant mothers treated with covid? Is it the same protocol for them as for non-pregnant women?

– There is a protocol for pregnant women.There are the same drugs as for the rest, with the exception of those that may be toxic to the fetus. For example, antiviral drugs that have not yet been tested. Or drugs that remove the cytokine cascade – they have not yet been fully tested and there is no confirmed information about their safety for the fetus. And if a woman’s condition becomes severe, then she may even be advised to terminate the pregnancy – including to connect those medications that can adversely affect the fetus, but save her life.In such cases, there is a choice – to save the mother or the child.

Of course, big consultations are held here, and only in this way is it resolved. There is never only one doctor behind the prescription of a drug that is potentially harmful to the child. We just do not yet know with a proven degree of certainty how this will affect the future.

Plus, every woman comes with her own pathology, with her complication, and every organism is individual. Therefore, doctors profess, of course, an individual approach – and therefore a consultation is held in each case.It is necessary to adjust, select the treatment.

“Age pregnant women are more responsible for their health”

– Does the course of coronavirus and pregnancy with it somehow differ depending on the woman’s age?

– Yes, of course. The fact is that, with age, a woman purely statistically accumulates a certain baggage of diseases, and this complicates the situation. But, fortunately, age-old mothers-to-be – especially by the age of forty – are more responsible about their pregnancy.Those who are older take care of themselves more. Especially when it comes to those who have done IVF – for them it is a hard-won pregnancy, and therefore they take care of their body like a crystal vase. See a doctor in time. And according to our statistics, there are very few such cases.

But future mothers, who are about 30 years old, are more careless: they go to work, travel abroad – among them, the maximum number of patients with coronavirus. And it is they who do not go to the doctor from the first day of illness, and this is very dangerous.

Fortunately, age-old mothers-to-be – especially those over the age of forty – take their pregnancy more responsibly. Those who are older take care of themselves more

– Are there differences between the three waves of coronavirus that you see in in the course of disease in pregnant women?

– In the first wave, our pregnant women were ill almost singularly. In the second wave – October – November – there was a massive incidence. And it was then that deaths appeared in the republic.And in our consultation there was a tragic incident: my mother died, unfortunately. The child survived. There was a lightning-fast course of the disease: it “became severe” within literally 4-5 days. She applied, was hospitalized, and from the first day she refused hospitalization. I returned the next day when I felt very bad. Doctors could not do anything, she left right before our eyes. She was not even 30 years old.

The third wave is even more impetuous.

And so we ring all the bells: if a woman deceives us and does not address us from the very beginning, it is literally deadly.

– How is it now?

– It’s good that now we have a tactic of treatment, we have learned how to treat it and prevent the death of women and children. God forbid to cope further.

Now we manage to hospitalize women in a state of moderate severity, and they are recovering. Just yesterday, one of our expectant mothers was admitted to the hospital. She was ill, she had a positive PCR, and as soon as the blood test got worse, we immediately hospitalized her. And she refused: “I will not lie down!” We persuaded her to at least go to the RKIB and have a CT scan there (CT for pregnant women is done only there).On the condition that if everything is fine on the pictures, she will be tested and go home for treatment. But we understood that CT would show defeat, because the picture of the blood spoke about it absolutely unambiguously.

Every day we gain more and more experience, and thanks to this we manage to save both mothers and children.

“The risk of getting radiation is incomparably lower than the risk of losing a child or a life”

– What blood changes do you see that indicate that it is time to run to the hospital?

– In the blood we see an inflammatory reaction and signs of blood thickening.

And then it means that we urgently need to carry out anticoagulation therapy. For pregnant women, it is recommended to do this only in an injection form – which means that it will be difficult to do it at home. Moreover, many simply flatly refuse to give themselves injections.

And in the hospital all this is done professionally, the woman is constantly under supervision. She is there and dehydration is compensated by droppers, and it must be replenished competently in order to maintain the desired balance. So the hospital is definitely shown in such cases!

We, of course, observe the child’s condition throughout the pregnancy and after the mother has recovered.Let’s see if there have been any complications or disturbances in intrauterine development

– Many are still extremely reluctant to agree to CT – after all, this is not very shown to a pregnant woman?

– Firstly, it is a digital method and low-dose irradiation. Secondly, a protective cape must be worn on the patient. And thirdly, the risks of getting a small amount of radiation are incomparably lower than the risk of losing a child or your own life. With a severe course of covid, knowing the CT scan is vital, and this is not a figure of speech.After all, if we see a large lesion in the patient’s well-being (and this is not uncommon!), It means that certain types of treatment must be involved. Doctors must be sure to see a detailed picture of the disease in order to cope with it.

And here’s another fact, which, perhaps, will reassure those who are afraid of CT: all those patients who underwent coronavirus treatment with us in November had already safely given birth to children, and the images did not affect their development in any way.

– That is, the task of the consultation is in time to identify disease , to start treatment on time and hospitalize the patient on time, if there is a moderate or severe course?

– Quite right.And patients with a mild course are treated at home, we call them every day, find out what their condition is. And if a woman tells us, for example, that her condition has worsened, we urgently call a team with a therapist to her to take tests, examine and correct the treatment. And if we see an increase, we send him to the hospital.

Among other things, we, of course, observe the condition of the child during the entire pregnancy and after the mother has recovered. We look to see if there have been complications or disorders in intrauterine development.

“If everyone around the pregnant woman is healthy – she has nowhere to get infected!”

– Is the pregnancy vaccine indicated?

– Vaccination against coronavirus during pregnancy is still advisory in nature, there are no mandatory indications for the timing. New recommendations should be released soon, where it will be prescribed that you can be vaccinated from 22 weeks, when the fetus has already formed.

Of course, if a woman wants, she goes and gets vaccinated during pregnancy. But we do not have such people in our consultation yet.There were cases when a woman did not know that she was expecting a baby, and during this time managed to make the second dose of the vaccine. Now this patient’s pregnancy is proceeding well, without complications, the child is developing normally.

– Now there is another wave, the incidence is high, it is easier to get infected. And what if, in such “war” conditions, an unvaccinated woman discovers that she is pregnant? Should she run to get vaccinated?

– We cannot yet recommend vaccination during pregnancy – there are no clinical trial results yet.But there is another option: to vaccinate the entire environment of a pregnant woman. Just like we save them from tuberculosis. Everyone who lives and works next to her needs vaccines. And one more important clarification: the social circle should be minimal during this period. You need to be in crowded places and at events as little as possible. If everyone around her is healthy, she has nowhere to get infected!

We cannot yet recommend vaccination during pregnancy – there are no clinical trial results yet.But there is another option: to vaccinate the entire environment of a pregnant woman

– But what about transport, for example? Or if she has other children attending school? We cannot vaccinate children yet. How to protect yourself from infection?

– Transport does not give such a high risk, there is a short contact. And if you follow absolutely all precautions, then the likelihood of getting infected is minimal.

Dense mask, antiseptics, social distance – these are not just empty words, it works! Be sure to rinse your nose with saline solution, rinse your throat, and wash your hands and face when you get home.Ventilate the rooms more often, try to get yourself separate dishes and a towel (this is already about the children who can bring the coronavirus home from school). Regular wet cleaning is also of great importance. All this works against any virus.

Passive immunization also works: it is imperative to maintain normal levels of vitamin C and vitamin D. It is imperative that the expectant mother has good, nutritious nutrition, which is of great importance. You need vitamins, you need meat and fish.And if a woman carefully and responsibly approaches her health, if she observes all the recommendations of doctors, then she will most likely not get sick.

But if you still feel a sore throat, any other signs of an acute respiratory illness, indisposition – you should immediately consult a doctor. Remember, delay is fraught with very serious consequences!

Lyudmila Gubaeva, photo: Rinat Nazmetdinov

SocietyMedicine Tatarstan

Regional center of hemostasis pathology

The center is headed by a doctor of the highest category, hematologist-hemostasiologist Valentina Yurievna Kutsemelova.Valentina Yurievna is a student of the founder of Russian hemostasiology Zinovy Solomonovich Barkagan.

So what is hemostasis?

Hemostasis is a biological system that, on the one hand, maintains a liquid state of blood circulating in blood vessels and a sufficient blood supply to organs, and on the other hand, prevents and stops bleeding from the most vulnerable small-caliber vessels.

Its components:

Endothelium, vascular subendothelium,
Cellular elements,
Plasma systems: coagulation, fibrinolytic (plasmin), physiological anticoagulant, kallikrein-kinin and complement systems.
Organs of synthesis, deposition and pooling of components – liver, spleen, bone marrow.

If the hemostatic system is not disturbed,
then there is no clinic of bleeding and thrombosis

If the dynamic balance is disturbed, the hour of the balance deviates either in the direction of pathological bleeding, or vice versa in the direction of thrombosis .
How can you suspect a problem of the hemostasis system in humans?
-Spontaneous nosebleeds, especially from both nostrils.
– Formation of bruises, hematomas without significant trauma.
-Very abundant and prolonged menstruation from the very beginning of their formation.
-Unexpected large blood loss during surgery, tooth extraction, minor injury.

Patient age can be any
Congenital bleeding tendency is usually observed already from childhood and adolescence and leads the patient to a pediatrician or hematologist. If pathological bleeding is manifested at a later age, as a rule, a more in-depth diagnosis of the cause of the condition is necessary.
But if the tendency to bleeding usually manifests itself quite clearly, then the tendency to thrombosis, the so-called. thrombophilia have many masks.

Thrombophilia – a tendency to early development and recurrence of intravascular thrombosis, leading to heart attacks and ischemia of organs and tissues.
Thrombophilia are congenital and acquired.

When to suspect thrombophilia?
-If occur at an early and middle age and / or recurrent stroke, myocardial infarction.
– Cerebral transient ischemic attacks occur without prior hypertension.
– Thrombosis of unusual localization occurs – thrombosis of hepatic and splenic vessels, recurrent mesenteric thrombosis, thrombosis of retinal vessels at a young age.
– Thrombophlebitis of the veins of the lower and / or upper extremities without previous venipuncture or varicose veins.
– Thrombophlebitis of the veins of the lower extremities, including high ileofemoral thrombosis while taking a combined oral contraceptive, hormone replacement therapy in perimenopause, during pregnancy and in the postoperative period, in the presence of plaster immobilization of the extremities.
-Paradoxical thrombosis during therapy with heparin, warfarin.

Another type of implementation of thrombophilia is recurrent miscarriage or infertility.
Why do reproductive problems occur?
Evolutionarily it turned out that during pregnancy it is natural:
-Increases the concentration of fibrinogen,
-Increases the activity of von Willebrand factors, VIII IX X II,
-Increases platelet aggregation,
-Fibrinolysis is inhibited.

I.e. hypercoagulation during pregnancy is an inevitable physiological condition , which by nature is aimed at effective implantation of the egg, adequate connection of the placenta with the uterus and stopping bleeding during childbirth, but pregnancy can also be regarded as a thrombophilic condition.

All this made it possible for women not to die of bleeding during childbirth, but with the achievements of medicine and human social development, we have long been living not in the harsh conditions of natural selection, but with a load of hereditary diseases and constitutional features that would have previously prevented reproduction.And it is implemented this way:

If a woman has an unrecognized background thrombophilia, then there is a summation of thrombotic factors and, as a consequence:
– Habitual miscarriage (spontaneous abortion or missed pregnancies),
-Early onset and severe gestosis,
– Delayed intrauterine growth of the fetus,
– Abruption of the normally located placenta,
– Thrombosis of umbilical cord vessels – intrauterine fetal death,
-Failures with IVF, primary infertility.

For thrombophilia:

– the adhesive characteristics of the preimplantation embryo change
-the fusion of syncytium
is broken
– the depth of trophoblast invasion decreases
– the production of chorionic gonadotropin
is suppressed
– thrombotic tendencies are enhanced by providing matrices for coagulation reactions.
-The last point explains the positive effect of anticoagulant therapy from the earliest possible date.

These mechanisms also explain the failed attempts at artificial insemination and embryo transfer in women with thrombophilia

With prolongation of pregnancy, thrombin is steadily generated not only in the vessels of the placenta, but also in others.”Shock” organs, early development and severe gestosis proceeds, the body “tries” to get rid of the thrombotic situation – late failures occur

Moreover, not only the so-called “increased clotting” can prevent the development of pregnancy, but also congenital defects in the genes of the folate cycle, especially if they are detected in both spouses. At the same time, the embryo is often prone to such developmental abnormalities that are incompatible with life and within the framework of natural selection it dies, most often failures in the first trimester of pregnancy or of the pre-embryonic type (very short delays in the menstrual cycle, or a short increase in hCG).In the study of the human population, the problem of the genes of the folate cycle is present in half of the people, therefore some geneticists are considered “normal” and are not taken into account. However, then it should be agreed that half of the couples in the world have reproductive problems and no longer receive treatment? It is necessary to understand that genetics needs trigger mechanisms, of which there are innumerable: alcohol consumption, insolation (intense tanning), uncontrolled use of dietary supplements, multicomponent vitamin complexes, taking high doses of retinol and its derivatives (for example, by using the widespread drug Aevit, Roaccutane, use of retinoic peeling), even long-term use of combined oral contraceptives worsen the situation in the folate cycle, and especially if the pair has a pathology in the genes of the folate cycle.Therefore, it is important to exclude the above situations for people planning reproduction, as well as to take special medications.

The most common thrombophilia in fetal loss syndrome:

Hyperaggregation syndrome
Antiphospholipid syndrome
Disorders in the system of physiological anticoagulants – disorders in the system of protein C, antithrombin 3
Resistance of the fifth factor A to APS (against the background of prior oral contraception or congenital mutation of FV Leiden)
Disorders in genes in the folate cycle
Disorders in the PAI-1 gene
Thrombophilia xr.inflammation, lipid and carbohydrate metabolism disorders

Therefore, in case of fetal loss syndrome, the study of the hemostatic system is mandatory, and even before its onset, so that treatment can be started at the stage of the fertile cycle (in the period preceding conception).
The pathology of the hemostasis system can be assumed, but it can only be proved with the help of high-quality laboratory diagnostics!

Possibilities of research of the hemostasis system in OKDC:

In the laboratory of PCR diagnostics, 12 positions of genetically determined thrombophilia are detected, including 4 genes of the folate cycle, Leiden mutation of the fifth factor, polymorphism in the gene of prothrombin, seventh, thirteenth factors, beta-chain of fibrinogen, alpha and beta-integrin, PAI-1;
In the ELISA diagnostic laboratory: determination of antibodies to phospholipids, beta-2-glycoprotein-1, prothrombin, peripheral blood diabetes diagnostics, ANA-screen, ANA-line, AT k DNA;
In the laboratory of biochemical and hemostasiological studies: a detailed coagulogram, including PT, aPTT, TB, fibrinogen, antithrombin-3, fibrinolysis, plasminogen, RFMK, d-dimer, clot retraction, the activity of von Willebrand factors, eighth, nineteenth, thirteenth, eleventh PAI-1, screening in the protein C system, also the study of the activity of the protein C, S, RAPS system, the presence of lupus anticoagulants as an express screening method, as well as with the help of clarifying methods, if necessary;
In the clinical and hematological laboratory, determination of the duration of bleeding according to Duke, OAC on the hemanalyzer and with the counting of platelets according to Fonio, if necessary, the study of the morphological features of platelets, the study of platelet aggregation with adf, epinephrine, ristocetin, collagen.

When detecting the pathology of hemostasis, the approach to treatment should be strictly differentiated (do no harm!) , especially for the treatment of pregnant women, as well as patients who have suffered the fate of paradoxical thrombosis, i.e. when thrombosis occurs during treatment with Warfarin, heparin, also in the case of massive spontaneous thrombosis at a young age:

It is necessary to correct the link of hemostasis where there is a violation.
Eliminate drug aggression as much as possible during organogenesis.
Treatment of the underlying disease is mandatory.
To minimize the risk of possible complications of therapy – laboratory monitoring of the effectiveness of therapy, wider use of combined treatment regimens is required.
Reliably evaluate the effectiveness of treatment.
To develop further tactics of patient management, including for many years, if the situation is congenital or far advanced.

If in your clinical practice there are patients with the above diseases, if there are people in your environment who have the above health problems or you have these symptoms, an examination within the framework of a specialized hemostasiological reception is recommended.

It is necessary to recognize in time a violation in the hemostasis system, determine which link of hemostasis suffers, and prescribe drugs that are suitable in each specific case.For this, the OKDC has an appointment with a hemostasis therapist who has completed specialization at the Federal Center for the Diagnosis and Treatment of Hemostasis Pathology under the leadership of Z.S. Barkagan.

You can also contact the hematologist of the OKDC V.Yu. Kutsemelova for questions of the hemostasis system. and therapist Smolyanitskaya P.G.

The rules for making an appointment are common for OKDC.

The priority of the examination under the compulsory medical insurance is given unconditionally to the primary differential diagnosis using high-tech examination methods, and not to the performance of routine coagulological tests, replacing the primary health care facilities.

norm or reason for panic

Uterine bleeding after termination of pregnancy is a common phenomenon in obstetric practice that occurs on the first day after the operation. The intensity and duration of blood loss are individual and depend not only on the characteristics of the female body, but also on the type of abortion.

Features of bleeding after abortion

Bleeding may be completely absent during the first two days after surgical termination of pregnancy, but later intensifies to menstrual bleeding and continues in some clinical pictures up to 6 weeks. This pathology indicates a hormonal imbalance, that is, there is insufficient “support” of endometrial tissues, which supports the development of pregnancy. As a result of this , bleeding after termination of pregnancy can only intensify, and continue intermittently for several weeks.It is important to understand that here we are talking about pathology.

Most women of reproductive age are concerned about the main question, how long will the bleeding last after an abortion? The question is individual, but if it does not pass more than two weeks after getting rid of the fetus, it is important to urgently contact your local gynecologist. The duration of the hemorrhage also depends on the duration of pregnancy: the earlier the abortion is performed, the more chances in a sparing “mode” and without serious consequences to solve such a piquant problem.

Cause of pathological bleeding after abortion

The appearance of bleeding after an abortion should not confuse the patient, but its duration should be cause for concern. Among the pathological causes of this symptom should be highlighted:

Perforation of the uterus;
Injury of the cervix;
Presence of residual fetal tissue;
Blood clotting disorder;
The response of the female body to certain anesthetics.

With such diagnoses, along with hemorrhage, there is an obvious violation of the temperature regime, convulsions, general weakness, fainting, hypotension, increased heart rate. It is important not to ignore such signs of shock, but to visit a medical center and a qualified specialist in a timely manner.

What to do in case of bleeding after termination of pregnancy

It is important to understand that it is impossible to stop prolonged bleeding after termination of pregnancy at home, only a competent gynecologist can determine an accurate and effective treatment regimen.Delay in this matter can cost the patient her life.

If the visit to the doctor is timely, then the first thing the patient is sent to an ultrasound scan. This accurate clinical examination allows you to determine the etiology of the pathological process and the future treatment regimen. If it became known that there is residual fetal tissue in the uterus, additional surgical intervention is necessary to properly clean its cavity. In the case of mechanical damage to the uterus or its cervix after interruption, the gynecologist prescribes reparation of the injured area of the uterus, bladder or intestines.

Possible complications

Bleeding after termination of pregnancy is dangerous to women’s health and seriously damages the woman’s reproductive system. Among the potential complications, doctors distinguish infertility, malignant formations and even the death of the patient. Therefore, the problem needs to be addressed in a timely manner, and to terminate the pregnancy at an early stage in order to avoid heavy bleeding.

90 000 Miscarriage, how to avoid – Planning and management of pregnancy in gynecology of the Litfond polyclinic after miscarriage

Miscarriage is always associated with serious consequences for the entire body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman’s work schedule.The unfavorable outcome of pregnancy requires a lot of mental and physical costs on the part of the parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step on the way to having a child.

Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible.And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.

Causes of miscarriage

Many are convinced that a miscarriage is due to a fall, bruise or some other physical shock. Any woman who has had a miscarriage can remember that shortly before that she either fell or lifted something heavy. And I am sure that I lost my unborn child precisely because of this. However, those women whose pregnancy was normal also fall and lift.This is not why most sudden miscarriages occur. The reason is in the violations of the pregnancy itself. About half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Compassionate nature, following in all the principles of natural selection, destroys the defective and unviable fruit. But you should not be afraid of this. The fact that there is a defect in one embryo does not at all mean that all the others will be the same.

In the other half of miscarriages, the woman’s body is almost always to blame.They are caused by various known and unknown factors, such as: acute infectious diseases in the first trimester of pregnancy, poor ecology or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.

The causes of miscarriage in the early and later periods may differ, although they may be the same. The most important thing is to find out and eliminate or compensate for your own cause of miscarriage.Having found the cause, the gynecologist will tell you how to avoid another loss.

Frozen pregnancy

The statistics of miscarriages also includes “frozen pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus can begin to decompose, and this, thereby, will lead to poisoning of the mother’s body.

Doctors resort to surgical curettage, which is associated with the risk of inflammation and complications.With such a miscarriage, the next pregnancy is planned after the full recovery of the body – not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and carry out treatment.

Miscarriage up to 6 weeks

The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that 70-90% of embryos had chromosomal abnormalities: they are accidental and will not occur in other pregnancies. You may be sick, taking medication, or under the influence of other harmful factors.Fate has saved you from a child with developmental defects.

The human body is perfect and finds a way to correct the situation with a miscarriage. Today is a tragedy for you. The preservation and birth of a sick, unviable child would be a real tragedy. So do not cry and understand: everything is for the better, you cannot help grief with tears … And after three months try again – it will almost certainly be successful.

It should also be noted that the fact of a miscarriage does not mean that you have lost something.So for a period of 7-8 weeks, the absence of an embryo in the ovum is found – “anembryonia”. It is believed that in 80-90% of cases, miscarriages are undiagnosed undeveloped pregnancies.

Miscarriage at 6 to 12 weeks

A miscarriage in this period is also considered early. The most common causes are:

Endocrine Disorders

Endocrine disorders, when the ovaries synthesize insufficient hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage.

Imbalance of hormones in a woman’s body is likely to lead to early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.

Progesterone provides preparation of the uterine mucosa for implantation, and is a hormone for maintaining pregnancy in the first months. If conception occurs, the embryo cannot properly anchor in the uterus.As a result, the ovum is rejected. But pregnancy can be saved with progesterone drugs if the problem is detected early.

Also, the cause of early miscarriage can be an excess of male sex hormones that suppress the production of estrogen and progesterone. Often, androgens, which affect the formation and development of pregnancy, are the cause of repeated miscarriages; also hormones of the thyroid and adrenal glands. Consequently, changes in the function of these glands can lead to miscarriage.

Untreated genital infections

This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpes infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune defense and the presence of other unfavorable factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth.Infection of the fetus and damage to the fetal membrane leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is also possible during pregnancy as prescribed by a doctor.

Viral infections and other diseases

Any diseases accompanied by intoxication and fever above 38 ^o C can lead to miscarriage. Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary angina can also become tragic; pneumonia carries a more serious risk.Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections.

Extremely dangerous during pregnancy rubella – it leads to severe fetal malformations, therefore, its infection during pregnancy is an indication for medical abortion.

Any disease during pregnancy can lead to the non-viability of the embryo. And the body, by miscarriage, insures you against unwanted offspring.With such a miscarriage, the next pregnancy has every chance to go well.

Immune causes of miscarriage

Sometimes in the blood of a pregnant woman, antibodies are formed that are hostile to the fetus. This cause can be predicted and eliminated in advance. Most often, a conflict arises when the embryo inherits the positive Rh factor of the father, and the negative Rh factor of the mother’s body rejects the tissues of the embryo that are foreign to it. Constant monitoring of the antibody titer and the introduction of anti-rhesus immunoglobulins allows you to maintain and maintain pregnancy.In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect.

Reduced immunity

Reduced immunity of a pregnant woman also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before your next conception.

Anatomical causes of miscarriage

The anatomical causes of miscarriage are the most intractable.Malformations of the uterus are a serious cause of miscarriage. Sometimes you just have to accept it.

Miscarriage between 12 and 22 weeks

This miscarriage is considered late. Its causes coincide with the causes of early miscarriages (anatomical, immune, infectious, endocrine).

At this time, miscarriage also happens due to isthmic-cervical insufficiency – a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2-3 trimester.Isthmico-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful observation of the pregnant woman allows you to identify the problem in time and make a surgical correction of the cervix before the onset of childbirth.

In isthmic-cervical insufficiency, there is only one method of treatment – a mechanical narrowing of the cervical canal. For this, the neck is either sewn up, or a special ring is put on it. However, the latter method is less effective because the ring can easily slide off the neck, then it will no longer restrain the process of its opening.

After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the vaginal microflora. The vagina is cleaned and the sutures are monitored daily for 5 days. Sutures are removed at 37-38 weeks and with premature onset of labor.

Isthmico-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens – male sex hormones or their precursors).

Miscarriage after 22 weeks

Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the lives of earlier children.

We recommend that you carefully examine for miscarriage, check the above factors. In addition to them, the cause of miscarriage can be antiphospholipid syndrome, while the woman’s body perceives the child as something alien and rejects him.This disease, like the others listed, is amenable to correction, i.e. you have a very real chance of carrying a child.

Miscarriages due to hemostasis disorders

All of the above reasons account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis).

Disorders of the blood coagulation system, leading to the loss of pregnancy, can be divided into thrombophilic (increased coagulability) and hemorrhagic (tendency to bleeding).Both of these extremes are dangerous for the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is impaired and the fetus is rejected.

The main hemorrhagic changes can manifest themselves even in childhood in the form of increased bleeding during cuts, tooth extraction, and the beginning of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of miscarriage. Early bleeding and chorionic detachment are difficult to stop.

You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.

When planning a pregnancy, you need to undergo a genetic examination and, if necessary, start treatment.

It is advisable to be examined for hidden defects of hemostasis, even for those who consider themselves healthy. This will help predict the occurrence of complications and prevent loss.Early therapy can prevent miscarriage in 98% of cases. If defects in hemostasis were found already during pregnancy, it can be difficult to maintain it.

What to do after a miscarriage?

Identify the cause! The ideal option is to be examined for future parents: it is much wiser to postpone conception and spend two or three months to identify the reasons than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.

Until you understand the reason, it will not evaporate.In most cases, the answers lie on the surface. Take care of your health and your future baby.

Make an appointment with an obstetrician-gynecologist by phone +7 (495) 150-60-01

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90,000 Abundant Periods Possible Causes | Kotex

Menstruation (menstruation) is bleeding from the uterus, usually lasting from 2 to 7 days and occurring on average every 25-35 days. Typically, blood loss during menstruation ranges from 30 to 50 ml, but the rate can be as high as 80 ml.To make it clearer, each completely soaked sanitary napkin or tampon absorbs on average about 5 ml of blood, that is, on average, women consume 6-10 pads or tampons per menstruation.

Abundant menstruation in the medical sense of the word is considered to be those periods in which the bleeding is so intense that the pad or tampon sometimes has to be changed every hour, that is, use 6-7 pieces per day and which last longer than 7 days. This condition is called menorrhagia and can cause anemia and clots larger than 2 cm in diameter.Often, such profuse periods are accompanied by severe cramps, which interfere with a full-fledged lifestyle.

Signs of menorrhagia:

Menstruation lasts longer than 7 days
Loss of more than 80 ml of blood per cycle
Using more than 16 tampons or pads per cycle
Leaky or completely soaking pad or tampon within 30 minutes
Large blood clots (with a two-ruble coin or larger)
The need to replace the gasket at night
You have to use two pads or a gasket and a tampon at once to avoid leakage

In addition, menorrhagia can be accompanied by symptoms that can also indicate anemia (condition, with which in the blood the content of hemoglobin and erythrocytes is low):

Increased fatigue
Dizziness
Pallor

What reasons can there be for heavy periods?

If your periods are heavy, prolonged and painful every time

This may be due to the presence of pathologies and changes in the body that you do not know about.

Hormonal imbalance

The female body secretes the hormones progesterone and estrogen, which regulate the menstrual cycle. Excess estrogen can cause the lining of the uterus to thicken, which in turn causes more bleeding during menstruation.

Ovarian dysfunction

The condition when the ovaries do not release an egg (no ovulation occurs) during the menstrual cycle is called anovulation. This is because the body does not produce progesterone as it does during a normal cycle.

Blood clotting disorders

From 10 to 30% of women with heavy periods suffer from blood clotting disorders, which can lead to difficulties in stopping bleeding.

Polyps of the uterus

Polyps are small, benign growths in the uterus that can increase the volume of blood secreted during menstruation. They can also cause minor bleeding between cycles and after penetrating intercourse. Sometimes polyps can degenerate into malignant tumors, especially in older women, so it is recommended to remove them.

Uterine fibroids

Uterine fibroids is a benign tumor in the muscle layer of the uterus. Most often they appear in women of late reproductive age (35-45 years). This is a very common condition that about 80% of women experience during their lifetime. Menorrhagia is most often caused by large or multiple fibroids. Most often, fibroids are small and do not have any symptoms.

Premenopause

This period is characterized by hormonal changes before menopause, and many women notice an increase in the volume of menstruation.

Recovery after childbirth

Often after childbirth, periods can be very abundant.In some women, they gradually become what they were before giving birth, but for many they remain abundant.

Endometrial hyperplasia

Some women may develop a condition in which the endometrium of the uterus becomes too thick. This condition is called endometrial hyperplasia and can cause profuse, prolonged bleeding with blood clots. This occurs most often after menopause, but sometimes it happens to young women as well.

Adenomyosis

Adenomyosis is a condition in which the endometrium of the uterus grows into the muscular and intermediate layers of the uterus.Most often occurs in women of childbearing age (25-35 years). In the places of endometrial germination, inflammatory processes occur. The condition is often difficult to diagnose and its causes are poorly understood.

Other diseases

Heavy periods can also be associated with endometriosis, thyroid disease, pelvic inflammatory disease, kidney disease, liver disease, and cancer.

If your period is heavy on the first day

For many women, menstruation is more intense on the first day, and then becomes weaker.However, if you have not experienced this before, you may need to think about whether you have changed your oral contraceptives or whether you have started taking any other medications that could affect your hormone levels.

Once abundant periods

Miscarriage

Often miscarriages can occur before a woman knows that she is pregnant, because at a very early stage they can pass like a heavy period.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg is attached outside the uterus.Ectopic pregnancy symptoms can easily be confused with heavy periods. This condition can be fatal.

If you are pregnant and you have heavy bleeding, you need to call an ambulance!

Non-hormonal IUD

Heavy periods are a typical side effect of using non-hormonal uterine devices.

Medicines

Blood thinners and anti-inflammatories may cause heavier menstrual bleeding.

Please remember that heavy menstruation is not always due to some pathology. Every woman’s menstrual cycle is unique and heavy bleeding may simply be a feature of your body. However, large blood loss can cause excess iron loss and anemia. With mild anemia, you may feel tired and weak. More severe forms can cause dizziness, headache, and heart palpitations. Heavy periods are often accompanied by severe uterine cramps, which cause severe pain (dysmenorrhea).Severe pain cannot be tolerated and this condition may require medication.

What can you do at home to ease heavy periods?

If you are in pain, take a nonsteroidal anti-inflammatory drug. You can also put a heating pad on your stomach — the heat relieves cramps.
Iron-rich foods and iron supplements can help relieve heavy menstruation and iron deficiency in mild anemia.
Iron-rich foods such as beef, liver and other offal, turkey, spinach, fish, pumpkin seeds, dried apricots, white beans, cocoa beans, champignons.It also makes sense to increase the amount of vitamin C, because it promotes the absorption of iron. A lot of vitamin C is found in kiwi, bell peppers, strawberries, citrus fruits, broccoli, tomatoes, kohlrabi, pineapple.
Drink plenty of water.

If you have heavy bleeding for several days, your blood volume may decrease significantly. Drink 4-6 extra glasses of water to maintain blood volume.

90,000 when it is dangerous, what to do, hemostatic drugs, is it possible to save the pregnancy

Waiting for a baby is a responsible and exciting period.Unusual sensations often force a woman to worry about trifles. But among all that is possible at this time, there is a circumstance that cannot be called nonsense. This is bleeding during early pregnancy. Why it happens, what needs to be done and whether you need to be careful, every woman should know.

Contents of article

What is considered bleeding

This is a discharge from the genital organs, of small, medium or large volume, in which blood is found.Its quantity is determined by their red, pink, brown colors. In the discharge, tissue particles, clots can also be seen.

All women should know if they can bleed in the early stages of pregnancy, and how this phenomenon is provoked. This will give her a chance to remain calm and at the same time not to lose vigilance in the event of a possible discharge.

Implantation of the ovum into the wall of the uterus

Since there is always a biological fluid of different consistency in the female genital tract, some people incorrectly assess the possible threat that lies behind bleeding.

A small amount of discharge is not yet evidence of the naturalness of what is happening. Blood can be retained inside the uterus or in the space between its wall and the placenta. Then at first very little comes out, but the woman will steadily lose strength. If it is noticed that blood has gone early in pregnancy, you must immediately find out what is the reason.

We recommend that you read about what brown discharge will indicate in early pregnancy. From the article you will learn about the peculiarities of discharge during pregnancy, gynecological diseases, what to do and when to see a doctor.

And here is more about what a mother can do to maintain a pregnancy in the early stages of pregnancy.

What kind of blood is in the first weeks of pregnancy

In the first weeks of pregnancy after conception, blood appears from the vagina during implantation (attachment) of the ovum. It can be drops, streaks, and scanty discharge is typical for an ectopic, and clots mean a miscarriage that has begun. Blood loss is severe during abortion against the background of progesterone deficiency.There are also those not related to pregnancy (for example, intestinal, nasal), as well as breakthrough due to incomplete restructuring of the hormonal background.

In the first days of pregnancy, at conception and implantation bleeding

In the first days of pregnancy, there is implantation bleeding, it appears about 5-8 days after sexual intercourse with the onset of conception. During this period, the ovum is attached to the wall of the uterus. Due to its introduction, the integrity of the inner shell may be disrupted, which is manifested by small bloody discharge.

They are similar to bleeding before menstruation, but disappear completely in 1-2 days. In this case, there are often no sensations, but some women note a slight soreness, less often there are pulling pains in the lower abdomen. The implantation blood secretion does not require any action; normally it may not be there.

Stitching pains on one side of the abdomen, brown discharge should be alerted, as they occur with an ectopic egg fixation. In this case, an examination by a gynecologist is needed.

Blood clot

The appearance of a blood clot at an early stage is dangerous. It may be a miscarriage that has begun. Normally, such discharge should not be. Even if there is no pain or it is moderate, then an urgent need to consult a gynecologist.

A drop of blood during pregnancy

A drop of blood can mean discharge from a polyp, erosion of the cervix, or due to the presence of fibroids in the uterine cavity. In the vast majority of women, they do not affect the overall well-being in any way, there is no pain or cramps in the abdomen.This phenomenon is short-lived, and the volume does not exceed a small speck.

Uterine fibroids

Severe bleeding

Severe bleeding at an early stage often occurs when a spontaneous miscarriage has already begun. It is accompanied by paroxysmal pain in the lower abdomen, radiating to the lower back. Blood loss is especially intense with a lack of progesterone. Additional symptoms include:

dizziness,
severe weakness,
headache,
increasing nausea,
increase in body temperature.

With an abortion in progress, there are regular cramping cramps in the abdomen, and the bleeding is constantly increasing. The secretions may contain parts of the ovum. Any suspicion of termination of pregnancy requires an ambulance call for delivery to the hospital.

Breakthrough bleeding

Due to incomplete hormonal changes in the body in early pregnancy, breakthrough bleeding occurs – discharge that coincides with menstruation.Their occurrence in the first months is considered harmless. For some women, they even go 3-4 times. In this case, the volume of discharge should be much less than with ordinary menstruation, and there should be no pain or slight pain is possible.

Bleeding during ectopic pregnancy

With ectopic attachment of the ovum, bleeding develops in early pregnancy. Its difference is that when tube implantation is interrupted (98% of cases), the bulk of the blood passes into the abdominal cavity.Therefore, with severe pain radiating to the rectum, legs, severe weakness and a drop in pressure (fainting), bleeding from the vagina is smeared or moderate, constant.

Intense blood loss occurs when the embryo is attached to the neck. It is caused by the close location of the uterine artery and weak contractions of the neck, its vessels do not have time to close after the rejection of the ovum. An ectopic pregnancy is extremely dangerous, an immediate operation is required, since a fatal shock is possible if untreated.

Ectopic pregnancy options

Androgens and bleeding early in pregnancy

Elevated levels of male sex hormones – androgens – cause bleeding at the beginning of pregnancy. This is due to the fact that 2/3 of women with such a violation remain at risk of miscarriage for up to 8 weeks. It has a hormonal development mechanism and, if untreated, gestation is interrupted. If the imbalance of hormones is detected before conception, then the woman is monitored in the first trimester in a hospital setting.

Sometimes pregnancy itself is a provoking factor for latent forms of hyperandrogenism . At risk are women who have:

hereditary tendency to terminate early pregnancy;
obesity;
polycystic ovary;
acne, increased oily skin;
Increased hair growth on the body, face and hair loss on the head.

In all cases of hyperandrogenism, progesterone must be used to prevent miscarriage.The treatment takes place under the control of blood tests.

Blood after ultrasound in early pregnancy

After an ultrasound in the early stages of pregnancy, discharge is possible if it was performed using a vaginal probe, and there is erosion of a polyp on the cervix. Less often, inflammatory diseases (cervicitis, colpitis) become the cause.

If there is no soreness in the lower abdomen, there is no deterioration in general well-being, and streaks or a couple of drops of blood appear on the pad, then there is no cause for concern.It is also important to take into account the very conclusion of the doctor. With an ultrasound scan, he clearly sees signs of a threat to gestation. There were no cases when ultrasound was the reason for the failure of a normal pregnancy. This diagnostic method is recognized as the safest.

Watch this video about the causes of bleeding in early pregnancy:

Blood color during pregnancy

Discharge of blood during pregnancy has a different color – scarlet with injuries of the vagina and cervix, bleeding polyp, dark, almost black happens with the onset, incomplete miscarriage, ectopic pregnancy.

Scarlet

Scarlet blood – arterial or capillary. It happens with traumatic damage to the mucous membranes – erosion, polyp. A light color of blood usually indicates that it is fresh, then its source is close to the cervical part of the uterus.

Black

Dark or black blood means that it has been in the uterine cavity for a long time, there is an admixture of venous in it, this is released when:

bubble drift,
ectopic tubal pregnancy,
inflammatory process,
started miscarriage.

Causes of bleeding during pregnancy

In addition to diseases that cause bleeding during pregnancy, it is important to know other reasons:

physical activity;
stressful conditions;
multiple pregnancies;
lack of folic acid;
injuries, especially in the abdomen;
active sex;
weight lifting;
rhesus conflict between mother and fetus;
smoking;
visit to the bathhouse, hot bath;
the presence of a spiral at conception;
carrying out diagnostic procedures with penetration into the uterine cavity;
the influence of unfavorable environmental or industrial factors.

Rh-conflict during pregnancy

Each of these factors can be decisive in the presence of any disease or hormonal disorder. It is also necessary to take into account the established fact that with abnormal genetic material (risk of severe fetal developmental disorders), even a small exposure is often enough to start a spontaneous miscarriage. It occurs precisely at an early date and even against the background of complete well-being.

Cervix bleeds during pregnancy

There are several types of diseases in which the cervix of a pregnant woman bleeds:

erosion due to infection, trauma, treatment with local drugs is the most common cause, it is asymptomatic, in the early stages it begins to bleed due to abundant blood flow;
polyp of the cervical canal – outgrowth of the mucous membrane of hormonal origin;
papillomatosis – viral infection with the formation of genital warts;
adenomyosis – growth of the inner layer of the uterus within the cervix;
myoma is a rare localization (cervical) tumor of muscle and connective tissue.

Adenomyosis of the uterus

To establish the source of bleeding and its cause, a gynecological examination and ultrasound are required. It is impossible to independently determine the pathology and its risk for pregnancy.

Early bleeding after IVF

In the early stages after IVF, bleeding is considered a threat of miscarriage. It can also occur in the absence of pregnancy, if the procedure was unsuccessful and menstruation began. Main risk factors for interruption of gestation in the first months:

the immune system rejects the fetus;
hormonal disorders;
insufficient blood supply to the uterus, structural anomalies;
diseases of the neck, tubes, ovaries;

90,253 infections;

long-term finding of the spiral without changing;
multiple pregnancies with ovarian stimulation;
excessive administration of hormones;
Injury to the genitals during oocyte collection;
kidney, heart disease, diabetes mellitus;
external factors – monotonous diet, smoking, alcohol intake, self-medication, stress, overwork.

Women who have undergone IVF are advised to consult a gynecologist for any unusual symptoms, even a slight bleeding.

Watch in this video about discharge after IVF in health and disease:

Signs of bleeding during pregnancy

In addition to the direct discharge of blood from the genital tract, signs of dangerous bleeding during pregnancy include:

constant pulling or cramping pain;
spread of pain to the sacrum, lower back, thighs, anus;
an increase in general weakness;
dizziness, darkening of the eyes;
increased nausea with urge to vomit;
increased body temperature with hot flashes, chills;
Loss of consciousness or light-headedness.

Any of these signs require immediate medical attention. Relatively harmless spotting with a polyp, myoma, cervicitis, or erosion usually proceeds against a background of well-being with minimal smearing or drip bleeding.

Serious threat to fetus and woman

At the initial stage of pregnancy, anything can seriously harm her: stress for any reason, physical effort, medication. The fruit is still too weak, and the tissues protecting it have not yet fully formed.Therefore, blood during pregnancy in the early stages of the cause can threaten her existence and the life of the woman herself.

Danger of interruption and miscarriage

These are common causes of bleeding. In addition to them, the woman is harassed by periodic throbbing pains in the lower abdomen. It all can start with a slightly noticeable bleeding. If this symptom is neglected, it will develop to such a level that the embryo will slip out along with the biological fluid.

But this outcome is by no means predetermined.If the fetus has survived, then at the onset of bleeding in the early stages of pregnancy, the chance to save it is quite high. It is necessary, without waiting for the cessation of discharge, to contact a specialist and demand help.

If the embryo immediately had serious defects or the process went too far, a complete miscarriage is likely. Other culprits can be infections affecting the reproductive or urinary system, trauma, inflammation. Abundant bleeding during early pregnancy, combined with pain, characterizes a complete miscarriage.

After a short time, the grasping sensations in the abdomen freeze, as does the discharge. A specialist examining a patient will find that the uterine pharynx is closed, and there is nothing in the cavity.

Blood clots during early pregnancy can be noticed even with a slight effort, for example, after going to the toilet. It is likely that these are particles of the fetal membrane or embryonic tissue.

A miscarriage is also incomplete, when the pregnancy is lost irretrievably, but the release of blood continues, and the cervix remains open.Here, there is still a danger for a woman, if scraping is not done in time. Bleeding with clots in early pregnancy is a symptom of incomplete miscarriage. The discharge becomes a deep red color, combined with unbearable cramping pain, a feverish state.

Watch this video for signs of early pregnancy miscarriage:

Ectopic pregnancy

An abnormal position of the ovum can also cause bleeding during early pregnancy.Normally, a week after fertilization, the place of the embryo is inside the uterus. But sometimes, for various reasons, the fetus lingers in the fallopian tube, enters the abdominal cavity or neck. The first circumstance is observed more often. Here we are not talking about preserving the fetus, the main thing is the life and health of the woman.

At first, a tubal pregnancy is symptomatically indistinguishable from normal. It is detected by a pharmacy test, causes toxicosis, changes in the mammary glands, and the absence of menstruation.

But the fetus grows, and it becomes cramped in the fallopian tube. The organ stretches, causing soreness in the area where the embryo is located. The bloody smear that complements it in the early stages of pregnancy, which intensifies over time, gives reason to suspect this particular diagnosis.

There are ways to remove the embryo from the fallopian tube while preserving the organ. If time is lost, it has to be removed, which in the future reduces the chances of conception. And when a woman suffers pain for a long time without telling the doctor about it, a rupture of the fallopian tube with violent bleeding is possible.This is already an imminent threat to life. In addition to strong bloody discharge, damage to the fallopian tube makes itself felt by a pain in the abdomen, which can lead to loss of consciousness.

Frozen Pregnancy

Minor bleeding in early pregnancy can be a signal of fetal freezing. For uncertain reasons, it stops its development, which also manifests itself:

Abdominal pain;
Cessation of enlargement and pain in the mammary glands;
Disappearance of toxicosis and flatulence characteristic of pregnancy;
Increase in body temperature;
A sharp decrease in basal temperature values.But the symptom can only be detected if it is measured regularly.

Sometimes the uterus tries to get rid of the frozen fetus. But in most cases, scraping is required. Stalling time means increasing the risk of sepsis.

Bubble drift

Abnormal development of the tissues that make up the placenta is called cystic drift. Its cause lies in the mistakes made by nature during fertilization. A benign (trophoblastic) tumor forms in the uterus instead of the embryo, fetal bladder and placenta.It looks like many small cysts arranged in a bunch.

In addition to the abnormally increased size of the uterus characteristic of this disease, there is another sign – blood during early pregnancy. It can be secreted for a long time until the uterus is freed from the tumor. The color of the discharge is dark, the consistency is rather thick. Ovum bubbles come out with blood.

And although there is little discharge, with their regularity, the occurrence of iron deficiency anemia is inevitable. Often, the process is complemented by vomiting, palpitations.Failure to provide timely assistance provokes the spread of trophoblastic cells to other parts of the body.

Diseases of the genital area causing bleeding

Pregnancy will not save you from gynecological problems. On the contrary, many of them are exacerbated at this time, and some are being discovered for the first time, because responsible mothers more zealously control their own well-being. And if it bleeds during early pregnancy, perhaps it reminds of a gynecological disease.

Cervical erosion

Changes in the surface epithelium make the cervix a possible source of bloody discharge. The ulcers formed on the mucous membrane make the organ very sensitive upon contact.

But even without obvious reasons for this, just sitting with tucked legs, a woman can sometimes detect blood in the early stages of pregnancy, and in subsequent ones too. It colors the selection red, brown, or pink. Neither the mother nor the developing fetus is in any way.Usually, the erosion is left for later, waiting for the end of the postpartum time.

So such discharge, which is not abundant and is not complemented by pain, may come out more than once, especially after sex.

Polyp

A benign neoplasm is also able to let you know about its existence with secretions. In this case, blood during early pregnancy is released poorly and painlessly. The choice of therapy remains at the discretion of the physician and depends on the accompanying circumstances.

But even when deciding to remove a large and bleeding polyp, there is no threat to the fetus and the woman. Along with the manipulation, medications are prescribed to maintain her condition. But often gynecologists take a wait-and-see attitude towards polyps, and the neoplasm painlessly exfoliates on its own.

Varicose veins

Many are sure that only the limbs suffer from varicose veins, and that mainly when the owner is overweight. In reality, if a diagnosis exists, bleeding during pregnancy is likely, including in the early stages.After all, the vagina is also riddled with veins, and the new position increases the load on their walls.

Often, the disease also affects the labia area, so the perineum swells and aches. The secretory function of the vagina is impaired, which makes sex strained and unpleasant. Minor discharge with bloody inclusions are found after it, and without a noticeable reason. They are not dangerous, but they complicate its course for a woman, increase discomfort.

Sexually transmitted infection

Sometimes discharge with impurities of blood appears when chlamydia, Trichomonas and other microorganisms are activated in the body, which got there through the genitals.In addition to dangerous inclusions, which in this case increase the likelihood of miscarriage, they have an unpleasant odor and may be accompanied by:

itching;
temperature;
loss of strength.

Non-pregnancy related bleeding

Typical types of bleeding, not associated with pregnancy itself, include intestinal (anal) bleeding in hemorrhoidal disease, nasal, from the gums. They are caused by several groups of factors:

hormonal changes that provoke relaxation and hyperextension of the vascular walls;
increased permeability, fragility of small capillaries;
decrease in blood clotting ability with congenital or acquired deficiency of platelets, coagulation factors;
lack of vitamins, especially ascorbic acid, K, rutin.

Any blood loss weakens the pregnant woman, leading to anemia. Therefore, it is necessary to treat the underlying disease (hemorrhoids, hemorrhagic diathesis, thrombocytopenia, vitamin deficiency), as well as a diet rich in protein and iron. Nuts, fresh herbs, pomegranate juice, liver, buckwheat porridge, chicken and turkey are recommended.

Is bleeding always a threat

Women in an “interesting position” are characterized by all sorts of fears, so they often exaggerate the severity of their own feelings.When pondering why they bleed in early pregnancy, many forget that this is also due to natural causes:

Egg implantation . During the entire period of gestation, the embryo remains fixed inside the uterus. The process begins already a week after fertilization, when the woman does not even know about the changes awaiting her. Most often, this event is asymptomatic. But sometimes a drop of blood during early pregnancy and a slight aching pain can signal implantation;
The time of menstruation is .With a slight hormonal disruption, the body is able to remember them, and then the woman notice smearing discharge with streaks of blood. There are few of them, there is no pain, sometimes it sips the lower abdomen. In principle, it is not dangerous if there is an opportunity to lie down calmly, taking the drugs prescribed by the doctor.
But when a woman allows herself to be nervous, does not reduce the load on the body, the ichor during early pregnancy can turn into strong discharge, which will end in interruption.

How long does the bleeding last during pregnancy

Non-dangerous types of bleeding during pregnancy last no more than 1-2 days.These include:

implantation,
breakthrough,
superficial (from the neck, vagina).

An important difference between them is the absence of pain or minimal discomfort. At the same time, the woman’s well-being does not change. With the threat of miscarriage, the duration of the discharge will depend on the effectiveness of treatment.

Is it always dangerous if bleeding begins in a pregnant woman

If a pregnant woman starts bleeding for an unknown reason, then it is considered dangerous in terms of the risk of interruption.Therefore, in all cases, you need to contact your gynecologist as early as possible. After examination and exclusion of the threat of miscarriage, treatment may not be required if the discharge is not associated with pregnancy, or represents breakthrough bleeding.

Actions, medications and hemostatic drugs during early pregnancy

Whatever triggered bleeding during early pregnancy, treatment is necessary in many cases. Trying to establish the cause on your own, wait or use homebrew means, means wasting time, risking your future baby and yourself.The women who timely applied to the gynecologist, despite the serious threat of miscarriage, in 80% of cases, carry a fetus normally and give birth to healthy babies.

To maintain pregnancy with an increased risk of termination, the following drugs are prescribed:

Papaverine (suppositories) or No-shpa in tablet form. Reduce the tension of the walls of the uterus, neutralizing pain and eliminating the possibility of pushing the fetus out of the cavity;
Dyufaston or Utrozhestan. Hormonal agents bring progesterone levels to normal.A lack of substance is often the culprit for bleeding. With a more serious threat of interruption, injections of the hormone are prescribed in pure form;
Motherwort, Valerian. The drugs reduce anxiety, thereby helping to relax, including the smooth muscles of the uterus.

But the main thing in providing assistance is hemostatic drugs during early pregnancy:

Dicinone

The active ingredient is ethamsylate.The drug supports the formation of platelets, which “seal” the vessels, preventing their contents from flowing out. There are tablets, but in especially serious circumstances, Ditsynon is prescribed intravenously.

Once in the bloodstream, the medicine begins to work after 20 minutes, and the effect lasts up to 6 hours.

Vikasol

Improves blood clotting, due to the production of prothrombin, but begins to act only 8-12 hours after entering the body, therefore it is not prescribed in emergency situations, but is used for complex treatment 4 tablets per day or 1-2 ml intravenously.

Tranexam, Exacil or Troxaminate

The drug is prescribed in tablets (1 or 2 3 times a day, starting from the severity of the condition) or injections with blood discharge or a predisposition to them. It is based on tranexamic acid, which helps clotting.

Therapy is often supplemented with the intake of vitamins C and E, folic acid, which strengthen the walls of blood vessels, reducing the likelihood of dangerous secretions.You cannot use hemostatic drugs on your own. All of them have side effects, so dosage and regular monitoring of blood viscosity are very important. The latter is especially important if there were problems with its coagulation before pregnancy.

See in this video about the mechanism of action and application of Dicinone:

What to do if a pregnant woman bleeds

If a pregnant woman bleeds, then you need to call an ambulance and lie down.You are not allowed to walk or travel to the hospital with your own transport. Being at rest during a threatened miscarriage is the basis for maintaining a pregnancy. Taking pills on their own is usually not only ineffective, but also often dangerous.

If the doctor, after the examination, insists on inpatient treatment, then in no case should this recommendation be ignored. At home, it is much more difficult to complete all appointments, protect yourself from stress and control the course of bearing a child.With an early visit to the doctor, most pregnancies remain.

How to stop bleeding during pregnancy

It is possible to stop bleeding during pregnancy only if the doctor’s recommendations are followed, he examines the size of the uterus, its tone, ultrasound, prescribes blood tests, selects hemostatic drugs (Vikasol, Etamzilat) and medications to eliminate the root cause.

If by all indicators the fetus is viable, then medications and complete rest are recommended.This is most often enough in the absence of serious diseases of the mother and child. At home, the results of treatment are worse, so most often you need to keep the pregnancy in the hospital under the constant supervision of a gynecologist.

Preservation of early pregnancy with bleeding

To preserve early pregnancy when bleeding occurs, the following drugs are prescribed:

Reducing uterine tone	Papaverine, No-shpa
Haemostatic	Vikasol, Etamsilat
Progesterone analogs	Dyufaston, Utrozhestan
Vitamins	folic acid, B6 (Magne B6), vitamin E

If the pregnancy cannot be saved

When bleeding that occurs during early pregnancy is caused by tubal placement, surgery is indispensable.Here the task is to save the woman and preserve the organ. If the fetus is still small, it is removed, leaving the fallopian tube functioning. If there is no chance to save her, the organ is removed in order to avoid rupture and more intense bleeding, which can bring the patient to death.

With a complete blister drift and a frozen pregnancy, there is no question of saving the fetus. It is necessary to free the uterus from its contents, which is done by scraping or vacuum cleaning.

If it is noticed that blood is flowing during early pregnancy, a woman should complain to the gynecologist and not resist when he offers hospitalization.The initial period is one of the most difficult for the embryo, but at the same time there are more chances for preserving the child and maximizing the avoidance of negative consequences for the mother’s health.

When using any drugs, you should consult a specialist doctor. There are contraindications.

Reasons for the appearance of

Various conditions can contribute to the development of blood secretions from the genital tract. Each period of pregnancy has a number of unique physiological characteristics. As a rule, the reasons leading to the appearance of blood from the genital tract in pregnant women differ.

Early

The appearance of small or moderate bleeding at a small stage of pregnancy is often associated with the peculiarities of the intrauterine development of the baby.

During implantation

In the first weeks from the moment of conception, a huge number of important biological processes take place in the developing child’s body.So, a fertilized egg begins to divide rather quickly and turns into a small embryo. The appearance of bloody discharge from the genital tract in early pregnancy often occurs 6-8 days after fertilization. The development of this symptom in this situation has a completely physiological feature and is due to implantation – the attachment of the ovum to the uterine wall.

In order to ensure a strong fixation, the ovum must firmly “attach” to the wall of the uterus.During implantation, there is a slight physiological damage to the endometrium (inner uterine membrane), which is manifested by the appearance of bloody discharge. As a rule, this symptom disappears rather quickly.

Many women often do not even notice it or do not pay any special attention to this event. It also happens that they simply do not realize that the implantation of the ovum is taking place in the body.

If a woman did not plan a pregnancy, then in this case she does not even suspect that she is already pregnant.The appearance of pink or reddish vaginal discharge, she can “write off” on the arrival of menstruation or exacerbation of some kind of chronic disease. Severe implantation bleeding can also be a manifestation of abnormal attachment of the ovum.

In the presence of a number of chronic diseases of the walls of the uterus (endometritis, endometriosis), spotting may be more pronounced and abundant in quantity. Usually, in this case, a pregnant woman has concomitant symptoms: the appearance of soreness in the lower abdomen, slight weakness, and sometimes dizziness.

With the development of multiple pregnancies

It also happens that during conception, several eggs are fertilized at once. Thus, the conception of twins occurs.During implantation, it can happen that one fertilized egg attaches, and the second does not. In this case, the pregnant woman may also have spotting or even slight bleeding. It should be noted that the death of one of the embryos can also occur after implantation.

In this case, the woman may also have bleeding from the genital tract. They usually appear suddenly. In this case, it is possible to determine the death of one of the embryos by means of an ultrasound scan.

Dyshormonal disorders

During pregnancy, the hormonal background of the expectant mother almost constantly changes. In the blood, the concentration of some hormones increases, then others. Such constant hormonal changes are necessary for the embryo to fully develop.

Lack of certain hormones during pregnancy can lead to the development of dangerous pathologies.So, a significant deficiency of progesterone in the blood can lead to the appearance of specific secretions.

Dyshormonal disorders occurring with the development of adverse symptoms can significantly worsen the prognosis of the course of pregnancy.

Late

The appearance of red discharge from the genital tract in the second half of pregnancy is quite often an unfavorable sign.When spotting or bloody discharge appears, it is very important to establish the cause that led to their occurrence. They can be very diverse.

Placental abruption

This condition is characterized by detachment of the placenta from the wall of the uterus. Normally, the placental tissue is firmly fixed to the uterine wall. This is necessary so that the baby, who “lives” in the mother’s womb during its intrauterine life, could receive all the necessary nutritional components for its development.Many blood vessels pass through the placenta, which carry oxygen dissolved in the blood.

Detachment of the placenta from the uterine walls occurs due to various reasons. The most striking sign of this pathology is usually bleeding. Most often, it develops suddenly. However, a woman does not always notice that she is bleeding. Sometimes placental abruption develops gradually. This contributes to the fact that the woman begins to appear reddish smearing discharge from the vagina.

Placental abruption may be preceded by some kind of mechanical stress. So, detachment of placental tissue can begin after intense sports or lifting too heavy objects. In some cases, the pathology develops rapidly and may even be accompanied by the development of massive blood loss.

Placenta previa

The low position of the placenta relative to the internal uterine os can also lead to bleeding during pregnancy.In most cases, such discharge appears systematically. They can disturb the expectant mother several times throughout the entire period of pregnancy.

Most often spotting with placenta previa develops in the third trimester of pregnancy. At this time, the fetus is already quite large and presses heavily on the cervix. This contributes to the fact that in the area of the delicate mucous membrane, small lesions and defects may appear, which will bleed.At the same time, blood droplets are mixed with the vaginal secretion, leading to its staining. This leads to the fact that a pregnant woman notices the appearance of red spotting in herself.

Placenta previa is a rather dangerous condition. It requires the expectant mother to follow a number of recommendations that are compiled for her by doctors in order to prolong the pregnancy as much as possible.

Spontaneous abortion

Adverse pregnancy outcomes, unfortunately, also occur in obstetric practice.Rejection of the fetus from the uterus and its intrauterine death can occur for various reasons. One of the possible symptoms that can develop with this pathology is the appearance of bleeding. It is usually quite severe, accompanied by severe blood loss.

In addition to the appearance of bleeding, the woman’s health is also significantly impaired. Another characteristic symptom of this condition is the appearance of severe abdominal pain. Massive blood loss is usually accompanied by clouding or even loss of consciousness.The woman is in critical condition, so she needs to be urgently hospitalized.

In case of untimely provision of medical care, the risk of a threat to a woman’s life is quite high.

Bubble drift

This pathology is relatively rare in obstetric practice.This pathological condition is associated with excessive proliferation of placental tissue. In the very early stages of pregnancy, a woman may not feel almost any unfavorable signs in herself. Dangerous symptoms manifest themselves much later.

One of the clinical signs of this condition is the appearance of specific red discharge. They are usually quite abundant. The prognosis for the development of this pathology is usually unfavorable.

Aggravation of cervical erosion

The presence of an eroded area on the cervix can also lead to the appearance of bloody spotting from the genital tract. During pregnancy, the hormonal background is constantly changing in the body. Some hormones affect the cell layers of the cervix, which can lead to exacerbation of erosion. In this case, the color of the vaginal discharge can be different – from red to brown.Usually, the discharge is scanty or insignificant.

The danger of exacerbation of cervical erosion is different – constant blood loss. Even small, but systematic blood loss can lead to the development of an anemic condition, which is unfavorable for both the expectant mother and her baby.

Injury to polyps

Polyposis tissue can grow on the walls of the uterus.In practice, there are often cases when pregnant women suffering from this pathology did not even suspect about it before the onset of pregnancy. The growth of polyps in the uterus is usually not accompanied by any uncomfortable symptoms. Often the first unfavorable signs appear during pregnancy. This is largely due to the active growth of the baby.

As the fetus grows, damage to a specific part of the uterus where the polyp is located may occur. This leads to his trauma, and hence the appearance of a slight bleeding.

If the polyp is rather small, then the woman will not notice pronounced bleeding. In this case, she may have only a small bloody discharge from the genital tract.

For any term

Several causes of bleeding from the genital tract can lead to adverse symptoms at any time during pregnancy.They are mainly associated with traumatic injury to the delicate mucous membranes of the female genital tract. They are usually easy to install. Many of them are preceded by some kind of mechanical effect, which contributes to the damage.

After intercourse

The appearance of bloody discharge can occur after having sex. In the first weeks of pregnancy, the mucous membranes lining the genital tract are slightly “loosened”.This is conceived by nature for the process of implantation of the ovum to the uterus to take place successfully. Sexual intercourse in this case can lead to injury and minor damage to the vulnerable mucous membranes. It can also make a woman notice the appearance of blood drops or reddish discharge on her underwear.

Sexual intercourse can damage the mucous membranes in late pregnancy. In order to avoid this, the couple should choose the most gentle poses.

After transvaginal ultrasound

Ultrasound examinations are performed several times during pregnancy. For the first time, ultrasound is prescribed to verify the fact of pregnancy, as well as to determine the location of the attachment of the ovum to the uterine wall. Also, during such a diagnosis, the doctor also assesses the condition of the reproductive organs of the expectant mother.

Transvaginal ultrasound is performed by inserting the probe into the vagina. With such an introduction, microdamage to the mucous membrane is also possible. In this case, as a rule, a woman has a slight vaginal discharge that has a reddish tint.

They usually appear without pain. This vaginal discharge usually goes away on its own.

After performing a gynecological examination

In some cases, spotting from the genital tract may appear after examination by a gynecologist. The appearance of this symptom is caused by the introduction into the genital tract of instruments intended for examination. In this case, a pregnant woman may also notice the appearance of drops of blood on her underwear. This symptom usually goes away on its own after a couple of days from the date of the gynecological examination.

After a failed douching

Violation of the technique of this procedure can damage the mucous membranes of the genital tract. This contributes to the fact that the woman may develop bleeding or bloody discharge. They usually appear almost immediately after unsuccessful douching. It should be noted that douching during pregnancy should only be resorted to after consulting a doctor.

Self-administration of medicinal products can have adverse effects on the fetus. Before introducing any funds into the vagina, you should definitely discuss the appropriateness of their use with your obstetrician-gynecologist.

With exacerbation of chronic diseases of the genital organs

Many pregnant women have certain pathologies even before pregnancy.This is confirmed by gynecological statistics. Doctors note that there are quite a few healthy women of reproductive age. Various factors contribute to the exacerbation of diseases of the reproductive organs. One of them is a physiological decrease in immunity. Changes in the functioning of the immune system during pregnancy occur in every pregnant woman and are completely normal.

The risk of exacerbation of chronic salpingitis, cervicitis, endometritis and other diseases during pregnancy is quite high.In some situations, with such pathologies, spotting spotting may appear. Exacerbation of chronic diseases of the intimate organs can develop at any time of pregnancy. Usually they are accompanied by the appearance of pain in the abdomen, and can also occur with an increase in body temperature.

What might they look like?

Bloody discharge can have a different appearance.So, they can be liquid and homogeneous or with clots. The coloration also varies. It can be pinkish to dark brown. With the development of uterine bleeding, the blood does not have time to “fold”, which leads to the fact that the discharge from the genital tract becomes bright red and even crimson.

The amount of discharge is a very important clinical indicator . This symptom is necessarily assessed by doctors when making a diagnosis and conducting differential diagnostics.So, for example, with an exacerbation of cervical erosion, the amount of discharge is usually insignificant. With placenta previa, more blood is released. Complete placental abruption is characterized by the development of massive bleeding.

What can be dangerous?

The appearance of bloody discharge from the genital tract means that blood loss occurs.Its severity is different and depends on the original cause that led to its development. Complications in this case depend on how often and for how long the expectant mother loses blood.

If spotting bothers the expectant mother several times during the entire period of pregnancy, then the risk of anemia is quite high. In anemic condition, the amount of hemoglobin and (or) erythrocytes in the blood decreases. Such a decrease in red blood cells, which are responsible for the transport of dissolved oxygen, leads to the development of a dangerous condition – hypoxia (oxygen starvation) of the internal organs.

It is important to note that hypoxia in this condition develops both in the pregnant woman herself and in her baby.

A child who is in the womb will definitely react to the arisen oxygen deficiency. Usually this is manifested by the fact that the fetus has a significantly increased heart rate, and also increases motor activity.These characteristic changes are also determined on the cardiotocogram.

To compensate for the functional disorders that have arisen, doctors usually resort to prescribing iron-containing drugs. The systematic intake of these funds helps to normalize the level of red blood cells in the blood. The positive effect of such therapy is significantly higher if it is carried out on condition that blood loss stops. If a pregnant woman continues to lose blood due to frequent bloody discharge, but receives iron-containing drugs, then the effect of their use will be much lower.

Massive blood loss, such as spontaneous abortion, is dangerous even for a woman’s life. In this situation, there is a sharp decrease in the volume of circulating blood, and, therefore, the total fluid content in the body. In such a situation, the work of the vital organs – the brain and heart – sharply deteriorates. With massive blood loss, a woman carrying a baby may even lose consciousness. In this case, timely provision of medical care is very important, including with the appointment, if necessary, of anti-shock drugs.

In addition to the adverse consequences for the body of the expectant mother, the fetus may also suffer.

Pathologies, which are accompanied by the development of bloody discharge, can lead to the formation of various defects in intrauterine development and in the fetus. This is largely facilitated by the violation of the uteroplacental blood flow, which can develop in a number of pathologies.

Is it possible to maintain a pregnancy if bleeding develops?

The appearance of blood from the genital tract can be an extremely dangerous sign.However, this does not always mean a sad outcome of pregnancy. The prognosis in this situation can be very different and largely depends on the cause that influenced the development of severe bleeding, as well as on the initial state of the organism of the expectant mother. Heavy, breakthrough bleeding can be dangerous by the development of massive blood loss. In this case, timely provision of specialized medical care is very important.

If a pregnant woman has bleeding, then you should not hesitate to call an ambulance.It so happens that every minute of delay can be decisive.

How is the diagnosis carried out?

It should be noted right away that only a doctor can determine the severity of the disorders that have arisen. A pregnant woman can assume why she has bloody discharge from the genital tract, but only a doctor can finally determine the pathology. To do this, he first of all needs to conduct a clinical examination.During such a simple examination, the doctor determines the condition of the mucous membranes, assesses the well-being of the fetus, and also takes smears for analysis.

Examination on the gynecological chair is carried out in this case rather carefully and carefully. Inaccurate examination may increase bleeding.

For a woman who has bloody vaginal discharge during pregnancy, the doctor will prescribe to be tested.The simplest, but quite informative is a complete blood count. This routine laboratory test can detect the presence of inflammation and assess the degree of blood loss by reducing the number of red blood cells and hemoglobin.

In some cases, the doctor also prescribes a biochemical study. It allows you to determine the indicators of blood clotting. Such an analysis helps the doctor figure out if there are any pathologies of hemostasis and, if necessary, prescribe the appropriate therapy.

Another research method, which is prescribed to women suffering from the appearance of spotting from the genital tract, is an ultrasound scan. Such an examination is carried out mainly in a transabdominal way. In this case, a specialist examines the state of the uterus and the baby in it with a special sensor, which he conducts along the anterior abdominal wall. Transvaginal ultrasound can lead to additional trauma to the mucous membranes, which will only provoke re-bleeding.

It is important to remember that before trying to cope with the resulting discharge, you should establish the cause that led to their appearance. This can only be done through various examinations that are carried out in medical institutions.

Treatment

It often happens that a woman who is faced with the appearance of bloody discharge while carrying her baby is afraid to see a doctor.This often leads to the fact that the diagnosis of various pathologies is carried out out of time. With such a delay, the prognosis of the course of pregnancy may change and become already unfavorable.

An obstetrician-gynecologist, to whom a woman suffering from the appearance of bloody discharge applies for an appointment, first of all establishes a diagnosis and the cause of the developed disorders. Then he chooses the tactics of further monitoring the pregnancy. If necessary, the doctor sends the expectant mother to hospitalization.

Choice of medical tactics

The main task with the appearance of bloody discharge from the genital tract is to take measures aimed at stopping the bleeding that has arisen. For this, various techniques can be used. Their choice is largely determined by the underlying cause that led to the development of adverse symptoms. If the condition of the expectant mother is rather difficult and there is a threat to the life of the fetus, then in such a situation, even emergency obstetrics may be required.Caesarean section in this situation is carried out for health reasons.

Drug therapy

Drug treatment of pregnancy pathologies, accompanied by the development of bloody discharge, is usually complex and multicomponent. In some cases, doctors may resort to prescribing hemostatic agents to stop bleeding. One of these drugs is Tranexam.It helps to cope with the bleeding that has arisen and improve the well-being of a pregnant woman. This remedy is prescribed by a doctor, since it has a number of contraindications.

In case of pathologies accompanied by the development of severe bleeding, it may be necessary to administer solutions through droppers. This treatment is aimed at replenishing the volume of circulating fluid in the body. Together with the solution, drugs that affect blood clotting can also be administered.

For disorders associated with dyshormonal disorders, drugs may be prescribed that affect the level of certain hormones in the blood.One of these tools is “Duphaston”. The use of this tool allows you to normalize the low blood level of one of the important pregnancy hormones – progesterone.

The remedy is prescribed by the attending physician. It is important to remember that self-administration of hormonal drugs can be dangerous by the development of formidable complications. Duration of admission and course dosage are selected individually.

Surgical obstetrics

With severe bleeding, especially with the development of severe fetal hypoxia, doctors may resort to a cesarean section.In some cases, this method of obstetric aid allows you to save the life of a woman and her baby.

Before performing a caesarean section, doctors must assess the condition of the mother and fetus. If the general condition of the pregnant woman is critical, then it is impossible to hesitate with the caesarean section. If the condition allows for the possibility of conservative therapy, then it is carried out first. If, against the background of the ongoing drug therapy, the general condition of the pregnant woman does not improve, then in this case, the doctors will be forced to resort to emergency obstetrics.

About what bloody discharge during pregnancy means and what a pregnant woman needs to do in order to bear and give birth to a healthy baby, see below.

Is bleeding and clotting normal in early pregnancy. Vaginal Bleeding and Blood Clots During Early Pregnancy: What’s Normal and What’s Not

Understanding Vaginal Bleeding in Early Pregnancy

How common is bleeding in early pregnancy?

Types of Bleeding During Pregnancy

Is bright red blood more concerning than brown blood?

Causes of Bleeding in the First Trimester

What is implantation bleeding?

Can hormonal changes cause bleeding in early pregnancy?

Potential Complications Associated with First Trimester Bleeding

How is a threatened miscarriage diagnosed?

Bleeding in the Second Half of Pregnancy

What are the potential causes of bleeding after 20 weeks?

When to Seek Medical Attention for Pregnancy Bleeding

Should you use tampons if you’re experiencing pregnancy bleeding?

Preventive Measures and Self-Care During Pregnancy

Can stress cause bleeding in early pregnancy?

Diagnostic Procedures for Pregnancy Bleeding

What tests might be performed if you experience bleeding during pregnancy?

Treatment Options for Pregnancy-Related Bleeding

How is a threatened miscarriage typically managed?

Can bed rest help prevent miscarriage in cases of early pregnancy bleeding?

Emotional Support During Pregnancy Complications

Where can you find emotional support if you’re experiencing pregnancy complications?

Future Pregnancies After Experiencing Bleeding

Does bleeding in one pregnancy increase the risk of bleeding in future pregnancies?

What precautions can be taken in future pregnancies if you’ve previously experienced bleeding?

Bleeding During Pregnancy: What’s Normal and What’s Not?: The Women’s Specialists of Fayette: Obstetricians & Gynecologists

Types of bleeding during pregnancy

Bleeding during the first half of pregnancy

Bleeding in the second half of pregnancy

Warning signs during pregnancy – Bleeding from the vagina during pregnancy

Causes of vaginal bleeding in the first trimester

Implantation bleeding

Hormonal changes

Threatened miscarriage

Miscarriage

Ectopic pregnancy

A molar pregnancy or hydatiform mole

Causes of vaginal bleeding in second and third trimesters

‘Late’ miscarriage

Problems with the cervix or neck of the womb

Placenta praevia

Placental abruption

A ‘show’

Bleeding in Early Pregnancy

S Vardhan

TK Bhattacharyya

SPS Kochar

B Sodhi

Ectopic Pregnancy

Predisposing factors for ectopic pregnancy

Clinical features

Diagnosis

Management

Abortion

Threatened Abortion

Incomplete Abortion

Complete Abortion

Missed Abortion

Septic Abortion

Vesicular Mole

Conflicts of Interest

References

Page not found | Sandwell and West Birmingham NHS Trust

Archives

7 Potential Causes for Large Blood Clots During Your Period

1. Thyroid Conditions

2. Polyps and Fibroids

3. Birth Control

4. Medications

5. Miscarriage

6. Endometriosis

7. Polycystic Ovarian Syndrome (PCOS)

Other Chronic Conditions

I have a blood clot under the placenta.

Implantation Bleed

Further Reading

“In a pregnant woman, the infection develops differently.”

“The child suffers in the womb while the mother is sick”

“With coronavirus, the saying does not work that houses and walls help”