Pregnant and bleeding for 3 weeks: How Much Is Normal? What Causes It?
3 Weeks Pregnant: Spotting the First Signs of Pregnancy
If all has gone according to plan, your baby is officially beginning to grow inside you during week three, even if she is only a bundle of cells at this point. You may not have a positive pregnancy test yet, but you can be on the lookout for these early pregnancy symptoms.
Tip of the week:
Many women feel fatigued after becoming pregnant, and it’s no wonder, considering all the work your body is doing to help your little one grow. One way to relieve this is to be sure you’re eating foods with plenty of iron and protein, such as leafy greens, lean meat, beans and fortified whole-grain cereals.
After your egg is fertilized (and so now known as a zygote), it makes an astounding transformation by dividing several times and turning into a ball of cells about the size of a grain of sand. This cluster is called a blastocyst, and it will now travel from your fallopian tube to your uterus, the place it will call home for the next nine months.
Of course, you won’t notice all of this action going on, and most likely it would be too early to take a pregnancy test, however, you may experience some signs of pregnancy.
You might have heard of something called implantation bleeding, which occurs anywhere from six days to two weeks after conception. This happens when your little blastocyst attaches to the wall of your uterus. Some women don’t have any bleeding, while others only see slight spotting and some may have what seems like a full-on period.
There may also be a slight rise in your basal body temperature upon conception. This is because your body is producing more estrogen and progesterone, which help it prepare for the changes it will undergo and may also lead to some unwanted side effects, like nausea. If you’ve been tracking your temperature for conception, you may notice this very early sign of pregnancy.
Speaking of nausea, you may soon begin to experience telltale morning sickness, which, deceivingly, can occur at any time of the day. Feelings of nausea can happen with or without vomiting and may be triggered by certain smells because your olfactory senses are now heightened. Your sensitive sense of smell may also cause cravings or aversions to certain foods.
Many women note changes in their breasts soon after conceiving. They may become tender, swollen or fuller than usual. Additionally, hormonal changes may make your nipples appear darker. Read more about physical changes that happen during pregnancy.
Other symptoms that the surge in hormones may cause are fatigue, mood swings, dizziness and constipation. If any of these get severe, contact your health care professional to find safe, effective ways to alleviate them.
Read more :
What No One Tells You About Trying to Conceive
10 Questions to Ask Your Health Care Professional When Trying to Conceive
Due Date Calculator
Bleeding During Pregnancy – 7 Causes Of Blood Loss
If you experience bleeding during pregnancy it can be frightening.
According to the American College of Obstetricians and Gynecologists, around 15-25% of pregnant women experience vaginal bleeding during early pregnancy.
However, a vaginal bleed in early pregnancy doesn’t always mean you’re experiencing a miscarriage.
Vaginal bleeding during pregnancy
Vaginal bleeding is any loss or discharge of blood from the vagina. It can happen any time from when the egg is fertilized to the end of your pregnancy.
To help you access more information about bleeding or spotting during pregnancy, you might like to read Spotting During Pregnancy – How Much Spotting Is OK?
Does bleeding mean a miscarriage?
Vaginal bleeding when pregnant doesn’t automatically mean you’ll experience a miscarriage.
In most incidences, pregnancy loss occurs between week five of pregnancy and week eight of pregnancy.
In most cases, in the first trimester of pregnancy, bleeding might last only about three days.
Although most women have one experience of bleeding, a small number will bleed throughout the entire pregnancy.
It can take the form of spotting, streaking, or period-like bleed, with or without clots.
7 causes of vaginal bleeding during pregnancy
Below are seven of the most common possible causes of bleeding during pregnancy. As you will see, it’s not always sinister.
It’s also possible to feel some mild cramping or stretching sensations during a healthy pregnancy.
#1: Implantation bleeding or streaking
When a fertilized egg implants in the uterine lining, it can result in light bleeding or streaking (streaks of blood) called implantation bleeding.
Usually, it lasts a couple of days in the first trimester and occurs around the time of implantation or when your period would have been due.
Some mothers mistakenly think they have simply had a light period and don’t realize they are pregnant.
For more information please read Implantation Bleeding – Everything You Need To Know.
#2: Breakthrough bleeding
Some mothers experience what’s known as ‘breakthrough bleeding’. This happens during the times when a period would normally be due.
This means bleeding appears at around 4, 8, and 12 weeks of pregnancy, and is usually accompanied by the feeling you would normally have when your period is about to begin.
During pregnancy, hormones prevent your period from occurring. If the levels of these hormone aren’t yet elevated enough to stop your period, breakthrough bleeding occurs.
Breakthrough Bleeding And Pregnancy | Causes And What To Expect has more information.
#3: Threatened or actual miscarriage
A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. Most often a miscarriage happens because the fertilized egg has complications that mean the pregnancy won’t continue.
It’s believed that 10-25% of all pregnancies end in miscarriage and 80% of these end in the first trimester. The risk of miscarriage decreases once the baby’s heartbeat has been found on ultrasound. When you enter the second trimester, the risk drops to less than 1%.
Common signs of miscarriage include first trimester vaginal bleeding or spotting, cramping, backache, and stomach pains.
For more information about miscarriage, we recommend:
#4: Bleeding after sex
Bleeding after sexual intercourse is one of the most likely causes of spotting or light bleeding in early pregnancies. However, it can occur in any trimester.
During pregnancy, the cervix has more blood supply and is quite sensitive to touch. Sexual intercourse can cause blood vessels to be irritated and bleed slightly.
Unless your doctor has instructed you to stop having sex, it’s safe to have sex. You might see some spotting afterwards.
Speak to your care provider, however, if the bleeding is ongoing, accompanied by cramping, or excessive.
For more information be sure to read Bleeding After Sex During Pregnancy.
#5: Ectopic pregnancy
An ectopic pregnancy occurs when the fertilized egg implants itself outside the uterus. In more than 90% of cases, it implants in a fallopian tube.
You might experience severe discomfort down one side of your abdomen, or generalized pain that doubles you over. You might also feel faint and nauseous.
The pain can disappear suddenly if the tube ruptures, but it will return within hours or days and you will feel really unwell.
Go to the emergency department and contact your ob-gyn.
An ectopic pregnancy that ruptures the fallopian tube will cause internal bleeding, damage to the tube, and maternal collapse.
Your fallopian tube might have to be taken out, along with the pregnancy.
For more information, read our article Ectopic Pregnancy – Symptoms, Signs, and Treatment.
#6: Bleeding from the placenta
A vaginal bleed without pain might be caused by an abnormally placed placenta. It’s quite common to have a low-lying placenta in early pregnancy.
Usually, by the third trimester, the placenta will have moved up as the uterus grows and is further away from the cervix. Sometimes, though, this doesn’t happen.
Here are three different placental problems that can result in a vaginal bleed:
Placenta previa will usually result in a vaginal bleed at some point in your pregnancy – usually after the 20-week mark.
There are different degrees of severity, but all cases of placenta previa require repeat ultrasounds for an accurate diagnosis.
If you have a placenta previa, to prevent risk to your baby, your doctor might recommend bed rest, induction, or c-section if the placenta remains over or too close to the cervix.
This article about placenta previa has more information.
Another cause of vaginal bleeding later in pregnancies is placental abruption. This is where the placenta partially or completely separates from the wall of the uterus.
Symptoms include severe pain and bleeding.
The blood might be visible or remain in the uterus, which will be tense, tight, hard to the touch and very painful.
Contact your doctor or health care professional if you have any of these symptoms and go immediately to your nearest emergency department.
Depending on the severity of the bleeding, you might be recommended bed rest, an induction, or even a c-section.
If you’ve had a previous c-section, or other procedures involving your uterus, vaginal bleeding could be caused by placenta accreta. This is when the placenta embeds too deeply into the uterus wall.
Rates of placenta accrete are on the increase as c-section rates around the world continue to go up.
This article on placenta accreta has more information.
#7: Uterine fibroids
Uterine fibroids are lumps of tight muscle and fibrous tissue, which can be found inside or outside the uterine wall.
Fibroids are best removed prior to pregnancy because they can potentially lead to ectopic pregnancy, heavy blood flow, and pregnancy loss.
However, many mothers who have fibroids are able to give birth without any problems.
Contact your health care provider for advice.
Read more in Fibroids And Pregnancy – 8 Things You Need To Know.
What kind of bleeding is normal during pregnancy?
If you’re bleeding during pregnancy, you might be wondering exactly how much vaginal bleeding is normal?
Light bleeding during the first trimester or bleeding in early pregnancy is common, and many women go on to have healthy pregnancies.
Second or third trimester bleeding or spotting isn’t normal.
Call your doctor or healthcare provider if you’re in either of those trimesters and have vaginal bleeding. Your doctor can run some tests to check for the cause, and help you make decisions about your care.
When should I be worried about bleeding during pregnancy?
All vaginal blood loss during pregnancy needs medical assessment, even if it’s ‘normal’ bleeding in the first trimester.
If you have any cramping, regular period-like pain, or fever, you should seek medical assistance quickly.
You especially need to see a doctor or midwife within 72 hours of any bleeding if you have a rhesus negative blood group (e.g. O- or A-).
This is to check whether your baby’s blood might have mixed with yours. If the blood has been mixed, and your baby is rhesus positive (e.g. O+ or A+) your body will see this as foreign matter and produce antibodies.
In the future, if you have any subsequent pregnancies, these antibodies will attack a baby with a positive blood type.
Find out more in Rhesus Factor And Pregnancy: A Must Read If You Have Rh- Blood.
Heavy bleeding during pregnancy
If vaginal bleeding is heavy (i.e. it flows out and you’re passing clots) and if it’s accompanied by cramps, backache, and period-like discomfort, contact your hospital immediately.
Keep calm and remember, it is your blood you’re seeing, not the baby’s blood.
Urgent medical assessment and intervention are important to ensure you and your baby are safe.
What should I do if I’m bleeding during pregnancy?
Seek medical advice immediately.
In order to avoid any infections, don’t use a tampon if you experience pregnancy bleeding. Always use pads or a panty liner.
You can keep them to show care providers, as they might need to see the consistency. It’s ok – your doctor or midwife has seen plenty of blood before.
If the bleeding is light, and you have no pain, contact your midwife or obstetrician to discuss.
What if I’m experiencing a miscarriage?
If you’re experiencing a miscarriage, unfortunately, nothing can prevent it from occurring if you’re not yet 20 weeks.
The important thing is to take care of yourself emotionally and physically. Be kind to yourself; you aren’t responsible for a miscarriage happening.
If you experience a miscarriage, to feel more physically comfortable try:
- Paracetamol/Panadeine/Naprogesic (a drug designed for period pain) to ease the cramps
- Hot water bottle or heat pack for your tummy
- Tea and support from your partner and others
You might feel the vaginal loss of the developing fetus and other tissue; after that, the bleeding should settle and stop.
If you continue to bleed, you might need a surgical procedure called a dilation and curettage.
Your doctor can provide medical advice, diagnosis, or treatment, as well as counseling for your pregnancy loss.
Bleeding During Early Pregnancy
If you’ve had bleeding early in your pregnancy, you’re not alone. Many other pregnant women have early bleeding, too. And in most cases, nothing is wrong. But your healthcare provider still needs to know about it. They may want to do tests to find out why you’re bleeding. Call your provider if you see bleeding during pregnancy. Tell your provider if your blood is Rh negative. Then they can figure out if you need anti-D immune globulin treatment.
What causes early bleeding?
The cause of bleeding early in pregnancy is often unknown. But many factors early on in pregnancy may lead to light bleeding (called spotting) or heavier bleeding. These include:
When the embryo implants on the uterine wall
Bleeding between the sac membrane and the uterus (subchorionic bleeding)
Pregnancy loss (miscarriage)
The embryo implants outside of the uterus (ectopic pregnancy)
If you see spotting
Light bleeding is the most common type of bleeding in early pregnancy. If you see it, call your healthcare provider. Chances are, they will tell you that you can care for yourself at home.
If tests are needed
Depending on how much you bleed, your healthcare provider may ask you to come in for some tests. A pelvic exam, for instance, can help see how far along your pregnancy is. You also may have an ultrasound or a Doppler test. These imaging tests use sound waves to check the health of your baby. The ultrasound may be done on your belly or inside your vagina. You may also need a special blood test. This test compares your hormone levels in blood samples taken 2 days apart. The results can help your provider learn more about the implantation of the embryo. Your blood type will also need to be checked to assess if you will need to be treated for Rh sensitization.
If your bleeding doesn’t stop or if you have any of the following, get medical care right away:
Soaking a sanitary pad each hour
Bleeding like you’re having a period
Cramping or severe belly pain
Feeling dizzy or faint
Tissue passing through your vagina
Bleeding at any time after the first trimester
Questions you may be asked
Bleeding early in pregnancy isn’t normal. But it is common. If you’ve seen any bleeding, you may be concerned. But keep in mind that bleeding alone doesn’t mean something is wrong. Just be sure to call your healthcare provider right away. They may ask you questions like these to help find the cause of your bleeding:
When did your bleeding start?
Is your bleeding very light or is it like a period?
Is the blood bright red or brownish?
Have you had sex recently?
Have you had pain or cramping?
Have you felt dizzy or faint?
Monitoring your pregnancy
Bleeding will often stop as quickly as it began. Your pregnancy may go on a normal path again. You may need to make a few extra prenatal visits. But you and your baby will most likely be fine.
3 Weeks Pregnant – Pregnancy Week-by-Week
3 Weeks Pregnant
Sperm met egg last week, and voila—you’ve made a baby! It’s so early that when you’re 3 weeks pregnant, you may have no idea that you’re actually pregnant. Conception just happened a few days ago, and there probably hasn’t been time for you to miss a period yet at week 3 of pregnancy.
Can You Tell You’re Pregnant at 3 Weeks?
While some people feel no difference at all at this early stage, others may start to notice 3 weeks pregnant symptoms. The experience at 3 weeks pregnant can really vary, so don’t fret if you don’t feel anything out of the ordinary. However, if you feel nauseous and your breasts are sore, that’s normal too. Everything changes quickly in early pregnancy, so no matter how you feel, be prepared to feel different in a week!
3 Weeks Pregnant Symptoms
When you’re 3 weeks pregnant, symptoms may not have appeared yet. That’s because most early pregnancy symptoms are caused by pregnancy hormones, and you probably don’t have a very high level of those in your body yet. (Oh, but you’ll get there!) Some signs of pregnancy at 3 weeks—and the few weeks following—are:
- Implantation bleeding. If your little soon-to-be-embryo has already made it to their new home, you may see a bit of spotting as the fertilized egg burrows into the lining of your uterus.
- Nausea. As the pregnancy hormone hCG begins to make its way through your newly pregnant body, you may notice some feelings of queasiness—or nausea so bad it makes you puke. Morning sickness should really be called all-day sickness since it doesn’t discriminate by time of day. If you’re feeling this symptom of pregnancy at three weeks, you may be further along than you thought. (Or you may even be 3 weeks pregnant with twins! That’s because twin moms-to-be often have higher levels of pregnancy hormones and therefore worse nausea.)
- Breast changes. Your breasts can start to get sore and your nipples may darken as your body starts prepping to make milk.
- Missed period. If your cycle is typically shorter than 28 days, you may realize toward the end of this week that you could be pregnant. The only way to know for sure is to take a pregnancy test.
- Positive home pregnancy test. Check the box of your home pregnancy test to see how accurate its results are before your missed period. Most are over 99 percent accurate once you’ve missed it, and some brands promise to detect pregnancy hormones in your urine sooner than that. (For example, when you’re 3 weeks 5 days pregnant or even 3 weeks 4 days pregnant.) Here’s the thing: The amount of pregnancy hormone hCG in your body might not be enough for the test to detect right away—but it doubles every 48 hours. If you get a negative result, follow up a few days and then a week later with another pregnancy test and then another, to be sure it wasn’t just too early to tell.
- Positive blood pregnancy test. In some cases—like if you’re at risk for miscarriage or ectopic pregnancy—your doctor may ask you to come into the office for a blood draw. Blood tests can detect smaller amounts of hCG than urine tests can, so you may find out that you’re pregnant sooner with a blood test than you would with an at-home test.
You may be excited to start noticing something different about your appearance, but at 3 weeks pregnant, a belly isn’t really a thing. Though you may feel a bit bloated, most pregnant women don’t start to show until around week 12 or later, so you’ve got quite a way to go before you actually look pregnant.
Before you start eating for two, know that doctors only recommend most women gain one to five pounds total in the first trimester—that’s the first 13 weeks. So you definitely don’t have license to start indulging at three weeks pregnant. In fact, you shouldn’t really do anything different except try to eat a healthy, well-rounded diet and to take a daily prenatal vitamin with at least 400 micrograms of folic acid in it. Doctors don’t recommend increasing your daily calorie intake until the second trimester. Once you hit week 14, you’ll want to add about 300 (healthy) calories per day.
3 Weeks Pregnant Ultrasound
Your now-fertilized egg (yay!) is on a journey through a fallopian tube, dividing and re-dividing into identical cells on its way to your uterus. A 3 weeks pregnant ultrasound may not detect your soon-to-be-baby. That super-teeny fertilized egg (called a morula) is smaller than a grain of salt and is on the move, but as early as week 4 your doctor may be able to see your uterine lining get thicker, a sign that the little morula has reached their destination for the rest of pregnancy (you guessed it: your uterus).
How Many Weeks Are You at Implantation?
Implantation occurs soon, at about 4 weeks pregnant. For implantation to happen, the cells in the fertilized egg, now a morula, will continue to divide until it becomes a blastocyst. About five to eight days after fertilization, the blastocyst will have arrived, where it will begin to implant in the wall of the uterus. What a journey!
Tips for 3 Weeks Pregnant
First things first: You’re probably chomping at the bit to officially find out that you’re pregnant, but be patient. A pregnancy test might not be able to detect a pregnancy just yet. Wait until the test you’ve purchased says it can detect a pregnancy—probably at the end of the week. Once you start testing, if you get a negative result, feel free to keep testing every couple days until you get your period.
Ace that test
When it’s time to take the pregnancy test at the end of the week, take it first thing in the morning. Your first morning pee is the most concentrated, making it the most likely to have a high enough concentration of hCG for the test to detect. Follow the directions exactly for the most accurate results.
Continue taking care of yourself
You should still be taking your prenatal vitamins everyday, drinking plenty of water and eating healthy, balanced meals. Continue to get regular moderate exercise and practice self-care.
Focus on foods that are high in calcium and iron to help support the extra blood your body is making. If you’re nauseous or vomiting, try making ginger tea, drinking some clear broth or eating a banana (yay, potassium!). Even ice cream can be a good compromise when you’re struggling to eat but still need protein and calcium. Make it a banana split with a few nuts and you’re covering your bases pretty well!
Pregnancy Checklist at 3 Weeks Pregnant
Bleeding during pregnancy: What you need to know
There are a number of reasons for bleeding during pregnancy—but it’s not as uncommon as you think.
“I was standing on the porch of my parents’ house when a little pool of blood started to form at my feet,” says Charlene Morris, a mom of two in Dawson Creek, BC. She was five weeks pregnant with her second child, Felix, now 11 months. After passing a large clot and checking it for tissue (as a maternity nurse, Morris knew what to do), the bleeding fortunately slowed down. Her parents live in a small town, and she knew she wouldn’t be able to get an ultrasound so late at night. “It was 11 o’clock, so I lay down, tried to relax and waited until morning to have my mom take me to the ER,” she says. “Luckily, the ultrasound and blood tests showed everything was just fine.”
Light bleeding during the first 12 weeks of pregnancy is common and doesn’t usually signal a problem. The main cause of spotting in the first trimester is implantation bleeding. It occurs very early on—even before you may know you’re pregnant—as the egg implants in the lining of the uterus. At this stage spotting can also occur following sex (because the cervix is tender) or due to a pelvic or urinary tract infection. If it lasts for more than a few days or is more than a small amount when you wipe, see your doctor. In the meantime, don’t use tampons or have sex until the spotting stops.
Heavy bleeding during the first trimester, however, can signal a miscarriage. “If it’s accompanied by abdominal cramping or back pain, and you notice tissue passing through the vagina with the blood, see your doctor or head to the ER as soon as possible,” says Jon Barrett, chief of maternal and fetal medicine at Sunnybrook Health Sciences Centre in Toronto. An ectopic pregnancy (where the fertilized embryo implants outside of the uterus, usually in the fallopian tube) can also cause bleeding. This condition can be serious if it develops enough to rupture the tube, but this outcome is rare and the condition itself only occurs in less than two percent of pregnancies.
Melanie Baker, a mom in Brampton, Ont., recently experienced another rare condition called a molar pregnancy, when the embryo doesn’t develop properly, and the tissue becomes an abnormal growth instead. Baker knew she was pregnant and heard the heartbeat at 13 weeks, but by 17 weeks things changed. “I was spotting and had severe pain in my upper abdomen. I didn’t realize the two were connected and thought the pain was my gallbladder at first,” she says. An ultrasound and blood tests confirmed gestational trophoblastic disease (GTD), and a few days later the abnormal tissue was removed in hospital. If not caught early, GTD can lead to serious complications, including a rare form of cancer.
During the second half of pregnancy, bleeding can be caused by a placental abruption (where the placenta partially detaches from the uterine wall), though in most cases it doesn’t pose a danger to mother or child, says Barrett. Bleeding may also be caused by placenta previa (where the placenta partly or completely covers the cervix), which can be risky if it continues into the third trimester.
Jody Swanson, a mom of three in St. Albert, Alta., is currently on hospital bed rest with her fourth pregnancy. Heavy bleeding at 24 weeks sent her to the hospital where an ultrasound confirmed placenta previa. At 28 weeks she had another major bleed and was admitted for the duration of her pregnancy.
Spotting during the final weeks of pregnancy is typically a sign of labour. In this case you may you also see evidence of the mucous plug (cervical discharge that is sometimes clear and/or bloody) and experience a dull backache, stomach cramps or a sensation of uterine tightening. If you’re not yet 37 weeks, it’s considered preterm labour and you should contact your practitioner right away.
Whatever your stage, don’t panic if you see a little blood. “Light spotting can be normal at all stages, but if you’re unsure call your doctor to be safe,” says Barrett.
A version of this article appeared in our November 2014 issue with the headline, “Seeing red”, p. 49.
Signs of miscarriage
How to deal with hemorrhoids during pregnancy
What is placenta previa?
Bleeding in Early Pregnancy – American Family Physician
Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.
Information from Your Family Doctor
What causes bleeding during early pregnancy?
About one in every four pregnant women will have vaginal bleeding in the first few months. Mild cramping and light spotting can be normal in early pregnancy. But vaginal bleeding may be a sign of something more serious. Some of the most common causes are:
Threatened miscarriage. This is when there is bleeding from the uterus but the pregnancy is still healthy. Sometimes a blood clot forms in the uterus and increases the risk of miscarriage. But most women with threatened miscarriage will have a healthy baby.
Ectopic pregnancy. This is when the pregnancy grows outside the uterus, usually in the fallopian tubes. Symptoms include heavy bleeding, dizziness, sharp pain in the stomach or shoulder, and cramps. Ectopic pregnancy is a medical emergency and can be life threatening.
Early pregnancy loss (also called miscarriage). This is the unexpected loss of a pregnancy before 14 weeks. Most miscarriages happen because the pregnancy is not developing normally.
Other causes of bleeding in early pregnancy include infections, hemorrhoids (HEM-uh-roids, or swollen veins in your rectum or anus), cervical cancer, and rare pregnancy-related cancers.
What should I do if I am bleeding?
Call your doctor right away. If you have heavy bleeding or severe pain, go to the emergency room.
Your doctor can do tests to see why you are bleeding. You may need a pelvic exam, an ultrasound, blood tests, or urine tests. Sometimes an ultrasound is all that’s needed to make sure your pregnancy is healthy. If it is still early in the pregnancy, you may need more tests to find the cause of the bleeding.
How is it treated?
It depends on the cause of the bleeding. No treatment is needed for a threatened miscarriage. Ectopic pregnancies need to be treated with medicine or surgery. After a miscarriage, the tissue may pass on its own. If not, you may need medicine or a procedure called aspiration to remove the tissue. Women with Rh-negative blood types may need a shot to help prevent problems in future pregnancies.
What can I do to prevent early pregnancy loss?
There is no way to prevent an early pregnancy loss after it has been diagnosed. There is often no way of knowing exactly why it happens. If you have an early pregnancy loss it is important to remember that you did not do anything to cause it. Most women who have had an early pregnancy loss can have healthy pregnancies in the future. If you have had two or more early pregnancy losses, talk to your doctor about whether you need other tests or treatment.
Keeping your body healthy is the best way to have a healthy pregnancy and baby. Talk to your doctor about any health problems before getting pregnant. Taking a prenatal vitamin with folic acid before you get pregnant can lower the risk of brain and spinal cord problems in your baby. Talk to your doctor before taking any over-the-counter or prescription medicines. Using cigarettes, drugs, alcohol, and large amounts of caffeine may increase your risk of early pregnancy loss.
Bleeding and Spotting in Pregnancy
Spotting and bleeding in pregnancy… Should I worry?
We know it can be scary, but bleeding or spotting in pregnancy is common. Of course it can be a sign that something is wrong, but it could also be something less sinister, read about some of the reasons for bleeding and spotting below.
At a glance
- Bleeding and spotting is common in pregnancy
- There are multiple reasons for bleeding and spotting in pregnancy
- All bleeding during pregnancy should be reported to your doctor or midwife
What is bleeding or spotting in pregnancy?
Spotting is light vaginal bleeding and is brown or pink in colour, much like the bleeding seen at the beginning or end of your normal period. If the colour is bright red then you have bleeding. The amount of blood is also key; spotting will most likely be a few drops but bleeding will be much heavier, possibly soaking a sanitary towel or panty liner.
Is bleeding or spotting in pregnancy the sign of a miscarriage?
Bleeding or spotting (especially during the first 12 weeks) doesn’t always mean that you are having a miscarriage or that it is going to happen.
Bleeding and spotting may in fact be more common than you think. A study by the National Institute of Health found that 1 in 4 of the women participating in the study reported bleeding and 8% of the women experienced heavy bleeding. Most of these episodes lasted less than 3 days and occurred between weeks 5 and 8 of pregnancy. Subsequent miscarriage was experienced by 8% of women with bleeding and 13% of those without.
What should I do if I experience bleeding during pregnancy?
All bleeding during pregnancy should be reported to your doctor or midwife. Be prepared that you may be told to rest or ‘wait and see’ if the bleeding is light, a small amount or if you are in the early part of your pregnancy.
If the bleeding is heavy or contains clots and is accompanied with pain contact your hospital’s pregnancy or maternity unit immediately.
Some causes of bleeding and spotting in pregnancy
Threatened or actual miscarriage
Studies indicate that around one third of pregnancies end in miscarriage but don’t fret – these figures refer to the first 12 weeks of pregnancy and include very early miscarriages that many women won’t even be aware of. Besides bleeding, other symptoms of miscarriage include mild to severe stomach cramps, back pain and loss of pregnancy symptoms such as nausea and passing tissue or clots.
Implantation bleeding can sometimes be one of the first signs of pregnancy and actually affects up to 1 in 3 women. This kind of bleeding occurs when the fertilised egg attaches to the uterine wall roughly 6 to 12 days after conception. Implantation bleeding is generally lighter than a period, but women have been known to experience significant spotting. Implantation bleeding can also cause cramping, but these will be mild with the cramps from your period feeling much more intense.
Some women may experience what is known as breakthrough bleeding around the time when their period would have normally been due. Breakthrough bleeding is generally light and likely to be accompanied by some common period symptoms such as back ache, cramps and feeling bloated.
Breakthrough bleeding can last for around three months and some women may experience bleeding throughout their whole pregnancy and still go on to have completely healthy babies.
Bleeding after sex
Bleeding after sex is one of the most common causes of bleeding. This is completely harmless and is caused by an increased blood supply and softening of the cervix. This type of bleeding should of course be reported to your doctor or midwife, but be prepared to be honest about your activities! “Have you had sex?” is often the first question asked when bleeding is reported. But don’t worry this doesn’t mean that sex with your partner should be taken off the table, read more about sex during pregnancy.
Less common than a miscarriage, around 1 in 100 pregnancies are ectopic and bleeding can be a sign. An ectopic pregnancy occurs when the fertilised egg implants outside of the uterus, usually in the fallopian tube. Other symptoms of an ectopic pregnancy include severe pain down one side of your abdomen, feeling faint and nausea. The pain may suddenly disappear if the tube ruptures but it will return soon enough and you will feel very unwell. If you have any signs of an ectopic pregnancy do seek medical advice immediately. Read more about ectopic pregnancy symptoms and treatments.
About 1-3 in 1000 pregnancies result in a molar pregnancy. A molar pregnancy is a very rare complication of pregnancy. It occurs when something goes wrong during the fertilisation process, and is caused by an abnormal cell growth of all or part of the placenta. With a molar pregnancy you will most likely have normal pregnancy symptoms early on, but eventually you will experience spotting or bleeding between 6 and 12 weeks.
Bleeding from the placenta
Bleeding may be caused by the placenta being very low down on the uterine wall and occasionally right over the cervix. This is called placenta praevia and it occurs in about 2% of women. You will normally find out if you have this condition at your 20 week scan. If diagnosed with placenta praevia, you will be need additional ultrasounds to monitor your condition.
Another cause of bleeding later in pregnancy is placental abruption (which occurs in around 1 in 200 pregnancies). This is where the placenta partially or completely separates from the wall of the uterus. Symptoms can include severe pain and heavy bleeding. If you smoke, have high blood pressure, kidney problems or pre-eclampsia you will be more at risk. This condition will require immediate hospital admission.
90,000 Bleeding during pregnancy – FAQ
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Barkalova Lilia Igorevna
Bdyuleva Anna Viktorovna
Belavina Valentina Nikolaevna
Biryukova Ekaterina Vladimirovna
Blinova Irina Vladimirovna
Brilliantova Nina Olegovna
Buderatskaya Natalya Vladimirovna
Vergasova Olga Leonidovna
Hamidova Amalia Hamidovna
Gvozdeeva Natalia Igorevna
Gogua Marika Andreevna
Gritsenko Lyudmila Vladimirovna
Grudeva Oksana Nikolaevna
Guber Olga Leonidovna
Guryeva Olga Anatolievna
Huseynova Samira Huseynovna
Davydenko Irina Vladimirovna
Dorofeeva Elena Gennadevna
Dragun Svetlana Alexandrovna
Dreval Ludmila Ivanovna
Dukhanina Marina Vladimirovna
Evgrafova Alexandra Vladimirovna
Zhadayeva Irina Aleksandrovna
Zhukova Elena Alexandrovna
Zarikhina (Kuzhelnaya) Ekaterina Yurievna
Zakharyan Elena Khorenovna
Zakharyan Yana Gennadievna
Zelenkova Svetlana Viktorovna
Zueva Valentina Nikolaevna
Idrisova Elina Aralyevna
Kadyrova Guzel Ilyasovna
Karabasheva Zukhra Sagitovna
Kirillova Maria Yurievna
Klinshova Elena Nikolaevna
Klyukovkina Dina Vladimirovna
Kovalenko Yulia Alexandrovna
Kolosovskaya Victoria Viktorovna
Kopyeva Olga Viktorovna
Korchagina Elena Vyacheslavovna
Kostina Natalya Viktorovna
Krivenko Anna Sergeevna
Kropacheva Oksana Valerievna
Kurbanova Adina Chingizovna
Kurkina Ekaterina Alexandrovna
Lapay Ulyana Valerievna
Litvinova Dina Olegovna
Lyashenko Lyubov Sergeevna
Maeva Nora Khachaturovna
Malova Svetlana Alexandrovna
Markova Tatiana Borisovna
Marfutova Elena Evgenievna
Matveeva Anna Evgenievna
Merkina Irina Alekseevna
Mirzoyan Zhasmen Vladimirovna
Mikhaleva Marina Vladimirovna
Morozova Natalya Alekseevna
Mosina Elena Evgenievna
Naidukova Alina Alexandrovna
Naumenko Anastasia Alexandrovna
Ogneva Anna Andreevna
Orlova Larisa Vladimirovna
Panoyan Haykanush Haykovna
Peho Svetlana Fedorovna
Pechenitsyna Olesya Dmitrievna
Pesheva Oksana Nikolaevna
Pogolsha Olga Ivanovna
Prilutskaya Svetlana Gennadievna
Rzayeva Elnara Eldarovna
Rubanik Alexander Mikhailovich
Saadulaeva Zariyat Islamutdinovna
Savilova Svetlana Anatolievna
Savinykh Elena Nikolaevna
Samoshkina Ekaterina Vasilievna
Sanakoeva Anna Vyacheslavovna
Svyatova Elizaveta Vitalievna
Smirnova Olga Petrovna
Sokolova Ekaterina Sergeevna
Strelchenko Albina Vladimirovna
Tagiyeva Takhmina Mamedovna
Tanriverdiyeva Elnara Kurbanalievna
Tarasova Taisiya Valerievna
Tkebuchava Tamara Iosifovna
Tonoyan Liana Agabeki
Usmanova Violetta Vadimovna
Fedorinova Natalia Vladimirovna
Fedorova Maria Vitalievna
Fedotovskaya Olga Igorevna
Khasanova Elena Vasilievna
Khubieva Asya Alievna
Tsoi Irina Vladimirovna
Shakirova Kristina Valerievna
Shapyrina Olga Valerievna
Shmeleva Olga Olegovna
Yudina Alla Evgenievna
Yagovkina Irina Alexandrovna
Yalovega Yulia Alexandrovna
Yassin Sofia Vadimovna
90,000 Spontaneous miscarriage and missed pregnancies
Over the past 10 years, the number of spontaneous miscarriages has been growing rapidly. The International Histological Classification Organization (FIGO) has declared an epidemic with an increase in the frequency of missed pregnancies.
Spontaneous miscarriage is the termination of pregnancy before the fetus reaches a viable term (up to 22 weeks of gestation and fetal weight of 500 g).
Most miscarriages (about 80%) occur before 12 weeks of gestation. Moreover, in the early stages up to 8 weeks of pregnancy, the cause of miscarriage is chromosomal abnormalities in 50% of cases.It turns out that nature weeds out the defective product of conception. And these causes are difficult to prevent, especially in the presence of hereditary diseases. Fortunately, accidental breakdowns are much more common than genetically determined ones. Therefore, subsequent pregnancies usually end well.
But the remaining 50% of miscarriages have very real and avoidable causes. They can be easily identified at the stage of preparation for pregnancy by a gynecologist.
What are these reasons?
– chronic diseases: inflammatory diseases of the uterus and appendages, polycystic ovary syndrome, uterine fibroids, endometriosis, malformations of the genital organs.
– infections: toxoplasmosis, listeriosis, genital tuberculosis, genital infections – chlamydia, mycoplasma, ureaplasma, syphilis.
– antiphospholipid syndrome.
– endocrine diseases: diabetes, thyroid disease.
– metabolic disorders in the body: obesity, folic acid deficiency, iron deficiency, vitamin D.
– male factor.
Of course, these causes are identified and eliminated before the planned conception.
There are harmful factors that can affect the development of the fetus in the early stages of pregnancy and lead to miscarriage:
– alcohol consumption.
– using caffeine (4-5 cups of coffee a day).
– smoking (more than 10 cigarettes per day).
– drug use.
– taking medications with teratogenic effects (for example: aspirin, nise and others from this group of drugs; antifungal agents; antidepressants; some antibiotics and a number of other drugs).
– toxins and occupational hazards: ionizing radiation, pesticides, inhalation of anesthetic gases.
What are the signs of possible pregnancy loss?
These are complaints of pain in the lower abdomen and lower back, bloody discharge from the genital tract.It is necessary to consult a doctor to exclude an ectopic pregnancy and conduct an additional examination (hCG test, blood test for progesterone, ultrasound).
In the early stages of pregnancy, with dubious ultrasound data or suspicion of an undeveloped (frozen) pregnancy, a wait-and-see tactic is selected with a repeat examination of the gynecologist, ultrasound, tests after 7-10 days. If
the diagnosis was made and the fact of uterine pregnancy was confirmed; in case of threatened miscarriage, conservation therapy is carried out in an outpatient day hospital.A miscarriage that has begun requires hospitalization in the gynecological department. In the case of a missed pregnancy, the pregnancy is terminated.
In accordance with the clinical treatment protocol approved by the Ministry of Health of the Russian Federation dated 07.06.2016. preference is given to drug therapy aimed at terminating pregnancy with prostaglandin analogues (misoprostol) with or without the use of an antiprogestin (mifepristone). If surgical treatment is necessary (in case of incomplete miscarriage in case of an infected miscarriage), it is recommended to use aspiration curettage (with an electric vacuum source or a manual vacuum aspirator).That has a significant advantage over curettage of the uterine cavity because it is less traumatic and can be performed on an outpatient basis.
All women who have had a spontaneous miscarriage need treatment aimed at preventing complications and preventing recurrent miscarriages.
Why is rehabilitation therapy necessary?
According to the decision of the XVIII World Congress of Obstetricians and Gynecologists , the diagnosis of chronic endometritis should be made to absolutely all women who have had an undeveloped pregnancy. Two out of three miscarriages according to Professor V.E. Radzinsky are caused by this disease. In the study of material from the uterine cavity, infectious pathogens were isolated: ureaplasma, mycoplasma, streptococci, staphylococci, Escherichia coli, viruses (herpes, HPV). Therefore, it is very important to carry out treatment immediately after termination of pregnancy.
If time is lost, it is necessary to carry out additional diagnostics: pipel biopsy of the endometrium with histological examination and examination for infections, including tuberculosis.Then, taking into account the results obtained, symptomatic anti-inflammatory therapy is carried out (immunomodulators, antibacterial drugs, physiotherapy, gynecological massage, mud therapy). In parallel, an examination is prescribed to identify other causes of miscarriage (male factor, chronic diseases of the mother, genital infections, antiphospholipid syndrome).
At the Mifra-Med medical center, at the level of modern medical requirements, all the possibilities for a complete adequate examination have been created: all types of tests, ultrasound, hysteroscopy, aspiration biopsy, consultations of narrow specialists (endocrinologist, therapist, neurologist, urologist).Our doctors-gynecologists of the highest category are Melko O.N., Novitskaya E.L., Tikhonova T.N. and urologist of the highest category Kanaev S.A. have sufficient experience in the rehabilitation and preparation of married couples for the next pregnancy with a successful outcome. Treatment is carried out in a day hospital with the use of drugs, physiotherapy, gynecological massage, prostate massage.
WE WILL NECESSARILY HELP YOU!
st. Yakovleva, 16 st. Kirov 47 B
tel. 244-744 tel.46-43-57
The drug “Mifepristone”. Medical termination of pregnancy
How Mifepristone works
“Mifepristone” is a synthetic steroidal anti-progestogen agent. The effect of its use is based on the principle of stopping the production of the hormone progesterone, which is necessary for the normal course of pregnancy. After taking “Mifepristone”, the contractile activity of the myometrium increases, the cervix softens, which leads to the rejection of a certain layer of the uterine mucosa and the evacuation of the embryo.
How long does Mifepristone work
It should be noted that only a qualified gynecologist can correctly calculate the dosage of the drug “Mifepristone”, as a rule, based on the duration of pregnancy and the woman’s weight.
The first intake of “Mifepristone” leads to endometrial rejection and cervical dilatation. To assess the body’s response to the action of “Mifepristone”, the patient must remain under the supervision of a doctor for several hours.
The second time you should visit the gynecological clinic after 36–48 hours. After assessing the woman’s condition, the doctor may prescribe the drug “Misoprostol”, under the influence of which the uterus begins to actively contract. In most cases, after taking Misoprostol, pregnancy ends within six to eight hours. After 10-14 days, it is necessary to undergo a gynecological examination and ultrasound control again to make sure that a miscarriage is taking place and that there are no complications.
“Mifepristone” until when
Up to 6 weeks gestation, the ovum is poorly attached to the uterus.Therefore, this is the most appropriate time for medical termination of pregnancy.
In some cases, after the examination, the doctor may prescribe an abortion with “Mifepristone” for up to 8 weeks of pregnancy.
The longer the gestation period, the greater the sensitivity of the uterus to drugs. Drug termination of pregnancy for more than 8 weeks may be accompanied by severe pain, bleeding.This situation is dangerous not only for health, but also for a woman’s life!
Pregnancy after “Mifepristone”
Approximately 1% of pregnancies can continue after taking Mifepristone. If the ultrasound data determine the presence of a living fetus, the patient is referred for a surgical abortion. This is due to the high probability of abnormal development of the embryo.
However, Mifepristone does not affect the reproductive function of a woman. Therefore, attention should be paid to the correct selection of the contraceptive.
“Mifepristone” side effects
Abortion “Mifepristone” has side effects that can be expressed in nausea, bleeding, spasms, headache, lethargy. Consultations of qualified doctors, as well as the correct calculation of the dosage, significantly reduce the negative consequences.
The consequences of using “Mifepristone” can be menstrual irregularities, exacerbation of inflammatory diseases of the pelvic organs.Cases of incomplete abortion are very rare.
- Probability of tubal pregnancy
- Duration of gestation more than 6 weeks
- Scars, tumors on the uterus, genital infections
- Anemia, severe
- Adrenal and hepatic insufficiency
- Taking drugs that reduce blood clotting
- Pregnancy while taking contraceptives
- Smoking over 35 years of age (medical advice required)
Mifepristone tablets are sold exclusively to doctors.In the MC “Health” medical abortion is carried out in modern, comfortable conditions by specialists of the highest category.
Gynecology: Blood clotting and pregnancy
When we talk about blood coagulation in everyday life, we most often discuss the problems of hemostasis. Hemostasis is a complex biological system that maintains the normal liquid state of the blood in the body and stops bleeding if the integrity of the vessels is damaged. Simply put, the body is tuned not to lose a drop of blood.
There are two mechanisms of hemostasis:
- 1. Vascular-platelet (primary).
- 2. Coagulation hemostasis (secondary, blood coagulation). From the Latin coagulation – coagulation, thickening.
Vascular-platelet hemostasis disorders
Violations in this link of hemostasis are most often manifested by increased bleeding, a tendency to form hematomas (bruises) with the slightest contact, or even spontaneously, for no apparent reason.In some situations, on the contrary, there is a tendency to excessively light thrombus formation.
There are factors that stimulate the formation of a primary thrombus, and violate it. Stimulants include the inflammatory process, because inflammation increases the content of biologically active substances in the blood. We can say that there is a readiness for the formation of a blood clot, it is only a matter of local damage to the vessel. Therefore, in severe infectious diseases, blockage of blood vessels can occur.Increased readiness for thrombosis during pregnancy, as well as in some hereditary diseases (thrombophilia). From foodstuffs, table vinegar (pickles) and coffee increase the activity of platelets.
The process of formation of a primary thrombus is disrupted with a decrease in the number of platelets (thrombocytopenia) and with a qualitative inferiority of platelets (thrombocytopathy). Thrombocytopathy can occur with certain medications. First of all, these are anti-inflammatory drugs: aspirin, analgin, brufen, and some antibiotics.Thrombocytopathy also develops in kidney disease. Spices, strong alcohol can also reduce the usefulness of platelets.
The blood coagulation system is actually several interconnected reactions that proceed in the form of a cascade, or chain reaction. At each stage of this process, the proenzyme (an inactive form of the enzyme) is activated. Thirteen of these proteins (blood coagulation factors) make up the coagulation system. They are usually denoted by Roman numerals from I to XIII.
Disorders in the coagulation system
A decrease in the content or activity of clotting factors may be accompanied by increased bleeding (for example, hemophilia A, hemophilia B, von Willebrand disease). Excessive activation of coagulation hemostasis (for example, Factor V Leiden mutation) leads to the development of thrombosis (thrombophilia).
Hemostasis and pregnancy
Among all the causes of miscarriage, in second place in frequency are problems in the hemostatic system.On the second after obstetric and gynecological reasons. What’s the matter?
During pregnancy, the body of the expectant mother prepares for childbirth. The hemostatic system is also being prepared in order to minimize blood loss during childbirth. Hemostasis is activated progressively with increasing gestational age. If a woman’s hemostasis is initially highly active, then during pregnancy microthrombi may form in the vessels of the uterus or placenta, which leads to a miscarriage or a frozen pregnancy.
Under what conditions can this happen?
1. In hereditary thrombophilia, more often in violation of the metabolism of folic acid and its compounds (folates), when the amount of homocysteine in the blood increases. The reasons for the increase in the level of homocysteine may be a lack of folic acid and vitamin B12 in the diet, diseases of the thyroid gland, kidneys. It can also increase in smokers, coffee drinkers and while taking medications such as theophylline (by the way, a relative of caffeine), niacin.Homocysteine damages the endothelium (inner layer) of blood vessels, and this damage triggers blood clots.
2. With antiphospholipid syndrome (APS) – this is the name of an autoimmune disease in which antibodies to their own coagulation factors are produced. As a result, blood clots also form spontaneously in the vessels.
Prevention of clotting disorders during pregnancy
In order to avoid complications of pregnancy, all pregnant women need to carry out a laboratory study – a clinical blood test, a coagulogram (blood coagulation parameters), determination of the level of homocysteine.
Women who have previously had miscarriages or missed pregnancies, as well as pregnant women as a result of IVF, are at risk of developing disorders in the hemostasis system. For patients at risk, it is recommended to conduct a complete study of the hemostasis system, blood for antiphospholipid antibodies. In the case of IVF (in vitro fertilization), blood coagulation parameters must be monitored throughout pregnancy. In accordance with the recommendations of the WHO (World Health Organization) expert committee, coagulogram and D-dimer monitoring should be performed at least once every 2 weeks.Correction of such violations is carried out jointly by a gynecologist and a hematologist.
In the ideal case, it is advisable to perform a full examination not after pregnancy, but at the stage of family planning.
In the Clinic of High Medical Technologies named after NI Pirogov, a system of diagnostics and treatment of patients with problems in the hemostasis system has been established and operates. Laboratory diagnostics, including genetic research, allows you to identify the causes of violations.The treatment of such patients at the stage of family planning and their management during pregnancy (both physiological and as a result of IVF) is carried out by qualified gynecologists in conjunction with a hematologist.
Events (registration, medical examinations, schedule of visits to doctors)
Up to 12 weeks
Early registration in a antenatal clinic
Taking medications: folic acid for the entire first trimester, no more than 400 mcg / day; potassium iodide 200-250 mcg / day (in the absence of thyroid disease)
At the first appearance
The obstetrician-gynecologist collects anamnesis, conducts a general physical examination of the respiratory system, blood circulation, digestion, urinary system, mammary glands, anthropometry (measurement of height, body weight, body mass index), measurement of pelvic size, examination of the cervix in the mirrors, bimanual vaginal study
No later than 7-10 days after the initial visit to the antenatal clinic
Inspections and consultations:
– a general practitioner;
– other specialist doctors – according to indications, taking into account concomitant pathology
In the first trimester (up to 13 weeks) (and at the first appearance)
1.General (clinical) blood test.
2. Biochemical blood test (total protein, urea, creatinine, total bilirubin, direct bilirubin, alanine transaminase (hereinafter – ALT), aspartate transaminase (hereinafter – AST), glucose, total cholesterol.
3. Coagulogram – platelet count, clotting time, bleeding time, platelet aggregation, activated partial thromboplastin time (hereinafter – APTT), fibrinogen, determination of prothrombin (thromboplastin) time.
4. Determination of antibodies of classes M, G (IgM, IgG) to rubella virus in the blood, to herpes simplex virus (HSV), to cytomegalovirus (CMV), determination of antibodies to toxoplasma in the blood.
5. General analysis of urine.
6. Determination of the main blood groups (A, B, 0) and Rh-affiliation. In Rh negative women:
a) examination of the child’s father for group and Rh-affiliation.
7. Determination of antibodies to treponema pallidum (Treponema pallidum) in blood, determination of M, G antibodies to human immunodeficiency virus HIV-1 and HIV-2 in blood, determination of M, G antibodies to viral hepatitis B antigen and viral hepatitis C blood.
8. Microscopic examination of the discharge of female genital organs for gonococcus, microscopic examination of the vaginal discharge for fungi of the genus Candida.
9. PCR of chlamydial infection,
PCR of gonococcal infection,
PCR of mycoplasma infection,
PCR of trichomoniasis.
A visit to an obstetrician-gynecologist every 3-4 weeks (with the physiological course of pregnancy).
Electrocardiography (hereinafter – ECG) as prescribed by a general practitioner (cardiologist).
Up to 13 weeks of pregnancy are accepted:
– folic acid no more than 400 mcg / day;
– potassium iodide 200-250 mcg / day (in the absence of thyroid disease)
Once a month (up to 28 weeks)
Blood test for Rh antibodies (in Rh-negative women with Rh-positive affiliation of the child’s father)
Biochemical screening of serum marker levels:
– pregnancy-related plasma protein A (PAPP-A),
– free beta-subunit of chorionic gonadotropin (hereinafter – beta-hCG)
In the office of prenatal diagnostics, an ultrasound examination (hereinafter referred to as ultrasound) of the pelvic organs is performed.
Based on the results of a comprehensive prenatal diagnosis, a geneticist’s conclusion is issued.
After 14 weeks – once
Culture of the middle portion of urine
To exclude asymptomatic bacteriuria (the presence of bacterial colonies more than 105 in 1 ml of an average portion of urine, determined by a culture method without clinical symptoms) for all pregnant women.
In the second trimester
General (clinical) analysis of blood and urine.
A visit to an obstetrician-gynecologist every 2-3 weeks (with the physiological course of pregnancy). At each visit to the antenatal clinic – determination of the circumference of the abdomen, the height of the bottom of the uterus (hereinafter referred to as WDM), the tone of the uterus, palpation of the fetus, auscultation of the fetus with a stethoscope.
Potassium iodide 200-250 mcg / day
Once a month (up to 28 weeks)
Blood for Rh antibodies (in Rh-negative women with Rh-positive affiliation of the child’s father)
Blood test for estriol, alpha-fetoprotein, beta-hCG
Only for late arrival unless biochemical screening for serum marker levels at 11-14 weeks
In the antenatal clinic, a second screening ultrasound of the fetus is carried out
In the third trimester (27-40 weeks)
1.General (clinical) blood test.
2. Biochemical blood test (total protein, urea, creatinine, total bilirubin, direct bilirubin, alanine transaminase (hereinafter – ALT), aspartate transaminase (hereinafter – AST), glucose, total cholesterol).
3. Coagulogram – platelet count, clotting time, bleeding time, platelet aggregation, activated partial thromboplastin time (hereinafter – APTT), fibrinogen, determination of prothrombin (thromboplastin) time.
4. Determination of antibodies of classes M, G (IgM, IgG) to rubella virus in blood, determination of antibodies to toxoplasma in blood.
5. General analysis of urine.
6. Determination of antibodies to Treponema pallidum (Treponema pallidum) in blood, determination of M, G antibodies to HIV-1 and HIV-2 human immunodeficiency virus in blood, determination of M, G antibodies to viral hepatitis B antigen and viral hepatitis C blood.
7.Microscopic examination of the discharge of female genital organs for gonococcus, microscopic examination of the vaginal discharge for fungi of the genus Candida.
A visit to an obstetrician-gynecologist every 2 weeks, after 36 weeks – weekly (with the physiological course of pregnancy).
At each visit to the antenatal clinic – determination of the abdominal circumference, VDM, uterine tone, fetal palpation, fetal auscultation with a stethoscope.
Potassium iodide 200-250 mcg / day
Oral glucose tolerance test (OGTT)
In Rh-negative women with Rh-positive blood of the child’s father and the absence of Rh antibodies in the mother’s blood
Administration of human immunoglobulin anti-rhesus RHO [D]
A certificate of incapacity for work is issued for maternity leave
The third screening ultrasound of the fetus with dopplerometry in the antenatal clinic.Inspections and consultations:
– a general practitioner;
After 32 weeks
At each visit to the antenatal clinic, in addition to determining the circumference of the abdomen, the height of the bottom of the uterus (hereinafter referred to as WDM), the tone of the uterus, determine the position of the fetus, the presenting part, the doctor conducts auscultation of the fetus using a stethoscope.
After 33 weeks
Cardiotocography (hereinafter – CTG) of the fetus is performed
In antenatal clinics, there are schools for pregnant women, which are attended by expectant mothers with their fathers.In the process of training, there is an acquaintance with the changes in a woman’s body during physiological pregnancy, an acquaintance with the process of childbirth, the correct behavior in childbirth, the basics of breastfeeding.
More than 37 weeks
Hospitalization with the onset of labor. According to indications – planned antenatal hospitalization.
Routine hospitalization for delivery
No later than 72 hours after delivery
All women with Rh-negative blood group who gave birth to a child with a positive Rh-affiliation, or a child whose Rh-affiliation is not possible to determine, regardless of their compatibility according to the AB0 system
Re-introduction of human immunoglobulin anti-rhesus RHO [D]
2. Recommendations for breastfeeding.
3. Consultation of specialist doctors on concomitant extragenital disease (if indicated).
4. Toilet of the external genitalia.
5. Dry processing of seams (if any).
6. Removal of external non-absorbable sutures (if any) for 5 days.
7. Early check-out.
1.Examination by an obstetrician-gynecologist;
2. Examination and palpation of the mammary glands.
3 days after childbirth
Ultrasound of the pelvic organs
After delivery by caesarean section
1. General analysis of blood, general analysis of urine.
2. Blood biochemistry (according to indications).
Ultrasound of the pelvic organs
90,000 VIII. Procedure for issuing a certificate of incapacity for work / ConsultantPlus
for pregnancy and childbirth <18>
<18> The specifics of the payment of maternity benefits and the duration of maternity leave are established by
Article 10 of the Federal Law of December 24, 2006 N 255-FZ.
46.A certificate of incapacity for work for pregnancy and childbirth is issued by an obstetrician-gynecologist, in the absence of one – by a general practitioner (family doctor), and in the absence of a doctor – by a paramedic. A certificate of incapacity for work for pregnancy and childbirth is issued at 30 weeks of pregnancy at a time of 140 calendar days (70 calendar days before childbirth and 70 calendar days after childbirth).
In case of multiple pregnancies, a certificate of incapacity for work for pregnancy and childbirth is issued at 28 weeks of pregnancy at a time of 194 calendar days (84 calendar days before childbirth and 110 calendar days after childbirth).
If a woman, when contacting a medical organization, within the prescribed period refuses to receive a certificate of incapacity for work for pregnancy and childbirth for the period of maternity leave, her refusal is recorded in the medical documentation. When a woman repeatedly applies for a certificate of disability due to pregnancy and childbirth for registration of maternity leave, a certificate of incapacity for work is issued for 140 calendar days (for 194 calendar days – in case of multiple pregnancies) from the period established by
paragraphs first or
second of this item.
(as amended by Order of the Ministry of Health and Social Development of Russia dated January 24, 2012 N 31n)
(see the text in the previous version
, version )
47. In the case when the diagnosis of multiple pregnancy is established in childbirth, childbirth is issued additionally for 54 calendar days by the medical organization where the birth took place.
48. In case of complicated childbirth, a certificate of incapacity for work due to pregnancy and childbirth is issued for an additional 16 calendar days by the medical organization where the birth took place.
49. In the case of childbirth, which occurred in the period from 22 to 30 weeks of pregnancy, a certificate of incapacity for work for pregnancy and childbirth is issued by the medical organization where the birth took place for a period of 156 calendar days.
(as revised by
Order of the Ministry of Health and Social Development of Russia dated 24.01.2012 N 31n)
(see the text in the previous
50. In case of termination of pregnancy up to 21 full weeks of pregnancy, a certificate of incapacity for work is issued in accordance with
Chapter II of this Procedure for the entire period of incapacity for work, but for a period of at least three days.
(clause 50 as amended by
Order of the Ministry of Health and Social Development of Russia dated January 24, 2012 N 31n)
(see the text in the previous
51. Women living (working) in settlements exposed to radioactive contamination as a result of the accident at the Chernobyl nuclear power plant (in the area of residence with the right to resettlement), as well as women living in settlements exposed to radiation pollution as a result of the accident at the Mayak production association and the discharge of radioactive waste into the Techa River, a certificate of incapacity for work due to pregnancy and childbirth on prenatal leave is issued for 90 calendar days <19>.
The duration of maternity leave to these persons is determined in accordance with
article 18 of the Law of the Russian Federation of May 15, 1991 N 1244-1 “On social protection of citizens exposed to radiation as a result of the disaster at the Chernobyl nuclear power plant” and Article 1 of the Federal Law of November 26, 1998 N 175-FZ “On social protection of citizens of the Russian Federation, exposed to radiation as a result of the accident in 1957 at the production association “Mayak” and the discharge of radioactive waste into the Techa River “(Collected Legislation of the Russian Federation, 1998, N 48, Art.5850; 2000, N 33, Art. 3348; 2004, N 35, Art. 3607; 2008, No. 30 (part II), art. 3616; 2011, N 1, Art. 26).
52. When a woman is on maternity leave while a woman is on annual basic or additional paid leave, parental leave until the age of 3 years, a certificate of incapacity for work for pregnancy and childbirth is issued on a general basis.
53. A woman who has adopted a child under the age of 3 months is issued a certificate of incapacity for work from the date of adoption for a period of up to 70 calendar days (with the simultaneous adoption of two or more children – for 110 calendar days) from the date of the child’s birth.
54. During the in vitro fertilization procedure, a certificate of incapacity for work is issued to a woman by a medical organization in accordance with a license for medical activities, including work (services) in obstetrics and gynecology and examination of temporary disability, for the entire period of treatment (stimulation of superovulation, ovarian puncture and embryo transfer ) before determining the result of the procedure and travel to the place of the medical organization and back.
In cases where the medical organization that performed the in vitro fertilization procedures does not have a license to perform work (services) for the examination of temporary disability, a certificate of incapacity for work is issued to a woman by a medical organization at her place of registration at the place of residence (at the place of stay, temporary residence) at on the basis of an extract (certificate) from an outpatient card issued by a medical organization that performed in vitro fertilization procedures.
55. In the event of abortion, a certificate of incapacity for work is issued in accordance with clause
, clause 11 of this Procedure for the entire period of incapacity for work, but for a period of at least 3 days, including when a short term pregnancy is terminated.
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Medical abortion – VMC Verte medical clinic
Medical abortion (using pills) is a non-surgical method of terminating pregnancy.
This type of abortion is the safest and most sparing modern method of abortion. This method became widespread in 1990. For medical abortion, pregnancy should not exceed 7 weeks.
Before a medical abortion, regardless of the gestational age, clinical blood tests, ultrasound, a vaginal smear for the degree of purity are performed. It is necessary to establish the exact duration of pregnancy and the location of the ovum in the uterine cavity (tubal pregnancy is excluded).
Medical abortion in our clinic is carried out by appointment on the day of treatment. After medical interruption, we assess the state of the uterus, observe and diagnose discharge from the genital tract. In our clinic, medical abortion is performed anonymously .
For many years, steroid research has been carried out by scientists from different countries. In 1975, the Romanville Research Center in France began a program to research anti-hormonal steroids.In 1980, Roussel Uclaf’s steroid synthesis research led to the creation of mifepristone, which is a synthetic oral steroid that antagonizes progesterone, glucocorticoids and androgens. The trade name of mifepristone RU 486 (RU 486 (Mifepriston) – MIFEGYNE®) comes from the first letters of the company and the number of the room in which the team that synthesized the drug worked.
Currently, the drug is marketed under the trade name mifepristone, mifegin, pencrofton, mitholian, etc.
MECHANISM OF ACTION OF MYTHEPRISTON (MYTHEGIN)
Under the action of Mifepristone, oocyte separation, a drop in beta-chorionic gonadotropin and secondary luteolysis occur. Increased contractility of the myometrium under the influence of Mifepristone and due to the stimulation of the synthesis of endogenous prostaglandins. Softening and dilation of the cervix. By acting on the endometrium, myometrium and cervix, Mifepristone leads to abortion and expulsion of the ovum.
CONTRAINDICATIONS FOR THE APPLICATION OF MYTHEPRISTON (MYPHEGIN)
- renal failure
- chronic adrenal insufficiency
- severe form of bronchial asthma
- allergy to mifepristone
- Suspected ectopic pregnancy
- unconfirmed pregnancy
Medical termination of pregnancy is not recommended for women who smoke over 35 to avoid complications from the cardiovascular system.
ADVANTAGES OF MYTHEPRISTON (MYTHEGIN)
Medical abortion is preferable for young and women who have not given birth, since an important advantage of medical interruption is the absence of the need for surgical intervention (therefore, the risk of developing all kinds of complications such as infertility, endometritis, etc.) is reduced
An important advantage is that the medical method makes it possible to terminate pregnancy at the earliest possible date, which also reduces the risk of developing all kinds of complications after the manipulation.
Several million women have already used mifepristone. The accumulated experience of termination of pregnancy allows us to state that its use provides a significant advantage in the case of its use for termination of pregnancy.
Benefits of medical abortion
- high efficiency – up to 98.6%
- Avoids the risks associated with anesthesia and surgery
- eliminates the risk of infection, the development of adhesions, obstruction of the fallopian tubes
- keeps the uterine cavity from instrumental action
- allows early termination of pregnancy
- well tolerated by patients who are negative about abortion
- causes moderate pain and uterine contractions
- does not affect the subsequent reproductive function of a woman.
METHOD OF ABORTION OF PREGNANCY WITH THE HELP OF MYTHEPRISTON (MYPHEGIN)
(the scheme is similar for all mifepristone preparations – mifegin, pencrofton, mitholian)
1 day. You confirm your desire to terminate the pregnancy, and also confirm that:
- you have no contraindications to taking mifepristone
- You have reviewed the information attached to mifepristone
- You have received additional clarification from your doctor
- sign an informed consent, confirming that you have received all the necessary information, are aware of contraindications and possible complications.You are taking mifepristone tablets in the presence of a doctor.
- The doctor gives his coordinates, by all means!
It is necessary to return to the doctor after 36-48 hours. At the same time, you should be well aware from your doctor where you should call or contact if necessary. Bloody discharge from the genital tract in some cases can begin at this stage.
3 days. You return to the medical clinic.
The doctor determines whether the abortion process has begun.If necessary, you take medications that stimulate this process. If you are concerned about any symptoms (lower abdominal pain, nausea, dizziness), the doctor may prescribe additional necessary medications.
For some time (2-4 hours) you remain under observation, then you return to your home. The expulsion of the ovum occurs either when you are in a medical clinic, or on one of the following days. Bleeding usually continues until a follow-up consultation.
Control. 14-17 days. Control examination by a gynecologist.
You will once again come to the clinic for a control examination. The doctor determines whether the fetus has been completely expelled. Control ultrasound is performed. If the pregnancy was not terminated, or the fetus was not completely expelled, the doctor will suggest you a surgical intervention. If necessary, hormonal regulation of the menstrual cycle and contraception are prescribed.
ANSWERS TO QUESTIONS
– Which method is the best?
There is no best method.Each of them has its own limitations. The choice should be based on the individual characteristics of the patient, on her medical history and on the conclusions of the doctor.
– Will I be able to go to work after taking MIFEPRISTON?
Yes, after taking mifegin, the patient can return to her daily activities, providing everything necessary in case of bleeding, which may begin 24 hours after taking the pills.
– Can I use MIFEPRISTON if I smoke more than 10 cigarettes a day?
Yes, smoking tobacco is not a contraindication for patients under 35 years of age.
– What should I do if after taking MIFEPRISTON I vomited?
Usually, complete absorption of the drug occurs within an hour and a half. Therefore, if you vomited during this time, the reception of MYTHEGIN must be repeated, if later, there will be no need for this.
– Is this procedure associated with severe painful sensations?
No, abdominal pain is generally mild.The need to resort to pain reliever occurs in only 16% of cases. But it is preferable to alleviate these sensations so that the patient remains relaxed, so as not to delay the expulsion of the fetus. Pain associated with contraction of the uterus is usually of the same intensity as with painful menstruation.
– Should I stay in bed after taking the drug?
There is no need to stay in bed. On the contrary, it will only delay the expulsion of the fetus.It will be enough to sit in a comfortable seat in a quiet place.
– Can this method cause profuse bleeding?
In exceptional cases, uterine bleeding may be profuse. A control examination of the uterus is required in 1.5 percent of cases. The patient is given the telephone number of the clinic and emergency medical service. That being said, it is strongly recommended that you use these phones without hesitation if necessary.
– If the miscarriage does not happen while I am at the clinic, how will I know that it really happened?
The doctor should inform the patient that expulsion of the ovum can occur at home.This most often occurs within the first 24 hours after the second dose. After two weeks, a control examination of the uterine cavity is usually performed.
– Is there a danger of infertility after taking MIFEPRISTON?
No, the blockage of progesterone receptors is temporary and reversible. There are no consequences – neither for the next menstrual cycle, nor for fertility in the future. In addition, since there have been cases of repeated pregnancies even before the start of the next menstruation, it is necessary to start using contraception as early as possible.