Vaginal bleeding in pregnancy Information | Mount Sinai

Pregnancy – vaginal bleeding; Maternal blood loss – vaginal

Vaginal bleeding in pregnancy is any discharge of blood from the vagina during pregnancy.

The ultrasound has become a standard procedure used during pregnancy. It can demonstrate fetal growth and can detect increasing numbers of conditions in the fetus including meningomyelocele, congenital heart disease, kidney abnormalities, hydrocephalus, anencephaly, club feet, and other deformities. Ultrasound does not produce ionizing radiation and is considered a very safe procedure for both the mother and the fetus.

External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

The placenta provides the fetus with oxygen and nutrients and takes away waste such as carbon dioxide via the umbilical cord.

Placenta previa is a condition of pregnancy when the placenta implants in the lower part of the uterus, partly or completely obstructing the cervical outlet to the vagina (birth canal).

There are many possible causes of bleeding during pregnancy. Bleeding should always be evaluated by a health care provider.

Considerations

Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

Causes

A small amount of light spotting or bleeding may be noted 10 to 14 days after conception. This spotting results from the fertilized egg attaching itself to the lining of the uterus. Assuming it is light and does not last very long, this finding is most often nothing to be concerned about.

During the first 3 months, vaginal bleeding may be a sign of a miscarriage or ectopic pregnancy. Contact the health care provider right away.

During months 4 to 9, bleeding may be a sign of:

• The placenta separating from the inner wall of the uterus before the baby is born (abruptio placentae)
• Miscarriage
• The placenta covering all or part of the opening to the cervix (placenta previa)
• Vasa previa (baby’s blood vessels exposed across or near the internal opening of the uterus)

Other possible causes of vaginal bleeding during pregnancy:

• Cervical polyp or growth
• Early labor (bloody show)
• Ectopic pregnancy
• Infection of the cervix
• Trauma to the cervix from intercourse (small amount of bleeding) or recent pelvic exam

Home Care

Avoid sexual intercourse until your provider tells you that it is safe to start having intercourse again.

Consume only fluids if the bleeding and cramping are severe.

You may need to cut down your activity or be put on bed rest at home. Your provider will talk to you about the specific kinds of activity changes you may need to make.

Medicine is not needed in most cases. DO NOT take any medicine without talking with your provider.

Also, talk to your provider about what to look for, such as the amount of bleeding and color of the blood.

When to Contact a Medical Professional

Contact your provider if:

• You have any vaginal bleeding during pregnancy. Treat this as a potential emergency.
• You have vaginal bleeding and have placenta previa (get to the hospital right away).
• You have cramps or labor pains.

What to Expect at Your Office Visit

Your provider will take a medical history and perform a physical exam.

You will probably have a pelvic exam, or ultrasound as well.

Tests that may be done include:

• Blood tests
• Pregnancy ultrasound
• Ultrasound of the pelvis

You may be referred to a high risk specialist for the duration of the pregnancy.

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Salhi BA, Nagrani S. Acute complications in pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.

Turocy J, Williams Z. Early and recurrent pregnancy loss: etiology, diagnosis, treatment. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 16.

Last reviewed on: 1/10/2022

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Vaginal bleeding in late pregnancy: MedlinePlus Medical Encyclopedia

One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away.

You should understand the difference between spotting and bleeding:

• Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.
• Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus.

Mid- or late-term bleeding may also be caused by:

• Having sex (most often just spotting)
• An internal exam by your provider (most often just spotting)
• Diseases or infections of the vagina or cervix
• Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

• Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
• Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

To find the cause of your vaginal bleeding, your provider may need to know:

• If you have cramping, pain, or contractions
• If you have had any other bleeding during this pregnancy
• When the bleeding began and whether it comes and goes or is constant
• How much bleeding is present, and whether it is spotting or a heavier flow
• The color of the blood (dark or bright red)
• If there is an odor to the blood
• If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
• If you have had recent injuries or falls
• When you last had sex and if you bled afterward
• If you’re feeling the baby move
• If you’ve had other complications during the pregnancy

A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:

• Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
• If spotting or bleeding continues, call your provider.
• If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.

For any other bleeding, call your provider right away.

• You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
• Your provider will also tell you whether you can drive yourself or you should call an ambulance.

Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn’s Current Therapy 2023. Philadelphia, PA: Elsevier 2023:1273-1276.

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 173.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae.  In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 43.

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Dental fluorosis – causes, treatment, prevention

What are the causes of pathology

In accordance with generally accepted sanitary standards, the maximum concentration of fluorine compounds in water should not exceed 1. 5 mg/l. But it should be remembered that fluorine enters the body also in the process of breathing and with food. An excess of this trace element negatively affects the enamel of the teeth – it begins to destroy it. If you do not see a doctor in time, bone pathologies such as osteoporosis or osteosclerosis may develop.

Important! The occurrence of the disease is associated with the individual characteristics of the organism. Sometimes fluorosis develops at a lower concentration of fluorine.

Mostly permanent teeth are affected, in rare cases – milk teeth in children. This is due to the fact that the mineralization of the first teeth in a baby begins and ends even in the period of intrauterine development. At this time, the placenta protects the baby’s body from an excess of fluoride. But if a pregnant woman lives in an area where the content of fluorine compounds in water greatly exceeds the norm, then the disease can also affect the baby’s milk teeth.

At risk are children aged 3-4 years, provided that they have consumed water with a high content of fluoride compounds for 3 or more years. This disease is also diagnosed in adults who work in industries with a high content of fluorine in the air.

Disease classification

Depending on the severity of the development of pathology, the following forms are distinguished:

• Stroke – characterized by the appearance of small stripes or strokes on the surface of the tooth. The upper jaw is most often affected by this form. The stripes are weakly expressed, and they can not always be seen on their own. Over time, they merge into one spot, in which strokes can also be distinguished.
• Spotted – this form is characterized by the presence of multiple chalky spots. They are well defined and are located on the entire surface of the tooth. When drained, large spots form.
• Chalky-altered form – it is characterized by the presence of an affected light brown area, which passes into healthy enamel. This lesion is more often observed on the upper and lower incisors.
• Chalky-speckled – characterized by the presence of distinct pigment spots. Sometimes there may be a variant of the presence of multiple dots on yellowish enamel. With this form, there is a rapid thinning of the enamel.
• Erosive – in addition to stains, erosive defects appear on the enamel. They contribute to the destruction of not only enamel, but also dentin.
• Destructive – the most severe form, in which the shape of the tooth crown is disturbed. This is due to the thinning of the enamel and the destruction of the hard tissue of the tooth. The teeth themselves are quite fragile, prone to various damages (chips, breaks).

The disease can occur in mild, moderate and severe degrees. It depends on the number of affected teeth, as well as the depth of the pathological process. In severe cases, the patient has more than 80% of the teeth affected. In this case, the dentin is affected, and deformation of the crown is observed. Also, fluorosis can cause pathological disorders of the bones of the skeleton.

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Manifestations of disease

Symptoms depend on the form and severity of the disease. At the very beginning (at the stage of a spotted or dashed form), areas with a changed color appear on the surface of the tooth. Stripes and lines are also visible. The enamel itself becomes rough, small bumps appear.

Subsequently, small spots lead to the formation of more extensive pathological areas. There is a heterogeneous mineralization of tooth enamel. It collapses and acquires a dull, matte color. At the same time, the smoothness and shine disappear.

A person with fluorosis complains of:

• for increased sensitivity to thermal stimuli;
• cosmetic defect, as the color of the enamel becomes yellowish or light brown;
• fragility and rapid abrasion of teeth;
• frequent chips;
• multiple caries.

X-rays show areas with reduced density, which indicates the process of demineralization, that is, a decrease in minerals in the enamel structure. It is for this reason that dyes are able to penetrate the porous structure of the tooth surface, which leads to the appearance of pigmented areas.

Dental fluorosis: treatment and prevention

Diagnosis is carried out at the reception at the dentist. Only a specialist will be able to distinguish the manifestations of fluorosis from the chalky spot, which is the initial stage of a carious lesion. An important distinguishing feature is that fluorous spots are multiple in nature and affect permanent teeth almost immediately after eruption. While the initial caries in the stain stage is observed on single teeth.

Treatment is selected individually and depends on how badly the enamel is damaged. At the initial stage of the disease, it is recommended to conduct a course of professional whitening followed by strengthening the enamel with the help of remineralization.

In this case, bleaching is carried out with a gentle composition based on inorganic acids. The number of procedures is selected by the doctor. Usually at least 10 sessions. During the period of whitening, it is recommended to take preparations with calcium. The result lasts for 6-8 months, then a second course of professional cleaning and whitening is required.

The remineralization procedure helps to strengthen the structure of the enamel, saturating it with minerals. Calcium and phosphorus compounds penetrate the dentin and restore the enamel from the inside. This procedure is carried out in several ways:

1. Applications with special composition.
2. Electrophoresis or phonophoresis.
3. Wearing mouthguards in which an active gel is applied.

On average, at least 15 procedures are prescribed. Before the procedure, it is necessary to carry out a complete sanitation of the oral cavity.

If the disease has already spread to the dentin, then simply bleaching will be ineffective. With moderate severity of fluorosis, methods of aesthetic restoration of the tooth are used:

• installation of ceramic veneers;
• restoration of the shape and color of the tooth with crowns.

Such methods are recommended not only for aesthetic purposes, but also for medicinal purposes. They help stop further tooth decay, reduce the sensitivity of the enamel.

Home care is also important – the use of fluoride-containing toothpastes, taking vitamin and mineral complexes, reducing the intake of fluoride with water and food.

How to prevent the development of the disease

The main preventive measure to combat fluorosis is to control the amount of fluoride in drinking water, as well as in the air. Such measures are especially important for areas in which an excess of the amount of fluorides in the sources of water supply to the population has been found to exceed the norms. Such events are held at the state level.

On an individual basis, it is recommended to use purchased purified water for drinking or use tap filters for additional purification. At the same time, it is important to engage in prevention from the moment the child is conceived. A pregnant woman should be especially careful when choosing food, as well as drinking water. Additional intake of vitamins C, D, and calcium gluconate allows several times to reduce the risk of fluorosis, especially in children.

When a baby is born, it is recommended to breastfeed him for as long as possible. After the introduction of complementary foods, instead of water, if possible, use juices or dairy products. If you live permanently in an endemic area, you need to annually take children to other areas for recovery. Replacing the water source for 3-4 months allows you to strengthen tooth enamel and stop the development of the disease.

An important point in the prevention of the disease is nutrition. Limit or completely eliminate foods containing fluoride. These are sea fish, nuts, spinach, sea kale. Eat more fresh vegetables or fruits.

Also, after consulting a doctor at home, you can use therapeutic remineralizing toothpastes or applications.

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description, photo, maintenance and care of lizards at home

Content:

• Species
• Contents
• Feeding
• Caring instructions for gecko
• Terminals

Eublefar is a funny lizard that is suitable for home keeping: such pets are unpretentious, and also do not cause allergies!

They easily get used to the person and over time are even able to show tender feelings towards the owner. So, eublefar will gladly sit on the shoulder or in the hands of the owner and even allow himself to take a nap for a short time.

Important! The average height of an adult is 25-30 cm (with a tail), weight is 60-70 gr.

Species

At home, spotted leopard geckos are more common. And this species has hundreds of colors, most of which are artificially bred. By the way, the color of eublefar is called morph.

Let’s take a look at some morphs:

Normal

This color is found in the wild. The color of the lizard is yellow, the tail may be gray. Dark spots are located on the body. The eyes are dark gray, the pupil is black.

Tremper Albino

Light yellow body with gray-brown stripes. The eyes are light gray with a bluish-pink tint.

Bell Albino

The body of the eublefar can be light yellow or, conversely, have a rich color. Brown stripes from head to tail.

Rainwater Albino

This morph was bred by our compatriots. A distinctive feature is light, delicate shades of color: yellow, purple, brown.

Murphy Patternless

Babies of this species are born with spots, but they disappear with age. Eublefar acquires a solid color.

Other popular morphs: Blizzard, Mack Snow, White&Yellow, Eclipse, Tangerine, Hypo, Black Night, Lemon Frost.

Contents

Keeping eublefar at home is not difficult. It is important to remember that in one terrarium can be inhabited by several females, but it is better to leave the male as the sole owner of the territory.

For a comfortable life, the lizard will need:

Terrarium

The optimal size for one eublefar is 45 * 45 * 30 cm. It is necessary to choose a model with a lid, otherwise the active pet will immediately get free.

It is important that the tank is equipped with a good ventilation system, and the humidity is maintained at 40-50%. Sometimes it is difficult to do this, for example in winter, when the air in the room is dry. In this case, it is necessary to spray the soil and walls of the terrarium with a spray bottle, or install a humidifier in the room.

Thermal mat

Helps maintain optimal temperature in the terrarium.

An important point: create two zones – warm and cool. The temperature in the first should be from 27 to 33 degrees, in the second – 23-26 degrees. You can correct it with the help of soil layers.

Ground

Use paper towels or ceramic tiles.

But it is undesirable to choose sand: geckos often swallow it, and this causes intestinal obstruction.

UV Lamp

Needed by young individuals for the assimilation of vitamin D3. Otherwise, the pet may develop rickets. For prevention, you should turn on the lamp for 10-15 minutes a day.

Wet chamber

Being in a humid chamber helps the lizard cope with molting. The fact that this process will begin soon is indicated by a change in the pet’s skin – it begins to crack, then turn white.

A small plastic container with a lid can be used as a wet chamber (you need to make a hole in it for entry), but a ready-made chamber is the best option. Place the tank in a cold corner of the terrarium. Moss or damp paper towels are suitable as bedding in a humid chamber.

Covers

Eublefars love to hide in shelters – they need a place where they can rest comfortably. Use any suitable decor – coconut house, ceramic grotto or other model.

If the size of the terrarium allows, it is optimal to place several shelters in a warm area. It is important that the elements do not have sharp corners that the reptile can get hurt on.

Driftwood

All lizards love to climb trees, and geckos are no exception. For these purposes, in terrarium it is necessary to place driftwood – one or two. Of course, these must be treated trees, cleaned of bark and insects. Therefore, they are recommended to be purchased at pet stores.

Drinker

An interesting fact: geckos drink water, like cats or dogs, lapping it with their tongue. A small bowl must be installed in the terrarium. A plastic, metal or ceramic model will do. Ceramic bowls are more stable, while metal and plastic ones wear out faster.

Important! It is necessary to change the water in the drinker every day!

Feeding

Eublefars are predatory creatures, therefore they prefer protein food . For them, you need to choose insects sold in pet stores fresh or frozen. Crickets will come. Mealworm , Zophobos , or silkworm larvae can be given as treats.

The pet’s diet should be varied. Do not feed the lizard the same food for a long time – this may cause disgust for this type of food.

It is important to observe the feeding regimen. It is desirable that eublefar receive food early in the morning or in the evening, since it is at this time that lizards living in the wild go hunting.

Important! Under no circumstances should insects caught on the street be given to reptiles, as they can be infected with dangerous parasites or be poisoned by chemicals!

The feeding regimen is determined by the age of the eublefar:

• 0 to 2 months: 2-3 crickets* daily;
• 2 to 4 months: 3-4 medium-sized crickets once every two days;
• 4 to 6 months: 3-5 large crickets once every three days;
• 6 to 10 months: 5-7 crickets once every 4 days;
• from 1 year old: 10-15 large crickets once every 5-7 days.

* Instead of crickets, you can use any other type of insect (larvae).

If you choose frozen food, place it in a small bowl and place in terrarium . After the pet has eaten, immediately remove the leftover food.

Important! Eublefaram should not be given any other food than protein!

It must be remembered that this type of lizard is prone to gaining excess weight, so it is important not to overfeed your pet. Obesity is quite simple to determine: the belly of the eublefar should not protrude too much when viewed from above, and the thickness should not exceed the volume of the tail.

In terrarium a small bowl with mineral supplement – calcium should be placed near the lizard. This is important for maintaining bone health. Eublefar should consume calcium as much as he wants. Once a week, vitamin is added to the mineral supplement.

Important! The average life expectancy of a eublefar is 15-20 years. However, there are individuals who reach the age of thirty. It all depends on the conditions of detention.

Gecko care instructions

1.