What type of bleeding is normal during pregnancy: Vaginal Bleeding and Blood Clots During Pregnancy
Bleeding During Pregnancy | ACOG
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.
Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.
Ectopic Pregnancy: A pregnancy in a place other than the uterus, usually in one of the fallopian tubes.
Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.
Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.
Fertilization: A multistep process that joins the egg and the sperm.
Hysterectomy: Surgery to remove the uterus.
Inflammation: Pain, swelling, redness, and irritation of tissues in the body.
Miscarriage: Loss of a pregnancy that is in the uterus.
Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.
Oxygen: An element that we breathe in to sustain life.
Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer.
Pelvic Exam: A physical examination of a woman’s pelvic organs.
Placenta: An organ that provides nutrients to and takes waste away from the fetus.
Placenta Accreta: A condition in which part or all of the placenta attaches abnormally to the uterus.
Placental Abruption: A condition in which the placenta has begun to separate from the uterus before the fetus is born.
Placenta Previa: A condition in which the placenta covers the opening of the uterus.
Preterm: Less than 37 weeks of pregnancy.
Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called “having sex” or “making love.”
Trimester: A 3-month time in pregnancy. It can be first, second, or third.
Ultrasound Exam: A test in which sound waves are used to examine inner parts of the body. During pregnancy, ultrasound can be used to check the fetus.
Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.
I’m Pregnant! Why Am I Bleeding?
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Many moms-to-be experience bleeding while they are pregnant. In fact, the American Pregnancy Association says studies show that 20-30 percent of women experience some degree of bleeding during early pregnancy. But how do you know how much bleeding is normal and when it’s a cause for concern? It depends on how far along you are, and how severe the bleeding is.
First, know how to tell spotting from bleeding.
Spotting is very light bleeding. It is common in the first trimester. The blood will be light brown or pink, similar to what you see at the end of a period.
Bleeding is heavier. The blood is bright red and is more like the bleeding you experience when having your period.
If you’re thinking about it, call your doctor.
When to Call the Doctor
David McKenna, MD, a Maternal-Fetal Medicine specialist with Perinatal Partners, advises calling your doctor if you see any sign of bleeding during pregnancy and have not yet talked to your doctor about it. This is especially the case for women who are pregnant for the first time. “Explain what’s happening to your doctor. Talk about your next steps and if – and when – you should call back,” he says.
Why You May Bleed During Pregnancy
First Half of Pregnancy
Spotting during this time is common, especially after sex, a pelvic exam, or a transvaginal ultrasound. In these cases, the blood might be coming from the cervix. It becomes tender during pregnancy and could be a bit inflamed or irritated. This type of bleeding can also occur prior to a miscarriage or with an ectopic pregnancy, but most often it is not a cause for concern.
Heavier bleeding during the first trimester can also be a sign of a miscarriage or ectopic pregnancy. This bleeding doesn’t mean a miscarriage will occur, or that you have an ectopic pregnancy. About half of pregnant women who have bleeding do not miscarry. The most important thing you can do is to let you doctor know about any bleeding, so that you can evaluated for the cause.
Second Half of Pregnancy
During the late second and entire third trimester, causes of bleeding can include:
- Placenta previa. This occurs when the placenta is low in the uterus and partly or completely covers the cervix. Most women notice no pain with the bleeding. Placenta previa occurs in 1 in 200 pregnancies and requires immediate attention when there is bleeding. Placenta previa often resolves on its own, especially when it is found early during pregnancy. Other times it can lead to an early delivery by Cesarean section.
- Placental abruption. This occurs when the placenta detaches from the uterine wall before or during labor. It can cause serious complications if it is not found early. It often comes with painful contractions. Placental abruptions are rare, occurring in just 1 percent of pregnant women. Risk factors for placental abruptions include maternal smoking, drug use and high blood pressure.
- Preterm labor. Defined as labor starting prior to 37 weeks’ gestation, preterm labor might also include these signs: regular contractions, cramping, back pain and increased pelvic pressure. If you think you’re going into early labor, call your doctor right away.
Be Prepared for These Questions
If you experience bleeding during pregnancy, be ready to answer these questions when you call or visit your doctor:
- How far along are you?
- When did you first have a positive pregnancy test?
- Have you had an ultrasound, and if so, what did it show?
- When did the bleeding start?
- Were there any obvious causes? For example, have you recently had intercourse or a vaginal exam?
- How heavy has the bleeding been?
- Have you had any pain or other symptoms with the bleeding?
If you are asked to make an appointment, your doctor is likely to check your cervix with a speculum. You might have an ultrasound or other testing to help learn the cause of the bleeding.
Many factors can cause spotting and bleeding during pregnancy. Because of that, it’s best to talk with your doctor if you have any bleeding. The bottom line is, if you’re thinking about it, call your doctor.“That’s what we’re here for,” says Dr. McKenna.
It’s easy to get the care you need.
See a Premier Physician Network provider near you.
Source: David S. McKenna, MD; Perinatal Partners; American Pregnancy Association; The American Congress of Obstetricians and Gynecologists; Whattoexpect.com
Vaginal bleeding – NHS
Bleeding during pregnancy is relatively common and doesn’t always mean there’s a problem – but it can be a dangerous sign.
Urgent advice: Call your midwife or GP immediately if:
- you have any bleeding from your vagina
Coronavirus (COVID-19) update
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Causes of bleeding in early pregnancy
In early pregnancy, you might get some harmless light bleeding, called “spotting”. This is when the developing embryo plants itself in the wall of your womb. This type of bleeding often happens around the time your period would have been due.
Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding – after sex, for example.
Miscarriage or ectopic pregnancy
During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy.
However, if you bleed at this stage of pregnancy it is likely you will go on to have normal and successful pregnancies.
If a pregnancy ends before the 24th week, it’s called a miscarriage. Around 1 in 5 pregnancies ends this way.
Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can also be other causes of miscarriage, such as hormone or blood clotting problems.
Most miscarriages occur during the first 12 weeks (3 months) of pregnancy and, sadly, most cannot be prevented. Other symptoms of miscarriage include:
- cramping and pain in your lower abdomen
- a discharge or fluid from your vagina
- a discharge of tissue from your vagina
- no longer experiencing the symptoms of pregnancy, such as feeling sick
If you have bleeding or any of the symptoms above, contact your midwife or GP straightaway.
An ectopic pregnancy is when a fertilised egg implants outside the womb – for example, in the fallopian tube.
It can cause bleeding and is dangerous because the fertilised egg can’t develop properly outside the womb. The egg has to be removed, which can be done through an operation or with medicines.
Symptoms of an ectopic pregnancy tend to develop in the 6th week of pregnancy but can happen later.
Other signs of ectopic pregnancy can include:
- tummy pain low down which may be on one side
- vaginal bleeding or a brown, watery discharge
- pain in the tip of your shoulder
- discomfort when peeing or pooing
Call 111 if you have symptoms of an ectopic pregnancy.
Causes of bleeding in later pregnancy
These can lead to bleeding, particularly after sex.
Your midwife or doctor can discuss tests and treatment with you.
This is when the plug of mucus that has been in the cervix during pregnancy comes away, signalling that the cervix is getting ready for labour to start. It may happen a few days before contractions start or during labour itself.
Find out about the signs of labour and what happens in labour.
This is a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.
Low-lying placenta (placenta praevia)
This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy, and put you and your baby at risk.
You may be advised to go into hospital for emergency treatment, and a caesarean section will usually be recommended. The Royal College of Obstetricians and Gynaecologists has more information on placenta praevia.
This is a rare condition where the baby’s blood vessels run through the membranes covering the cervix.
When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a life-threatening amount of blood.
Finding out the cause of bleeding in pregnancy
To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels.
Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes it might not be possible to find out what caused the bleeding.
If your symptoms are not severe and your baby is not due for a while, you’ll be monitored and, in some cases, kept in hospital for observation.
How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are.
Being in hospital allows staff to keep an eye on you and your baby, so they can act quickly if there are further problems.
Find the answers to common health problems in pregnancy.
Video: what should I do if I start bleeding during early pregnancy?
In this video, a midwife tells you what to do if you start to bleed during early pregnancy.
Media last reviewed: 20 March 2020
Media review due: 20 March 2023
Spotting During Pregnancy | American Pregnancy Association
Spotting during pregnancy is a common concern that many pregnant women face. Approximately 20% of women report they experience spotting during their first 12 weeks of pregnancy. Bleeding that occurs early in pregnancy is usually lighter in flow than a menstrual period. Also, the color often varies from pink to red to brown. The majority of women who experiencing spotting during pregnancy go on to have a healthy pregnancy and baby.
Spotting During Pregnancy Versus Bleeding
Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen anytime from conception (when the egg is fertilized) to the end of pregnancy.
Light bleeding, or spotting, during pregnancy is common, especially during the first trimester. It is considered spotting when you notice a few drops of blood occasionally in your underwear, or if you wipe yourself with tissue and see a little blood on the paper. There should not be enough blood to fill 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. Whether you are bleeding or spotting, it is best to contact your healthcare provider and describe what you are experiencing.
What Causes Spotting During Pregnancy?
Implantation bleeding is a common cause of spotting early on in pregnancy. Implantation bleeding happens when the fertilized egg attaches to the uterine lining. This can trigger a few days of light bleeding or spotting. This spotting occurs before a woman even knows she is pregnant and is often mistaken as a pending period. Bleeding that occurs after the day a woman expects her period is typically too late to be considered implantation bleeding, and is more likely related to early pregnancy in general.
Another common cause of spotting is a cervical polyp (a harmless growth on the cervix), which is more likely to bleed during pregnancy due to higher estrogen levels. This may occur because there is an increased number of blood vessels in the tissue around the cervix during pregnancy. As a result, contact with this area (through sexual intercourse or a gynecological exam, for example) can cause bleeding.
Even without the presence of a cervical polyp, there are a few things that may cause some spotting in the couple days after:
- Sexual intercourse
- Gynecological exam, such as a vaginal ultrasound
- Heavy lifting/excessive exercise
When to Worry About Spotting During Pregnancy?
Spotting or bleeding during pregnancy is not expected and may be abnormal, but it is not always a cause for concern. However, it is important to contact your healthcare provider to discuss the symptoms you are experiencing. The good news is that 50% of women with bleeding during pregnancy go on to have a healthy pregnancy and a healthy baby.
Any spotting or bleeding in the second or third trimesters should be reported to your healthcare provider immediately. In the first trimester, spotting is somewhat more common, but should also be reported to your doctor or midwife.
Call your obstetrician especially if you notice heavy bleeding similar to a menstrual period to make sure the bleeding is not a result of pregnancy complications, such as an ectopic pregnancy. Abnormal bleeding in late pregnancy may be more serious because it can signal a complication with you or your baby. Call your doctor as soon as possible if you experience any bleeding in your second or third trimester. Your healthcare provider will most likely check for cervical polyps, and make sure your cervix is closed.
To help manage your spotting during pregnancy and to increase the probability of continuing with a healthy pregnancy, your healthcare provider may encourage you to do the following:
- Bed rest or more naps
- More time off your feet
- Staying well hydrated
- Limit your physical activity
- Elevate your feet when possible
- Avoid lifting items over 10 pounds
Remember, the good news is the majority of women who experience spotting during pregnancy go on to have a healthy pregnancy. However, do not let this fact keep you from contacting your healthcare provider. It is important to discuss spotting and bleeding with your doctor.
Want to Know More?
Compiled using information from the following sources:
1. Mayo Clinic Guide to a Healthy Pregnancy, New York, NY: HarperCollins Publishers Inc.
2. Obstetrics and Gynecology: The Essentials of Clinical Care. New York, NY: Thieme New York
3. Danforth’s Obstetrics and Gynecology, Ninth Ed. Scott, James et al., Ch. 17
4. Williams Obstetrics, Twenty-Second Ed. Cunningham, F. Gary et al., Ch. 51
Pregnancy Bleeding: What’s Normal, What’s Not?
With your body going through so many changes during pregnancy, it’s no surprise that most women are constantly reaching for the phone to give their doctor a call. It can be difficult to know what’s serious and what’s just another symptom, so keep reading for everything you need to do about vaginal bleeding while pregnant—because it’s not all serious.
Vaginal Bleeding in the First Trimester
During the first trimester, vaginal bleeding is actually pretty common—in fact, it occurs in about 20% of pregnancies, and most of those women go on to have perfectly healthy pregnancies. The most important thing to know is the difference between light and heavy bleeding, and when to call your doctor.
For starters, there’s a big difference between spotting and bleeding. The term “spotting” refers to a few drops of blood—not enough to cover a pad or panty liner. You may already be familiar with spotting from your period days! Bleeding, on the other hand, means a blood flow that’s heavy enough to require wearing a pad. If actual bleeding occurs during your trimester, wear a panty liner or pad so you can get a clear idea of exactly how much you’re bleeding so you can tell your doctor. Remember that you shouldn’t use a tampon or douche while you’re pregnant.
Causes of Vaginal Bleeding in the First Trimester
Implantation bleeding occurs when the fertilized egg implants in the lining of the uterus. This typically happens around the time of your expected period, so sometimes you don’t even know you’re pregnant yet.
Hormone production during pregnancy can change and soften your cervix, making it more likely to bleed during pregnancy. You could also have a cervical polyp, or benign overgrowth of tissue, that can bleed easily. You could experience some spotting or light bleeding after sexual intercourse, or after a pelvic examination. A vaginal infection could cause some vaginal bleeding as well, and is usually accompanied by an abnormal vaginal discharge.
Vaginal bleeding could also be a sign that you have an ectopic pregnancy, which occurs when the fertilized egg implants outside of the uterus, usually within one of the fallopian tubes, where the blood supply isn’t enough to sustain a normal pregnancy. About one in every 60 pregnancies is ectopic. The most common signs are increasing abdominal pain, the absence of menstrual periods, and spotting. About half of women with an ectopic pregnancy won’t have all three signs, so if you notice any of them it’s a good idea to talk to your doctor.
If you’re experiencing heavy vaginal bleeding during your first trimester, it could be something serious. Bleeding, abdominal pain, and back pain are all common signs of a miscarriage, which occurs in 15-20% of all pregnancies, usually during the first 12 weeks of gestation. A threatened miscarriage could also cause vaginal bleeding and milk cramping—the difference is that in a threatened miscarriage, the cervix remains closed and the fetus is still viable. In many women, the bleeding stops and they go on to have healthy pregnancies. Unfortunately for some, the bleeding doesn’t stop and a miscarriage occurs.
A molar pregnancy, or gestational trophoblastic disease, is an abnormality of fertilization that results in the growth of abnormal tissue in the uterus. This tissue mimics the typical symptoms of early pregnancy, even though there’s no fetus. In a “partial mole,” the abnormal tissue is growing alongside the fetus, which results in severe birth defects. A molar pregnancy cannot result in a normal pregnancy, or a normal delivery. A sonogram or ultrasound is needed to diagnose a molar pregnancy.
When blood collects between the gestational sac and the wall of the uterus, a subchorionic hemorrhage occurs. Your body frequently reabsorbs clots like these, but sometimes you may experience a passage of old, dark blood or even small clots from your vagina.
While the causes of bleeding are varied in their severity, if your vaginal bleeding is heavy you should call 911, and go to the emergency room.
Second and Third Trimester Vaginal Bleeding
While light vaginal bleeding is fairly common during your first trimester, it’s more serious in your second and third trimesters. Like the first trimester, however, sometimes having sex or a pelvic examination can cause light bleeding. Problems with your cervix, like cervix insufficiency or infection can also lead to bleeding.
Some more serious causes of bleeding and heavy bleeding later in pregnancy include placenta previa, preterm labor, uterine rupture, or placental abruption.
Any time you notice bleeding at any stage of pregnancy, it’s reasonable to call your doctor—even if it’s light bleeding, it could be a sign of some serious problems to come. If you’re experiencing heavy bleeding accompanied by pain or cramping, seek immediate medical attention.
For more of what you need to know, call the maternity experts at RMC today.
Bleeding or pain in early pregnancy
Vaginal bleeding in the early stages of pregnancy is common and does not always mean you have a problem.
However, depending on the volume of bleeding, it can be a warning sign of a miscarriage or an ectopic pregnancy.
One in 4 women will experience bleeding and/or pain during their first 12 weeks of pregnancy. Unfortunately half of these pregnancies may also end in miscarriage, which cannot be prevented.
Sadly, 1 in every 5 to 6 pregnancies are miscarried. There is no medication or treatment that can be given to prevent a miscarriage.
Most miscarriages are a one-off event and having a miscarriage doesn’t mean you can’t have a successful pregnancy in the future.
Miscarriage – a loss of pregnancy before 20 weeks gestation (growth).
Causes of bleeding and pain in early pregnancy
There are several possible causes of bleeding and/or pain in early pregnancy.
- Implantation bleeding – this happens when the fertilised egg implants in the uterus lining, causing some cramping pain or light bleeding.
- Bleeding from the cervix – this is more common in pregnancy due to the increased blood flow.
- Ectopic pregnancy – this is when a pregnancy takes place outside of the uterus, such as in the fallopian tube.
- Molar pregnancy – this is a rare abnormal development of the placenta.
Sometimes the cause of the bleeding or pain is unknown, but the pregnancy will continue.
At the emergency department
If you experience bleeding or pain in early pregnancy, seek immediate emergency medical advice. You may have to go to the emergency department at King Edward Memorial Hospital.
It is recommended women experiencing symptoms of a miscarriage go to the emergency department at King Edward Memorial Hospital, if this is possible.
A doctor or midwife at the emergency department will run a number of tests to check:
- how much blood you have lost
- your blood group
- your urine
- your blood pressure
- your heart rate
- your temperature.
If you have minimal blood loss and are not in severe pain, you will be assessed as a non-emergency patient and you may be referred to the Early Pregnancy Assessment Service (EPAS) clinic at King Edward Memorial Hospital.
If you previously had an ultrasound that confirmed your pregnancy is in your uterus, the bleeding you are experiencing will not be due to ectopic pregnancy.
Where to get help
- Always dial 000 in an emergency.
- See your doctor.
- Visit a GP after hours.
- Ring healthdirect Australia on 1800 022 222.
- Call the emergency department at King Edward Memorial Hospital on 9340 2222.
- Bleeding and pain in early pregnancy is common.
- Heavy bleeding or blood clots could indicate a miscarriage or an ectopic pregnancy.
- Such symptoms can include bleeding, spotting, cramps and stomach pain.
Women and Newborn Health Service
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.
Vaginal Bleeding During Pregnancy | Michigan Medicine
The following guidelines will help you determine the severity of your vaginal bleeding.
- Severe bleeding means you are soaking through your usual pads or tampons each hour for 2 or more hours. For most women, soaking through their usual pads or tampons every hour for 2 or more hours is not normal and is considered severe. If you are pregnant: You may have a gush of blood or pass a clot, but if the bleeding stops, it is not considered severe.
- Moderate bleeding means that you are soaking more than 1 pad or tampon in 3 hours.
- Mild bleeding means that you are soaking less than 1 pad or tampon in more than 3 hours.
- Minimal bleeding means “spotting” or a few drops of blood.
Vaginal bleeding can be a sign of miscarriage or preterm labor during pregnancy in the first trimester. During the first trimester of pregnancy:
- Up to 25% of pregnant women have some spotting or light vaginal bleeding. Of these women, about 50% do not have a miscarriage. Vaginal bleeding during pregnancy is more common among women who have been pregnant before than in women who are pregnant for the first time.
- Very early spotting sometimes occurs when the fertilized egg implants in the uterus. Implantation takes place 6 to 10 days after fertilization.
Bleeding in the second or third trimester of pregnancy may mean a problem is present, such as:
- Placenta previa. Normally, the placenta is attached to the top portion of the uterus. In placenta previa, the placenta has attached low in the uterus, and partially or completely covers or blocks the cervix.
- Placenta abruptio. Normally, the placenta is firmly attached to the uterine wall until birth. If the placenta separates from the uterus before the baby is delivered, this is called placenta abruptio or abruptio placenta or placental abruption. Placenta abruptio usually occurs in the third trimester of pregnancy, but it can occur any time after the 20th week.
Current as of:
October 8, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Kathleen Romito MD – Family Medicine
Adam Husney MD – Family Medicine
Elizabeth T. Russo MD – Internal Medicine
Kirtly Jones MD – Obstetrics and Gynecology
Current as of: October 8, 2020
Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Kathleen Romito MD – Family Medicine & Adam Husney MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & Kirtly Jones MD – Obstetrics and Gynecology
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Endometrial pathology | Gynecology | Directions of DSP Medica
Endometrial pathology is common among patients with primary and secondary infertility and is one of the main reasons for IVF failure.
Endometrium is a unique tissue of the female body, which in women of reproductive age undergoes regular dynamic changes every month and is intended for the implementation of reproductive function. Exposure to infectious agents, trauma, dyshormonal changes in a woman’s body lead to pathological changes in the endometrium, as a result of which the ability of the endometrium to implant an embryo and / or carry a pregnancy is impaired.
Endometrial pathology includes:
Thin endometrium (endometrial hypoplasia)
Intrauterine synechiae (Asherman’s syndrome)
benign endometrium from the base (basal layer) of the endometrium in the form of an outgrowth, has a base (“leg”), a body and grows towards the uterine cavity.Endometrial polyp is the most common type of endometrial pathology, it can be single or multiple.
The main reason for the formation of polyps is a chronic inflammatory process in the endometrium.
– profuse and / or prolonged menstruation
– acyclic spotting from the genital tract
– smearing spotting before and after menstruation
– spotting in peri- and postmenopausal women
– miscarriage – infertility
Endometrial hyperplasia is a pathological diffuse or focal proliferation (thickening) of the endometrium.
The main reason for the development of endometrial hyperplasia is hormonal disorders in a woman’s body in the form of a relative or absolute excess of estrogens in the absence or insufficient effect of progesterone. Most often, anovulatory menstrual cycles, obesity, hormone-producing ovarian tumors, and improper use of hormonal drugs lead to an excess of estrogen. However, infectious and inflammatory changes in the endometrium can also cause endometrial hyperplasia.
– heavy and / or prolonged menstruation
– acyclic uterine bleeding
“Thin” endometrium, when its “thin” endometrium is considered to be – the thickness during ultrasound examination does not exceed 7 mm. “Thin” endometrium is characterized by impaired maturation of the endometrial glands against the background of a pronounced impoverishment of its vascular network.
Reasons for the appearance of a thin endometrium:
– mechanical damage to the endometrium (surgical abortion, scraping of the walls of the uterine cavity, intrauterine contraceptives, numerous surgical operations on the uterine cavity)
– chronic inflammatory process in the endometrium.
– drug exposure (OK, chemotherapy).
– autoimmune diseases.
Clinical manifestations of a thin endometrium:
Intrauterine synechia (Asherman’s syndrome) – a pathological condition characterized by the formation of connective tissue adhesions to the walls of the endometrium and deformationIn the presence of synechia, the normal endometrium undergoes atrophic transformation.
Causes of intrauterine synechiae:
– mechanical damage to the endometrium (surgical abortions, scraping the walls of the uterine cavity, intrauterine contraceptives, numerous surgical operations on the uterine cavity)
– chronic inflammatory process in the endometrium.
– scanty menstruation or their complete absence
Diagnosis of endometrial pathologies.
The first line of diagnostic search to assess the state of the endometrium is an ultrasound examination of the pelvic organs. The information content of the method depends on the type of endometrial pathology and the woman’s age. In the presence of subtle structural changes in the endometrium (small glandular polyps, thin synechiae …), ultrasound examination may be of little information.
The “gold standard” for the diagnosis and treatment of intrauterine pathology is hysteroscopy.
Hysteroscopy – visual examination of the uterine cavity using an optical system.
Hysteroscope is a diagnostic and at the same time surgical instrument, consisting of an optical tube and channels for miniature instruments or energy conductors.
With the help of a hysteroscope, the doctor:
– Examines the uterine cavity, assesses the state of the endometrium and the nature of intrauterine pathology.
– Has the ability to accurately take an endometrial biopsy, remove polyps or altered areas of the endometrium, with minimal tissue trauma, using microinstruments
– Has the ability to perform intrauterine operations under visual control using electrical and laser surgery (dissection of synechiae, intrauterine septa, resection of large polyps, submucous nodes, total removal of the endometrium)
Thus, hysteroscopy combines in one procedure the diagnosis and surgical treatment of endometrial pathology and operates on the principle of “see and treat”.
The final diagnosis, for the choice of further tactics for the treatment of endometrial pathology, gives a histological (and immunohistochemical) examination of the sections of the endometrium obtained during hysteroscopy.
Realizing the importance of respect for the endometrium and at the same time mastering all the techniques of hysteroscopic manipulations, gynecologists-reproductologists of the Medica Family Planning Center in a complex of therapeutic manipulations use low-traumatic elimination of intrauterine pathologies with the subsequent restoration of menstrual function and fertility.
90,000 Anemia during pregnancy
Anemia is understood as a decrease in the level of hemoglobin in the blood.
During pregnancy, the amount of fluid in the woman’s body increases, and hence the volume of circulating blood. Due to this, the blood “liquefies” and the proportion of hemoglobin in its total volume falls. This is considered normal, and therefore the lower limit of the amount of hemoglobin during pregnancy is set at 110 g / l (the norm for a non-pregnant woman is 120-140 g / l).But a further drop in hemoglobin levels is dangerous for the health and even the life of the expectant mother.
Depending on the values of this indicator, anemia during pregnancy can be:
- mild severity – 110–90 g / l;
- moderately expressed – 89–70 g / l;
- heavy – 69-40 g / l.
The most common complications of anemia during pregnancy are:
- threat of termination of pregnancy;
- low blood pressure;
- Premature placental abruption;
- fetal growth retardation;
- premature birth;
- anemia in the first year of a child’s life.
So anemia during pregnancy is by no means a harmless condition. It has serious consequences for both the mother and the fetus.
During pregnancy, iron is consumed not only for the mother’s hematopoiesis, but also for the needs of the fetus. This consumption increases especially actively at 16–20 weeks, when the process of hematopoiesis starts in the fetus. By the end of pregnancy, iron stores are depleted in any woman and it takes 2-3 years for them to fully recover.
Other causes of anemia in pregnancy are:
- iron deficiency in food mainly due to insufficient amount of meat in the diet;
- deficiency of vitamins of group B and C, necessary for normal absorption of iron;
- diseases in which there is a lack of proteins involved in iron metabolism, including severe gestosis;
- early preeclampsia (toxicosis), which interferes with proper nutrition;
- frequent births with short intervals.
If we talk about the risk groups for the development of anemia during pregnancy, then these include women: with multiple pregnancies and multiparous; who had menstruation lasting more than 5 days before pregnancy; who have had symptoms of anemia during a previous pregnancy; with gestosis; with chronic diseases of the gastrointestinal tract, liver, chronic infections; vegetarians. Everyone at risk should be especially careful about their condition and, if possible, take care of the prevention of anemia during pregnancy.
Considering that during pregnancy the need for a woman’s body in a microelement increases by 15–33%, symptoms indicating hypoxia usually come to the fore: weakness, rapid fatigability; sleep disturbance: during the day – drowsiness, at night – insomnia; headaches; dizziness, tinnitus; dyspnea; palpitations; fainting.
The tolerance of the symptoms of anemia is individual: someone faints at relatively high hemoglobin values, someone refuses to be hospitalized with hemoglobin at a level of about 70 g / l, sincerely not understanding the severity of anemia and its danger during pregnancy.That is why a clinical blood test during pregnancy is mandatory and several times. The drop in serum iron and serum ferritin values is also significant. A decrease in the amount of the latter to 12 μg / l indicates an iron deficiency, even if hemoglobin is still normal.
Treatment of anemia while waiting for the baby will include diet therapy. One of the foundations of both the prevention and treatment of anemia during pregnancy is proper nutrition. Food for the prevention of anemia during pregnancy should contain a sufficient amount of substances necessary for normal blood formation – these are meat and fish.In these products, iron is initially bivalent, therefore it is easily absorbed. But diet alone may not be enough even for prevention.
Iron preparations are prescribed for the treatment of anemia. Usually they are limited to means for oral administration (i.e., inside) – iron preparations in injections are recommended only in severe cases and only in a hospital setting.
Both Russian and foreign experts note that the prevention of anemia in pregnant women is more effective than its treatment, and the higher the hemoglobin level, the easier it is to bring it back to normal.However, common sense also speaks of the same. Therefore, when planning a pregnancy, and even more so when expecting a child, it is better to engage in the prevention of anemia without waiting for the iron deficiency to become noticeable.