Heavy bleeding during early pregnancy. Causes of bleeding during early pregnancy: what to do? Bleeding in the early stages due to frozen pregnancy

Pregnancy is the most responsible and important time for every woman. The expectant mother very sensitively and closely monitors changes in her condition; any deviations in the direction of worsening well-being are alarming and cause anxiety. Bleeding is what frightens expectant mothers the most. Why does bleeding occur in the first half of pregnancy?

Why does bleeding occur in early pregnancy?

Bleeding, especially early in pregnancy, is dangerous symptom, which may lead to irreversible consequences. Even if there is very little blood, you cannot ignore the discharge; you should immediately consult a doctor for advice and medical help. Statistics say that about 20% of pregnant women experience bleeding at the beginning of pregnancy, and about 100 Russian women die annually from complications associated with them.

Bloody discharge can occur for various reasons. Among them are the following:

• risk of miscarriage;
• miscarriage;
• ectopic pregnancy, when a fertilized egg attaches and begins to develop outside the uterus;
• non-developing or frozen pregnancy, in which the fetus dies in utero;
• implantation (introduction) of an egg into the inner layer of the uterine wall;
• hydatidiform mole;
• inflammatory processes - cervical erosion, uterine fibroids, cervical canal polyps, endometriosis;
• abnormalities of embryonic development (chromosomal abnormalities);
• hormonal imbalances - deficiency of progesterone (the so-called pregnancy hormone);
• trauma (blow, bruise) to the abdomen;
• rough sex.

Causes of bleeding

Ectopic (ectopic) pregnancy is a phenomenon in which a fertilized egg attaches outside the uterus - on the cervix, ovary, fallopian tube, abdominal cavity.

The main reason ectopic pregnancy is obstruction of the fallopian tubes. Such a deviation may occur due to various diseases in the anamnesis:

• infections (chronic or transferred) of the uterus and appendages;
• tumors;
• adhesions and scar tissue as a result of inflammatory processes;
• adnexitis - inflammatory disease of the appendages;
• endometriosis - inflammation of the mucous layer of the uterine cavity;
• surgeries on female genital organs;
• abortion;
• hormonal disorders;
• anomalies of pipe development;
• intrauterine device.

The risk of ectopic pregnancy increases with age.

Another cause of bleeding is a non-developing pregnancy. This is an abnormal cessation of embryonic growth and development, which most often occurs before 3 months. Factors that provoke fading of pregnancy:

• pathologies of the internal genital organs;
• intrauterine infections leading to fetal malformations:
  • herpes,
  • rubella,
  • toxoplasmosis,
  • cytomegalovirus;
• autoimmune disorders, such as antiphospholipid syndrome;
• hormonal disbalance;
• IVF (in vitro fertilization);
• severe stress;
• hard physical labor;
• some medications;
• bad habits - alcoholism, smoking, drug taking.

Uterine bleeding may indicate a threat of spontaneous abortion or a miscarriage. Factors that provoke miscarriage may be:

• hormonal imbalance - progesterone deficiency or androgen excess;
• Rh factor conflict;
• immune disorders;
• genetic failures - chromosomal mutations;
• sexually transmitted infections;
• diseases of the genital organs - uterine fibroids, endometriosis;
• isthmic-cervical insufficiency, which can develop due to mechanical injuries to the cervix during abortion, difficult childbirth or hormonal abnormalities;
• infectious and inflammatory diseases:
  • viral hepatitis,
  • angina,
  • rubella,
  • pyelonephritis,
  • appendicitis;
• chronic diseases of the heart, blood vessels, kidneys;
• abdominal injuries;
• severe stress, which cannot be the root cause of miscarriage, but is a predisposing factor;
• endocrine diseases.

Hydatidiform mole is another cause of heavy uterine bleeding. This pathological condition, in which normal development of the embryo does not occur (it may be completely absent), and the trophoblast (the outer layer of cells of the fertilized egg) grows. During the normal course of pregnancy, the placenta is formed from the trophoblast; in the case of a hydatidiform mole, this does not happen. The cause of this pathological deviation is considered to be the absence or incomplete set of chromosomes of the mother in the presence of a double chromosome set of the father. This phenomenon can occur if 2 sperm simultaneously fertilize an egg with developmental anomalies - nuclear-free or with a delay in chromosome set. Viral or infectious diseases, lack of estrogen, and genetic mutations are considered to be provoking factors for the drift. The cause-and-effect relationships of hydatidiform mole have not been fully studied.

Implantation bleeding occurs in approximately 30% of pregnant women and is not particularly dangerous. They look like scanty menstruation. This bleeding occurs a few days after ovulation or 7 days before the expected start date of menstruation. The fertilized egg penetrates the epithelium of the inner layer of the uterus, thereby damaging the blood vessels.

Breakthrough bleeding (breakthrough menstruation) at the beginning of pregnancy indicates hormonal imbalances. Sometimes this happens repeatedly in the first months of pregnancy, and the discharge resembles ordinary menstruation, which is why the expectant mother may not be aware of her special situation. This phenomenon occurs due to sudden hormonal changes in the female body.

Minor bleeding can be triggered by exacerbation of gynecological diseases, such as cervical ectopia, polyps, uterine fibroids and others.

Symptoms of bleeding during pregnancy

The leading symptom, regardless of etiology, is discharge with blood from the vagina; it can be scanty or abundant, with or without mucus, clots. Depending on the factor that provoked the bleeding, other manifestations are added.

Ectopic pregnancy

The danger of ectopic pregnancy is that it proceeds in the same way as a normal one, that is, the woman experiences symptoms characteristic of healthy pregnancy:

• nausea;
• fatigue;
• malaise;
• swelling of the mammary glands;
• weakness;
• delay of menstruation.

The embryo develops, grows, and manifestations appear that are characteristic of ectopic pregnancy:

• intense pain, almost unbearable, in the lower abdomen or on the side where the egg is attached;
• pain increases with movement, bending;
• bright red blood - in case of cervical pregnancy;
• with tubal pregnancy - brown discharge;
• feeling of lightheadedness;
• loss of consciousness.

If the pregnancy is cervical, then the bleeding is very heavy and prolonged, since this place is rich in blood vessels.

Symptoms of a non-developing pregnancy

At the very beginning of pregnancy, especially if it is the first pregnancy, a woman may not immediately understand that something is wrong with the fetus. Most often, pregnant women go to the doctor when heavy bleeding begins - the uterus spontaneously tries to reject the dead fetus. Bleeding does not start immediately when pregnancy is fading. The first symptoms of this condition:

• manifestations of toxicosis cease, if it was observed before;
• the mammary glands stop swelling and hurting;
• a nagging pain of moderate intensity is felt in the lower abdomen.

Then the pain may intensify, become cramping and spotting begins.

Risk of miscarriage

This condition manifests itself with three main symptoms:

• bleeding from the uterus (from light pink spotting to significant discharge reminiscent of menstruation);
• hypertonicity of the uterus, which is determined using ultrasound;
• nagging pain in the abdomen, which can radiate to the lower back.

Increased bleeding and deterioration of general condition most often indicate that a miscarriage is beginning. At the same time, the pregnant woman feels severe weakness, dizziness, nausea, increased pain. The discharge is initially small brownish or red with mucus, but after 1–2 days it becomes abundant, with large clots. Bleeding becomes more severe with straining and movement.

There are several stages of miscarriage:

1. Threat of abortion - slight spotting and painful sensations are observed. In this case, the child can be saved.
2. The beginning of a miscarriage - the pain becomes cramping, the bleeding intensifies. Pregnancy can still be saved.
3. Spontaneous abortion is common, the main symptoms are intense pain and a lot of blood with clots. It is no longer possible to maintain the pregnancy.

Video - signs of early miscarriage

Signs of a hydatidiform mole

Along with bleeding, a woman experiences symptoms characteristic of early toxicosis:

• nausea;
• fatigue;
• change in taste;
• vomiting;
• dizziness;
• weakness;
• increasing symptoms of liver failure.

In the discharge, you can often find characteristic bubbles that have come off the chorionic villi (the embryonic part of the unformed placenta). Discharge with blood during hydatidiform mole is frequent, abundant, and leads to the development of anemia.

Hydatidiform mole can be complete (simple), incomplete (partial) and destructive, when the altered chorionic villi grow into the uterine wall. This form is the most severe and often causes severe internal bleeding, and the growth itself becomes malignant.

Implantation bleeding

This type of bleeding does not affect normal course pregnancy and is characterized by scanty discharge or a small amount of pure blood. Discharge caused by implantation of an egg into the uterine wall never occurs. dark color and can last literally from one hour to 2-3 days. At this time, the pregnant woman may feel slight pain in the lower abdomen, but most often there is no pain.

Signs of breakthrough bleeding

The discharge resembles regular menstrual blood, only in a smaller volume. This phenomenon occurs once at the very beginning of gestation or can be repeated for another 3-4 months.

Bleeding due to gynecological diseases, such as erosion, is usually mild and not accompanied by other symptoms.

Bleeding due to mechanical damage to the vagina or cervix during a gynecological examination or after intense sex also does not differ in intensity. Most often they manifest themselves as light spotting discharge, end quickly and do not recur.

Diagnosis of uterine bleeding

Diagnosis always begins with an examination of the pregnant woman, an objective assessment of her condition, the nature of the discharge, and anamnesis collection in order to establish the presence or absence of diseases that provoked bleeding. Laboratory and hardware examination of the patient gives the doctor a clear idea of ​​the cause of the bleeding and determines further treatment tactics. A standard examination of a pregnant woman with bleeding includes:

• clinical blood test;
• determination of blood group and Rh factor;
• blood chemistry;
• blood test for syphilis, HIV, hepatitis;
• clinical urine analysis;
• coagulogram (test for blood clotting);
• Ultrasound of the pelvic organs, preferably transvaginal method.

Further additional examinations depend on the identified pathologies. It can be:

• blood for hCG;
• hormone analysis;
• analysis for TORCH infections (toxoplasmosis, herpes, cytomegalovirus, rubella);
• smear for sexually transmitted infections.

Diagnosis of ectopic pregnancy always begins with an examination in a chair. The doctor can determine the place of attachment of the fertilized egg by the appearance of bloody discharge. A blood test is performed for hCG (human chorionic gonadotropin hormone) over time. With a healthy pregnancy, the level of the hormone doubles daily, but with an ectopic pregnancy it does not. Ultrasound is prescribed using the transvaginal method, when the sensor is inserted through the vagina. The method allows you to determine the place of attachment of the fetus. In doubtful cases, culdocentesis is used - a puncture of the posterior vaginal wall. Based on the nature of the aspirate (fluid extracted during puncture), the doctor can diagnose an ectopic pregnancy.

The doctor determines a frozen pregnancy by collecting and analyzing complaints and anamnesis (how long ago the discharge and other symptoms began, concomitant gynecological diseases, the functionality of the reproductive system). A gynecological examination indicates that the uterus is smaller than it should be at this age. In a blood test for hCG, the values ​​​​lag significantly behind the level during a normal pregnancy. Using an ultrasound, it is determined that the size of the fetus is smaller than expected and there is no heartbeat.

Diagnosis of threatened miscarriage and spontaneous abortion involves collecting anamnesis and complaints. Ultrasound shows hypertonicity of the uterine walls. When there is a threat, individual areas of uterine tone are clearly visible; when the process of abortion begins, contraction of all the walls of the uterus and detachment of the fertilized egg are visible. If a miscarriage is suspected, the doctor conducts an examination on a chair with a two-manual vaginal examination, that is, by touch he determines the size and tone of the uterus, and whether the cervix is ​​dilated.

It is quite easy for a specialist to diagnose hydatidiform mole. The doctor examines and ultrasonography. On an ultrasound, a specialist observes a picture characteristic of a hydatidiform mole. This examination is most often sufficient to make a correct diagnosis.

Treatment of bleeding

The causes of bleeding can be completely different and the consequences can be completely unpredictable, so if bloody discharge appears, you should immediately seek medical help.

If the discharge is very slight and is not accompanied by pain, you can independently contact a gynecologist at the antenatal clinic, provided that she is nearby. In case of heavy bleeding, pain, or deterioration in health, you must call an ambulance immediately! Before the team arrives, you need to lie down and place a pillow or soft cushion under your feet. You should not take any medications, so as not to smear clinical picture. The most dangerous condition that can cause bleeding is ectopic pregnancy. In this case, every minute counts.

Treatment of uterine bleeding is carried out depending on the reasons that caused it. In any case, the patient needs rest and strict bed rest.

Therapy for the threat of spontaneous abortion and the initial stage, if there are no deviations in the development of the embryo, is aimed at preserving the fertilized egg. The following drugs are prescribed:

• hemostatic - Dicynon, Tranexam, Vikasol, aminocaproic acid;
• to reduce the tone of the uterus, antispasmodic drugs - No-shpu, papaverine, magnesium sulfate;
• progesterone preparations - Utrozhestan, Duphaston;
• vitamin products - MagneB6, folic acid, Iodomarin, vitamin E.

Drugs used to treat bleeding in early pregnancy - gallery

Dicynone is used as a hemostatic drug Tranexam is effective for uterine bleeding Vikasol is prescribed for bleeding of various etiologies No-Shpa is used as an antispasmodic for increased uterine tone Magnesium sulfate is used to relieve spasms, for increased uterine tone Duphaston and Utrozhestan - hormonal drugs, which are prescribed for progesterone deficiency. A complex preparation for pregnant women with magnesium and vitamin B6 in the composition.
Folic acid belongs to the group of B vitamins and is used as a stimulator of hematopoiesis.

If treatment is started on time and all medical recommendations are followed, pregnancy can most often be saved. Emotional peace and refusal of sexual activity also play an important role in this case. After the pregnant woman’s condition has normalized and the bleeding has stopped, the doctor may prescribe tincture of valerian or motherwort for a sedative effect.

A pregnant woman should eat fully and balanced. Her diet should include food rich in protein - dairy and dairy products, meat, liver, eggs, fish. Every day, the expectant mother needs to eat fresh vegetables and fruits, especially those rich in vitamin C - citrus fruits, apples, currants, tomatoes, bell peppers, zucchini, potatoes, cauliflower. It is very important to include vegetable oils and fatty fish in the diet - to strengthen blood vessels and harmonious development healthy pregnancy.

Of the physiotherapeutic methods, gynecologists give preference to electrophoresis with magnesium to reduce the tone of the uterus. For the same purpose, acupuncture, an electro-relaxator device, or endonasal galvanization are sometimes used - the effect of galvanic current on certain areas.

If spontaneous abortion still cannot be prevented, an operation is performed to remove the remains of the fetus and scrape out the uterus. After surgical intervention Oxytocin is prescribed - a drug for contracting the walls of the uterus and hemostatic agents. After surgery, antibiotics are indicated to prevent bacterial complications, as well as a course of hormonal and vitamin therapy. During this period, one should not neglect the prescribed drug treatment, otherwise there is a risk of complications in the form of inflammatory processes, which can ultimately lead to the formation of adhesions and infertility.

Ectopic pregnancy is always treated surgically. Laparoscopy or laparotomy is performed with removal of the fertilized egg and fallopian tube if it is significantly damaged and the organ cannot be saved. In case of cervical ectopic pregnancy, the bleeding is stopped and the embryo is removed. In some cases, it is necessary to remove the cervix and even the uterus itself while preserving the appendages.

If the bleeding is caused by a frozen pregnancy, then doctors choose the appropriate treatment tactics:

• observation (may be relevant only for several days after the death of the embryo) - due to a sharp drop hCG level the uterus begins to contract and expels the frozen fetus on its own;
• interruption through medications (can be used up to 8 weeks) - progesterone antagonists and other drugs that stimulate miscarriage are prescribed;
• operation - removal of the fertilized egg by curettage of the uterine cavity with a curette or vacuum aspiration.

After the operation, a course of antibiotic therapy is carried out, immunomodulators and restoratives - vitamins - are prescribed.

Treatment of hydatidiform mole also has its own characteristics. In more than 50% of patients, tumor tissue is isolated without medical intervention. Overgrown formations from the uterus are removed using one of the following methods:

• up to 12 weeks, manual removal is carried out, and then instrumental revision of the uterus;
• up to 20 weeks, the vacuum aspiration method is used. Curettage is used only for small tumors, otherwise there is a risk of perforation (violation of the integrity) of the uterine walls.

The removed tissues are sent for histological examination. If a hydatidiform mole has a destructive form, especially with severe bleeding, the threat of uterine perforation, or growth in the vagina, an operation to remove the uterus is performed. After such an operation, a course of chemotherapy is prescribed. For metastases to other organs, radiation therapy is sometimes performed.

Bleeding caused by hormonal changes in the body in the early stages of pregnancy does not require special treatment. In some cases, doctors will prescribe hormonal medications.

If we talk about alternative medicine, then besides tinctures of valerian and motherwort, it is not recommended to drink other herbs, since they are most often ineffective and can even worsen the situation.

Video - bleeding during pregnancy, therapy

Complications and consequences of uterine bleeding

The most severe complications can occur during ectopic pregnancy:

• rupture of the pipe - entails severe bleeding into the abdominal cavity, which can be fatal;
• tubal abortion, when the fetus enters the sterile abdominal cavity, can threaten the development of purulent inflammation of the peritoneum - peritonitis.

The most severe consequence of an ectopic pregnancy is the loss of reproductive organs during surgery and subsequent infertility.

If you delay seeking medical help, a miscarriage can result in:

• large blood loss;
• inflammatory processes - salpingoophoritis, endometritis;
• adhesions;
• difficulties with conceiving and bearing a healthy baby;
• infertility.

The loss of a child is a huge stress for a woman and can provoke depression and serious psychological disorders.

Bubble drift is fraught with the following consequences:

• amenorrhea - absence of menstruation;
• high risk of complications during childbirth - anomalies labor activity, bleeding;
• sepsis;
• metastases in malignant course;
• infertility.

A frozen pregnancy is dangerous due to endometritis; the decomposition of a dead fetus can cause peritonitis and sepsis.

Prevention of bleeding in early pregnancy

Pregnancy needs to be planned. Before you think about conceiving a child, you need to undergo a full examination of the body, eliminate all foci of infection, and, of course, special attention should be paid to the health of the reproductive system. During pregnancy, it is necessary to visit an antenatal clinic in a timely manner, undergo regular examinations by a gynecologist, and take the required tests. It is imperative to maintain a positive emotional background, go for walks more often fresh air, eat right, drink clean water. Refuse bad habits costs long before the planned pregnancy. You should not take any medications without a doctor’s prescription, and if you have suspicious symptoms, you should immediately contact a gynecologist.

No one will argue that pregnancy is the most wonderful period in the life of every woman, but we should not forget that this is a period of extraordinary responsibility, attentiveness and, unfortunately, anxiety, first of all, about the state of one’s health. It is the body that gives us the first signals that something is wrong. Of course, you shouldn’t ignore them: it’s better to be on the safe side with a doctor than to cause damage to your health and that of your baby.

Is there bleeding during pregnancy? A fairly common occurrence during pregnancy. Occurs in more than 20% of women. And, as a rule, in half of the cases it goes away on its own and does not indicate any violations. But in the other half of cases, bleeding is dangerous, since it can end. This is signaled by the appearance of dark blood clots.

Secondly, they can also appear due to hydatidiform mole - a condition when the placental tissue begins to grow. Bleeding in such cases is profuse, but painless. In this case, curettage is performed and the hormonal status is monitored for about six months.

Another cause of bleeding is chromosomal abnormalities or other defects, which, unfortunately, are incompatible with the life of the fetus. In any case, pregnancy will end in spontaneous miscarriage. After a miscarriage, a woman must consult a doctor to prevent the development of post-hemorrhagic shock. Usually in such situations, diagnostic and therapeutic curettage of the uterus is performed so that there are no remnants of the fertilized egg, placenta, or ruptured vessels left in it. After - the woman will pass examination to determine the real cause of the miscarriage.

Bleeding may occur if the woman did not notice the miscarriage that had occurred. In this case, after rejection of the fertilized egg, bleeding begins after some time, caused by the remains of the embryo and its membranes in the uterine cavity. In such a situation, you should consult a doctor immediately! He will urgently do a curettage.

Also a cause of bleeding. This is a condition when pregnancy develops outside the uterine cavity. Most often it occurs due to partial or complete obstruction of the fallopian tubes. Unfortunately, in such a situation, as a rule, one tube is removed and the abdominal cavity is washed out. If you do not consult a doctor in a timely manner, peritonitis may occur.

Bleeding occurs in the case of a “frozen” pregnancy. A week after intrauterine death of the fetus, spontaneous miscarriage will begin.

Bleeding in later stages is no less dangerous, since in the second or third trimester bleeding is a clear indicator of pathology and becomes a threat to the life of the baby and the health of his mother. That is why you should be very attentive to all the signals from your body.

The first cause of bleeding later- placental abruption. At risk are women with preeclampsia, abdominal injuries, and polyhydramnios. In addition to bleeding (which in some cases may not occur), there will definitely be severe pain throughout the abdomen. The condition of the fetus will also deteriorate sharply, and therefore doctors will urgently decide on the issue of surgical delivery. Placenta previa is also common: when it is located in the area of ​​the internal os of the cervical canal. Due to the thinning of the uterine wall, blood vessels rupture and bleeding begins. Its color is bright scarlet. The baby does not suffer, but the mother’s body does.

Bleeding may also occur due to erosion of the cervix, fibroids, or due to trauma to the genital organs.

How to stop bleeding during pregnancy

It is not possible to stop uterine bleeding that has started during pregnancy on your own. Even if hemostatic drugs are at hand, this will not solve the problem. After all, the danger lies in the pathology as a whole that caused the bleeding, and not just in the very fact of bleeding.

In each individual case, treatment will be different, depending on the cause of the bleeding and the woman’s condition. Doctors’ priority is always the life of the expectant mother, and if she is not in danger, then the life of the child: they will certainly try to save him.

Thus, if bloody discharge from the genital tract appears during pregnancy, you should immediately consult a doctor. If real bleeding begins (blood from the vagina is released into the large quantities, and not in the form of spotting, and has a bright red color), then without delay, without wasting a minute, you should go straight to the hospital. If there is such an opportunity, then it is better not to wait for an ambulance or taxi to arrive, but to go to the medical facility in your own car, saving time.

In some cases, your doctor may recommend blood-stopping medications as emergency treatment. For example, if there is every reason to believe that pregnancy is in danger of failure, and there is no opportunity to appear for an in-person examination with a doctor (for example, the woman is away from settlement), then you need to contact your doctor by phone for advice. Dicinone injections are often used to stop uterine bleeding. An antispasmodic (No-spa), a sedative (valerian or motherwort) is also required; in some cases, a drug containing progesterone may be needed.

The doctor will certainly prescribe bed rest for his ward, maximum physical (including sexual) and emotional rest. A woman needs to lie down all the time, raising her legs to a height. You can only get up when absolutely necessary, avoiding sudden movements and turns.

There are often cases when bleeding during pregnancy can only be stopped through surgery. Still, much more often the outcome turns out to be successful, with only one caveat: if a woman applies for professional help. Therefore, be responsible to yourself and your future baby - do not hesitate.

Very often, you can prevent the opening of bleeding if you recognize the signs of a threatened miscarriage at the very initial stage and take the necessary measures. Indeed, the onset of bleeding is often preceded by a deterioration in the pregnant woman’s condition, the appearance of characteristic pains, contractions and spasms of the uterus, which the woman clearly feels by tension and petrification of the lower abdomen. Any of these signs should be a reason to see a doctor.

Especially for- Tatyana Argamakova

Bleeding is one of the fairly common complications that accompany pregnancy. For most expectant mothers, spotting causes concern, and sometimes real panic. Indeed, even minor discharge may indicate a risk to the development and preservation of the fetus. However, the condition does not always signal a threat of miscarriage.

The nature of bleeding may vary. For some, it is a weak spotting discharge without pain, for others it is strong, sometimes profuse, accompanied by cramping pain in the lower abdomen, chills, and dizziness. According to statistics, such a pathology occurs in 20-25% of pregnant women.

The expectant mother must remember: whatever the causes of the pathological condition, she must inform the gynecologist about them. Any discharge, even very scanty and not causing discomfort, is regarded as a pathology and can be dangerous for the development of the fetus. Bleeding is most often diagnosed in the first trimester of gestation.

Causes of pathology in the early stages - up to 15 weeks

Sometimes small spotting of a brown or dark color occurs at the very beginning of pregnancy, at 2 weeks. Some women may mistakenly perceive them as the beginning of menstruation. In fact, this is the result of the attachment of the fertilized egg to the wall of the uterus. Implantation bleeding may occur somewhat later, even at 5 weeks. It is not dangerous and does not cause discomfort.

At the beginning of pregnancy, bleeding after intercourse is possible. If it is minor, there is no need to worry. But if they become regular and are accompanied by other negative sensations, there is a threat of termination of pregnancy.

Let's look at the main causes of bleeding during pregnancy:

1. Miscarriage. Spontaneous abortion before 28 weeks. It occurs for various reasons. Among them are pathologies of the structure of the genital organs, endocrine and infectious diseases, genetic pathologies of the fetus, stress, excessive physical activity or injuries. The risk of miscarriage is very high when bleeding occurs at 8 weeks of gestation.
2. . It occurs as a result of tubal obstruction, when the fertilized egg cannot penetrate the uterine cavity for further development. Bleeding in this case often occurs at 6 gestational weeks, when the fallopian tube can no longer stretch. This is an extremely dangerous condition for a woman, which requires immediate surgical intervention.
3. . Usually occurs in the early stages. During a frozen pregnancy, the bleeding is not severe and is accompanied by minor pain in the lower abdomen. The woman is required to undergo mandatory hospitalization for curettage of the uterine cavity and removal of the fertilized egg.
4. . With this pathology, bloody discharge is accompanied by the discharge of small bubbles. Vacuum aspiration and sometimes removal of the uterus are indicated.
5. , fibroids, polyps. These neoplasms in the organ cavity are not directly related to pregnancy, but can cause bleeding at 3-4 weeks and later.
6. Infectious diseases. They can not only cause severe bleeding, but also harm the development of the fetus. Therefore, such diseases require immediate treatment.
7. Insufficient progesterone levels.

Some procedures can cause a small discharge mixed with blood, for example, taking blood from the umbilical cord (cordocentesis) or testing amniotic fluid(amniocentesis).

During a miscarriage, contractions occur in the uterus, which tries to get rid of the fetus. One of the signs is discharge with clots, and sometimes together with fragments of tissue of the fertilized egg. If the pregnancy could not be maintained and a spontaneous abortion took place, curettage of the uterine cavity will be a mandatory procedure, since even minor remnants of the fertilized egg can cause an infectious process and other complications. The presence of clots may also indicate a missed pregnancy.

• At week 10, a pathological condition may occur due to disorders of the blood coagulation system.
• At week 11, the risk of miscarriage decreases, but this does not mean that the appearance of spotting should not alarm a woman. They can appear after violent sexual intercourse, physical trauma or severe overheating, for example, after visiting a sauna.
• At 13-15 weeks, a woman is recommended to undergo tests to identify possible fetal malformations. Such tests will help avoid complications in the second half of pregnancy.

Impact of ultrasound examination

Today, an integral part of mandatory screening is the procedure. Some expectant mothers fear that the procedure may harm the baby. You can often hear that after an ultrasound, a woman started bleeding.

The discharge in this case is insignificant, lasts no more than two days and does not harm either the mother or the unborn baby. They can be caused by hypersensitivity of the internal genital organs or accumulation of blood.

Bleeding in the second half of pregnancy

If bleeding in the first half of pregnancy is associated with a risk spontaneous miscarriage, in later stages it is most often associated with pathology of the placenta.

• Placenta previa

Occurs in 2-5% of pregnant women when the placenta is not positioned correctly. There are complete and partial presentations. In the first case, scarlet bleeding without pain is observed. In case of partial presentation, opening of the amniotic sac is indicated to correct the condition.

This pathology is dangerous for the expectant mother, as it can cause hemorrhagic shock. It also negatively affects the condition of the unborn child, increasing the risk of premature birth.

• Premature placental abruption

Always accompanied by bleeding. Can cause late toxicosis, multiple pregnancy or large fruit, heart defects, physical trauma (fall), abnormalities of the uterus. Women experience severe pain in the lower abdomen and increased tone of the uterus. The fetus experiences hypoxia due to insufficient oxygen and other elements useful for development.

• Uterine rupture

The blood is bright scarlet and severe abdominal pain indicates excessive stretching and thinning of the walls of the uterus, destruction of the muscle layer. Occurs during a hydatidiform mole or in the presence of scars on the uterus left after a previous pregnancy. Doctors recommend not getting pregnant after a cesarean section for at least two years.

• Bleeding from fetal vessels

A rare pathology that occurs no more than one case per 1000 births. The cause may be damage to the umbilical cord or blood vessels of the fetal membrane.

Bleeding in the second half of pregnancy is dangerous because it can provoke hemorrhagic shock in the mother, premature birth, birth of a child with developmental pathologies.

Elimination of bleeding

What to do if pregnancy is accompanied by significant or scanty bleeding? First of all, a woman must remain calm and not panic. Not in all cases such a violation leads to fetal death.

Of course, yes, provided that you register with the antenatal clinic in a timely manner and immediately apply for medical care. Even if the discharge is minor and your overall health is good, you should consult a doctor as soon as possible.

To find out how to stop bleeding, you need to determine the cause of its occurrence. To do this, the woman is sent to undergo tests and undergo the following diagnostic procedures:

• general urine and blood tests;
• blood test for HIV and syphilis;
• Ultrasound of the pelvic organs;
• blood test for hCG levels;
• vaginal examination.

If there is a suspicion of an ectopic pregnancy, a diagnostic test is performed.

The main goal of treatment in the early stages of gestation is to stop bleeding and prevent miscarriage.

Treatment includes the following:

• hemostatic drugs – Dicynon;
• antispasmodics that reduce uterine tone - No-shpa;
• hormonal drugs that provide the level of progesterone necessary to maintain pregnancy - Duphaston, Utrozhestan;
• sedatives (tinctures of motherwort, valerian);
• vitamin therapy – Magne B6, vitamin E, folic acid.

In case of a frozen pregnancy, it is mandatory. After the procedure, hormonal therapy and drugs aimed at restoring the functions of the circulatory system are prescribed. If a woman is diagnosed negative Rh factor, after curettage, she is injected with anti-Rhesus immunoglobulin to prevent Rh-conflict.

Treatment of ectopic pregnancy is only surgical. During surgery, the fertilized egg embedded in the tube or the fallopian tube itself is removed.

After the first successful results of treatment, when the pregnancy can be maintained, the woman is given complete rest. In some cases, bed rest is recommended. Intimate life if there is a threat of miscarriage, it should be completely stopped. All prescribed medications must be taken for a long time, even in the absence of bleeding and satisfactory health. The exact dosage and duration of administration are determined by the attending physician.

Therapeutic measures for placenta previa depend on the intensity of the discharge. If they are abundant, an immediate cesarean section is prescribed, even if the fetus is premature. Subsequently, the woman undergoes treatment aimed at restoring blood loss.

With scanty discharge, they are limited to opening the amniotic sac. However, if this measure is ineffective and the discharge does not stop, a caesarean section is also indicated.

Bleeding caused by placental abruption is more difficult to diagnose, since this pathology involves internal bleeding combined with external bleeding. In 25% of cases there is no external discharge at all. To stop the bleeding, a cesarean section is performed with further treatment to compensate for blood loss.

Can Clexane cause bleeding during pregnancy?

This drug is used to treat thrombosis, angina, and renal failure. Reviews about it may be contradictory. Indeed, taking Clexane increases the risk of miscarriage, so its use is only permissible under close medical supervision.

The drug "Clexan"

In addition to increasing discharge, the drug can cause side effects such as hemorrhoids and local allergies. It is prescribed in cases where the effectiveness of its use outweighs the possible risks.

Clexane is contraindicated for:

• threat of spontaneous abortion;
• diabetes mellitus;
• some diseases of the upper respiratory tract;
• tuberculosis.

Application of Duphaston

The drug is prescribed to replenish progesterone. This is a hormone necessary for a successful pregnancy. For bleeding during pregnancy, Duphaston is prescribed in the first trimester.

The drug "Duphaston"

The dosage is calculated individually, taking into account the patient’s hormonal disorders, the nature of the discharge and her general well-being. The most typical dosage is 40 mg of a single dose of the drug and further doses of 10 mg three times a day.

Duphaston is taken until the symptoms of threatened miscarriage completely cease. In the future, it is possible to change the dosage to maintain normal course carrying a child.

Like most medicines, Duphaston can cause side effects. These may be inflammatory processes in the kidneys, constipation, hemorrhoids. In some cases, negative reactions from the liver (signs of jaundice) may occur. With such side effects the drug is discontinued. It can be replaced with other drugs, for example, Utrozhestan. Duphaston does not have a negative effect on fetal development.

Self-medication at home using untested traditional medicine is unacceptable! Only the attending physician can prescribe hemostatic drugs and other medications!

Prevention

Every pregnant woman should carefully monitor her health. Expectant mothers who are included in the so-called risk groups should be especially careful.

Among the preventive measures aimed at avoiding pathological discharge during pregnancy, the following can be identified:

1. Maximum limitation of physical activity and emotional stress.
2. Avoid cycling, heavy lifting, fast running, strength sports, and walking on stairs.
3. If certain indicators are present, minimize, and in some cases completely eliminate, sexual activity.
4. Do not use tampons or douche, which may cause increased discharge.
5. Drink enough liquid (at least 8-10 glasses a day).

Important conditions for prevention are the prevention of abortions, proper contraception, treatment of gynecological diseases before conception, and the birth of children under the age of 35.

Bleeding in early pregnancy, as well as in the third trimester, is quite treatable. Compliance with all the instructions of the attending physician will allow the woman to avoid negative consequences and give birth to a healthy, strong child.

Bleeding during pregnancy is the most common pathology. And this is not just a pathology, but also a serious complication, which, unfortunately, not every pregnant woman is aware of. This is primarily due to the common misconception that you can have periods during pregnancy. But in fact, there should be no bleeding normally during pregnancy. Very rarely (in 3% of cases out of 100), some pregnant women experience slight spotting bleeding at the very beginning of pregnancy, when the woman does not yet know about her pregnancy. This occurs at the moment of attachment of the fertilized egg to the uterus, and, as a rule, corresponds to the expected period of menstruation. Only in this case is bleeding normal. In other cases, any bleeding is regarded as a pathology

Causes of bleeding during pregnancy

Bleeding can occur both early and late in pregnancy. Depending on how early or late the bleeding occurred, we can assume the pathology that caused the bleeding.

Bleeding on early pregnancy (up to 12 weeks of pregnancy), may indicate:

About the beginning of a miscarriage;
- about ectopic pregnancy;
- about a non-developing “frozen” pregnancy;
- about hydatidiform mole.

Bleeding in late pregnancy (after 12 weeks) may be due to abruption or placenta previa.

It should be noted that if bleeding occurs during pregnancy, this does not mean that it is associated specifically with fetal pathology. The reason for this may also be exacerbation of gynecological diseases in expectant mother- cervical erosion, uterine fibroids, cervical canal polyps and so on. Bleeding can also be caused by a banal injury to the genital organs.

Bleeding during pregnancy can be of varying intensity - spotting, moderate or heavy with clots. Quite often, bleeding is accompanied by painful sensations. The pain can be intense and sharp, spreading throughout the entire abdomen. Often they resemble contractions, as happens, for example, with a miscarriage. Or there may be a slightly noticeable nagging pain in the lower abdomen. In addition to pain and bleeding, a pregnant woman’s blood pressure decreases, her pulse quickens, and weakness appears. But it is impossible to make a diagnosis based on the nature and intensity of pain and bleeding, since with one pathology different women these indicators vary.

If the bleeding is insignificant, this does not mean that you need to lie at home and wait until it passes. Any bleeding during pregnancy is a reason for an emergency visit to a gynecologist. Such conditions can be dangerous for both the life of the fetus and the mother.

Diagnosis of the cause of bleeding during pregnancy

In order to identify the exact cause of bleeding, an examination by a gynecologist and a series of diagnostic studies in a hospital or maternity hospital are necessary.

During the examination, the doctor takes a smear from the vagina. A pregnant woman undergoes a general and biochemical blood test, a coagulogram, a blood test for HIV, hepatitis, and syphilis; general analysis urine. Her blood type and Rh factor are determined. An ultrasound of the pelvic organs and fetus is required.

Further, depending on the identified pathology, additional studies may be prescribed. So, in case of miscarriage, non-developing pregnancy the blood is additionally examined for hCG (human chorionic gonadotropin), hormones, tests are taken for TORCH infections (herpes, rubella, cytomegalovirus, toxoplasmosis); smear for sexually transmitted infections. If an ectopic pregnancy is suspected, a diagnostic laparoscopy is performed. In cases of hydatidiform mole, the level of hCG is also examined.

To diagnose the cause of bleeding in late pregnancy, additional studies, as a rule, are not required, due to the high informativeness of ultrasound.

Treatment of bleeding during pregnancy

Treatment is prescribed depending on the pathology and stage of the disease. When a miscarriage begins, measures should be aimed at maintaining the pregnancy and stopping bleeding. If, according to the results of an ultrasound, the fetus is viable, in the early stages of pregnancy hemostatic drugs (Ditsinon), antispasmodics to reduce the tone of the uterus (No-spa, suppositories with papaverine), hormonal drugs - gestagens (Duphaston or Utrozhestan) are prescribed until the 16th week of pregnancy to maintain progesterone levels - “pregnancy hormone”, vitamins and microelements (vitamin E, Iodomarin, folic acid, MagneB6). If the effect is good, the bleeding stops and the pregnancy continues. If a miscarriage does occur and the discharge is profuse, the uterine cavity is curetted to remove the remnants of the fertilized egg.

When the diagnosis of “frozen” pregnancy or hydatidiform mole is confirmed, as in the case of a miscarriage, curettage of the uterine cavity is indicated. After curettage, the hormone Oxytocin and hemostatic drugs are prescribed to contract the uterus. Bloody discharge after curettage stops after a week.

For ectopic pregnancy, treatment is surgical. A laparoscopy or laparotomy is performed and the affected fallopian tube is removed or the fertilized egg is squeezed out of the tube.

In case of placenta previa, if the discharge is insignificant, antispasmodics, magnesium drips, beta-adrenergic agonists (Ginipral), antiplatelet agents (Trental or Curantil) and vitamins are prescribed to maintain pregnancy. With placenta previa, bleeding may continue until delivery. All this time the woman is supposed to stay in the maternity hospital. When reaching full term (38 weeks of pregnancy), a cesarean section is performed. If the bleeding is heavy, a cesarean section is performed as an emergency, even if the fetus is premature. To compensate for blood loss, infusion therapy is performed (transfusion of fresh frozen plasma and red blood cells).

If placental abruption is suspected, an emergency cesarean section is performed, regardless of the gestational age and fetal viability. In parallel, infusion therapy is carried out.

All women with Rh-negative blood immediately after curettage, surgery for ectopic pregnancy and caesarean section anti-Rhesus D-immunoglobulin is administered to prevent Rh-conflict between mother and fetus when fetal blood enters the mother’s bloodstream.

All pregnant women who have experienced bleeding and managed to maintain pregnancy are advised to have sexual abstinence and emotional peace. Many drugs that are prescribed in the hospital must be used after discharge, even if there is no bleeding, in order to protect yourself from the repeated threat of miscarriage. If bleeding reappears, the pregnant woman should also immediately contact a gynecologist.

IN rehabilitation period after stopping the bleeding, sedatives are used - tinctures of motherwort or valerian. Non-drug and physiotherapeutic treatment is recommended - acupuncture, endonasal galvanization, and so on.

As for traditional medicine, except for tinctures of motherwort and valerian, which have been used in obstetrics for a very long time, it is better not to use other herbs for bleeding, since in most cases they are ineffective, and in the worst case, harmful during pregnancy and can further aggravate the situation.

Complications of bleeding during pregnancy:

Miscarriages that cannot be treated;
- antenatal fetal death;
- infectious complications, septic shock, which occurs due to the presence of tissue remains of a dead fetus in the uterine cavity;
- with large blood loss, hemorrhagic shock may develop, which can lead to death;
- Choriocarcinoma is a rare malignant cancer that can occur after curettage for hydatidiform mole.

Prevention of bleeding:

Natural family planning - no abortion;
- limitation of physical and sexual activity during pregnancy;
- timely treatment of chronic gynecological diseases (especially genital infections) before pregnancy;
- implementation of reproductive function up to 35 years.

Consultation with a doctor on bleeding during pregnancy

1. Can I use any medications to stop bleeding at home?
This is not possible, you must immediately consult a doctor.

2. How quickly can you get pregnant again after curettage?
After 3-6 months, after examination and appropriate hormonal treatment.

3. Do you have periods during pregnancy?
They don't.

4. Can bleeding occur during pregnancy due to sex?
They can.

5. She went into storage at 5 weeks. The bleeding did not go away and a miscarriage occurred, although she took hormones. Tell me, maybe the dose of hormones was insufficient?
Maybe, but unlikely. We need to find out why you had a miscarriage after the examination. The doctor probably prescribed hormones to compensate for the lack of progesterone in the body, which often happens with miscarriages. But a miscarriage can also occur due to genetic defects of the fetus (in 75% of cases) and then hormones have nothing to do with it.

6. How can you tell by the nature of the bleeding whether it is a miscarriage or a frozen pregnancy?
No way, only a doctor can determine for sure after an examination and ultrasound.

7. I have placenta previa. There is no more bleeding. Is it possible to have sex?
It is forbidden. It is necessary to abstain from sexual intercourse until delivery.

8.I started spotting after missing my period for a week. What is this?
Take a pregnancy test and see a gynecologist. Either it is pregnancy or ovarian dysfunction.

9. Can there be bleeding due to the bath?
Maybe all thermal procedures are undesirable during pregnancy, especially in the short term.

Bloody vaginal discharge during pregnancy, especially in the early stages, always worries women very much. And this, in general, is correct. Bleeding in such a situation can be a symptom of quite serious diseases and pathologies. However, is bleeding in early pregnancy always dangerous?

Of course not. Bloody discharge can be caused by a number of reasons, some of which are not dangerous at all. Below we detail all the reasons that can cause bleeding during pregnancy.

Implantation bleeding is considered by some experts to be one of the first signs of pregnancy. In any case, before implantation occurs, there cannot be any other signs, since the fertilized egg has not previously been in contact with the mother’s body and is, as it were, suspended in the uterus.

During implantation, the fertilized egg, which penetrates the uterine mucosa, can damage a small blood vessel, resulting in minor bleeding in the first month of pregnancy.

Usually implantation occurs around the 25-28th day of the cycle, that is, approximately when the next period should begin. It is with menstrual bleeding that implantation bleeding is most often confused, because a woman usually simply has no idea about pregnancy during this period.

However, the nature of the discharge during this period differs significantly from menstruation. The discharge is much less abundant and usually lasts 1-2 days. There is no increase in bleeding, as during menstruation.

Breakthrough bleeding

Breakthrough bleeding is bleeding that occurs as a result of a hormonal breakthrough in the menstrual cycle. Due to a sharp change in hormonal levels at the beginning of pregnancy, coupled with minor hormonal disturbances, in some cases bleeding occurs, coinciding with menstruation, but much less heavy than menstrual bleeding.

Such bleeding can be repeated not only in the first month, but also several more times. Because of this, some women do not even realize they are pregnant until 3-4 months. Actually, this explains why you can’t rely only on late periods when diagnosing pregnancy; you always need to pay attention to several signs.

Breakthrough bleeding is also not particularly dangerous and is not a symptom of the disease.

Infections and erosion as causes of bleeding in the early stages

Infectious and inflammatory processes in the cervix and cervical canal can also cause bleeding in early pregnancy. In this case, spotting will appear after any traumatic actions: sex, examination by a gynecologist, physical activity and so on.

This group of causes of bleeding during pregnancy includes, for example, cervical erosion. This phrase hides damage to the mucous membrane of the cervix, which can be either congenital or acquired as a result of various diseases and injuries.

In most cases, the disease is asymptomatic and does not cause any inconvenience to the patient. However, in some cases, bleeding and pain occur.

Erosion does not in any way affect pregnancy, fetal development or the birth process. Therefore, some doctors argue that there is no need to treat it during pregnancy. Other experts insist that it is still worth treating erosion. Of course, the woman herself will still decide. Study the information, weigh the pros and cons, and make a decision: whether to treat erosion immediately or wait until after pregnancy.

With an infection there is no choice. If bleeding is caused by an infectious disease, it must be treated. Moreover, as quickly as possible. Almost all infections have a negative impact on fetal development. In the worst cases, changes can render the fetus nonviable and cause miscarriage.

It is usually recommended to treat infections before the start of pregnancy, but this is not always done. And no one is safe from infection after conception.

Risk of miscarriage

The most serious and unpleasant cause of bleeding, and at the same time, unfortunately, far from the rarest, is. Behind this phrase lies a whole galaxy of reasons and diagnoses, some of which leave expectant parents at least a ghostly hope of maintaining the pregnancy, some of which are a death sentence.

Unfortunately, or fortunately, it depends on which side you look at: most early miscarriages occur in the first 4 weeks, when the woman simply does not know about her pregnancy. On the one hand, in this case, hope for maintaining the pregnancy drops, and on the other, the woman has not yet gotten used to, and has not even begun to get used to, the idea that she will become a mother.

The chances of fetal survival are minimal even if the cause of the miscarriage is genetic abnormalities. In such a situation, the mother’s body rejects the nonviable fetus. Often, miscarriage begins after the death of the fetus.

The cause of the threat of miscarriage can be various chronic and infectious diseases of the mother, abnormalities in the structure of the uterus, hormonal imbalances, Rh conflict, and so on. The risk of experiencing a miscarriage increases with age, as well as with multiple pregnancies. Women who smoke, drink and use drugs are also at risk.

What to do if there is bleeding?

As you can see, bleeding does not always indicate some serious threats and diseases. However, this does not mean that when spotting appears, you can relax and not worry.

You should consult a doctor in any case. It is unlikely that a woman will be able to diagnose herself without making a mistake. Is it worth risking your child, and your health, and sometimes your life?

If it turns out that there is a threat of miscarriage, then how quickly the woman gets to the doctor will determine whether she will be able to maintain the pregnancy. In addition, if bleeding is not stopped in time, not only the embryo, but also the pregnant woman can suffer.

If bleeding occurs, it is necessary call an ambulance and lie down. Peace is the most important recommendation, which should not be violated under any circumstances.

It is also not recommended to get to the hospital on your own. Walking and traveling on public transport are very serious stresses if there is a suspected risk of miscarriage.