BLEEDING IN PREGNANCY
Any vaginal bleeding should be seen by a doctor immediately!
Bleeding in the first few weeks may be harmless(spotting),and resolves with bed rest..but a doctor MUST be consulted,no matter however little or painless the bleed is.
Bleeding can be due to Placental separation(abruptio placentae),Placenta in the lower part of uterus(placenta previa),Preterm labor,Abortions,Ectopic pregnancy(foetus away from normal position in uterus,like inside the fallopian tube).Molar pregnancy
ABRUPTIO PLACENTA
Most common cause of vaginal bleed after 28th week,usually associated with severe pain,cramps,faints.
The placenta becomes separated from the uterus either in part or in total,leading to death of foetus,if not attended to immediately.The common causes are smoking,alcohol,drugs,hypertension during pregnancy,blunt injury.Bleeding can be mild to severe,and requires urgent hospitalisation.In mild cases,the pregnancy is continued,with bed rest.More severe cases will need delivery of child through cesarean section.Mother may need blood transfusions.
PLACENTA PREVIA
The placenta may cover the cervical opening either partially(marginal) or totally(complete),and is detected during examination,or ultrasound scan.Usually the pregnancy proceeds to full term and normal delivery is possible in the partial type ,but will require delivery by cesarean in the complete type.
PRETERM LABOR.
Labor before 37th week(Normal is at 40th week).Exact cause not known,but usually seen in very young or very old mothers.Also in mothers with smoking,alcohol,infections of vagina,bladder,multiple pregnancy,large amount of fluid in uterus(polyhydramnios).
The mother may feel abdominal cramps,increasing in intensity,with vaginal discharge of blood.
Most are managed with bed rest and drugs to reduce uterine contractions,but in advanced cases may require delivery and care of baby in ICU if delivered before 37th week.If possible,delivery may be delayed by two days to give the mother 2 doses of corticosteroids to help the maturation of the baby's lungs.
ECTOPIC PREGNANCY
In this condition,the foetus develops away from the normal place in the uterus,usually in the tubes.The mother experiences pain in one side of the abdomen,irregular bleed,usually by the 7-8 week.If there is rupture of the tube,in untreated cases,severe bleeding may cause shock and death.
Causes could be previous surgeries,Intrauterine contraceptive devices,infections in the past,which cause block or obstruction to movement of the egg,after its release from ovary.
Will need to be removed as soon as diagnosed.
MOLAR PREGNANCY
sometimes a part of placenta,or remnants of placenta from a previous pregnancy,may develop as a tumor that looks like a bunch of grapes.The patient will experience all the symptoms of a normal pregnancy,like increase in abdominal size,cessation of menses,severe morning sickness(vomiting),but will have occasional episodes of vaginal bleed with discharge of grapes like masses.An ultrasound scan and blood test for HCG(very high levels) will reveal the condition.
Treatment is removal of the mass(Along with the foetus if present,which does not develop,or is abnormal).Usually cured completely after removal.The patient will require periodic checkups to look for recurrences.Sometimes may require chemotherapy.
