What Is an Antepartum Hemorrhage?

The normal placenta should be attached to the upper part of the uterus. If it is attached to the lower part of the uterus or directly covers the inner cervix, it is called placenta previa. When the uterus is irregularly contracted in late pregnancy, or the lower part of the uterus is dilated after childbirth, the placenta covering the cervix can be separated from the uterus and cause bleeding. Placenta previa is common in women with multiple miscarriages, endometrial inflammation, or atrophic lesions. The bleeding is not painful. Pregnant women often have little or no back pain or falling sensation. Vaginal bleeding can be repeated, many times, and a small amount, which can cause severe anemia in pregnant women. It can also cause massive bleeding at one time, which can cause pregnant women to fall into shock. Failure to handle it in time will lead to maternal and child death.

Prenatal bleeding

Prenatal bleeding refers to vaginal bleeding that occurs prenatally after 28 weeks of pregnancy. Traumatic pregnancy, excessive labor, dystocia, uterine surgery, multiple births, polyhydramnios, improper fetal position, etc. are all likely to cause prenatal bleeding. In addition, pregnant women themselves have the following problems, which can easily lead to prenatal bleeding: vaginal disorders such as traumatic trauma and varicose veins; abnormalities in the placenta and uterus, such as uterine rupture, cervical erosion or tumors; blood diseases. The most common causes are early placental detachment and placenta previa.

Causes of prenatal bleeding

The normal placenta should be attached to the upper part of the uterus. If it is attached to the lower part of the uterus or directly covers the inner cervix, it is called placenta previa. When the uterus is irregularly contracted in late pregnancy, or the lower part of the uterus is dilated after childbirth, the placenta covering the inner mouth of the cervix can be separated from the uterus and cause bleeding. Placenta previa is common in women with multiple miscarriages, endometrial inflammation, or atrophic lesions. The bleeding is not painful. Pregnant women often have little or no back pain or falling sensation. Vaginal bleeding can be repeated, many times, and a small amount, which can cause severe anemia in pregnant women. It can also cause massive bleeding at one time, which can cause pregnant women to fall into shock. Failure to handle it in time will lead to maternal and child death.

Prenatal bleeding caused by these two diseases, regardless of the amount of bleeding, need to seek medical treatment in a timely manner, otherwise it can lead to intrauterine distress or even fetal death, can also cause coagulation dysfunction, postpartum bleeding is difficult to stop, and induce acute Renal failure and other lesions.

The occurrence of vaginal bleeding in the third trimester of pregnancy, whether accompanied by abdominal pain or not, no matter what causes it, is a bad phenomenon. If you don't seek medical treatment in time, let it continue to develop, the consequences will be very serious. Therefore, when vaginal bleeding is found in the third trimester of pregnancy, great attention should be paid to it. Don't take it lightly, so as not to regret it.

Placenta prevail is one of the main causes of prenatal bleeding in late pregnancy. It means that the placenta is attached to the lower part of the uterus or is covered at the inner mouth of the cervix, lower than the exposed part of the fetus. In recent years, due to the development of B-ultrasound technology, it has been found that the placenta with a lower position in the second trimester of pregnancy has mostly risen to the normal position. Therefore, most scholars believe that after 28 weeks of pregnancy, ultrasound, vaginal examination, cesarean section or vaginal delivery to determine the abnormal placental planting can be diagnosed as placenta previa. Patients with bleeding during the second trimester were diagnosed with advanced miscarriage, although the placenta was found to be abnormal by ultrasound. The cause may be related to the abnormal placenta. Modern ultrasound finds that there are more abnormalities in the placenta in the second trimester than in the third trimester. Therefore, attention should be paid to the presence of the placenta previa during labor induction. The incidence of placenta previa is 1 in 200 pregnancies, the incidence is 0.26% to 0.9% in foreign countries, and the incidence is 0.24% to 1.57% in China.

Prenatal bleeding symptoms

For painless vaginal bleeding, it is often found suddenly at night when sleeping, and the amount of bleeding is more or less, often repeated. Because the bleeding comes from the open blood vessels of the placenta and belongs to the mother's blood, a small amount does not have an immediate effect on the fetus. It should be noted that complete placenta previa and partial placenta previa can cause a large amount of bleeding during labor, so it is advisable to undergo cesarean delivery for production, and it is easy to cause major postpartum hemorrhage after delivery. In some cases, the uterus may be performed immediately. Resection to stop bleeding, especially those with an implanted placenta. If the fetus is not yet mature when bleeding occurs, pregnant women should rest in bed completely. If there is not much bleeding and the fetus and mother are not affected, you can wait for the fetus to mature before giving birth.

The cause of prenatal hemorrhage is early placental dissection. The placenta was originally released from the uterus after the fetus was born. However, the early placental dissection was stripped before the fetus was born, because the placenta is where the fetus lives in the womb. Therefore, the occurrence of early placental detachment is a very serious situation. The cause of early placental detachment is not yet clear, but if pregnancy is associated with preeclampsia, the incidence will increase, and very few are related to trauma. The principle of early placental dissection is to give birth to the fetus as soon as possible. If the cervix is suitable for immediate production, it can also be delivered through the vagina, otherwise it should be performed by caesarean section immediately. The bleeding caused by early placental ablation is often much more than the vaginal bleeding, so blood transfusion equipment is indispensable. If fetal distress has been caused by early placental ablation, fetal mortality will also increase. Of course, in addition to the above two reasons, including premature delivery, cervical rottenness, cervical polyps, or cervical cancer, etc., may cause bleeding during the late pregnancy. In short, when prenatal bleeding is found, you should seek medical treatment immediately. Absolute bed rest can be very helpful in determining the absence of fetal distress and the stability of the mother's life.

Prenatal bleeding treatment

Antenatal hemorrhage is an obstetric emergency, if the treatment or treatment is not timely, the consequences are serious and often endanger the life of the mother and child. There are many causes of prenatal bleeding. The most common impact on mothers and children is placenta previa and placental abruption.

1. Placenta previa The placenta previa is abnormally attached to the uterus, and the placenta is attached to the lower part of the uterus. If the cervix is completely covered, or even rolled across the cervix from one side to the other, it is a central placenta. Partial placenta previa is not completely covered.

Placenta previa

Placental bleeding is often non-inducing, painless, and recurrent vaginal bleeding. There are also people who are shocked by the first major bleeding, which often occurs unconsciously. Sometimes the patient wakes up in the middle of the night and finds himself lying in a pool of blood. This kind of bleeding is more serious, which mostly occurs in the central placenta previa. Immediate surgery is needed to end the pregnancy. There is more bleeding during surgery, such as placental adhesions, and the possibility of removing the uterus when hemostasis is difficult.

2. Placental abruption Placental abruption is one in which the placenta is in a normal position and is partially or completely detached from the uterine wall before the fetus is delivered.

Most manifested as painful vaginal bleeding. Placental abruption bleeding may have hidden bleeding, dominant bleeding and mixed bleeding. Recessive bleeding is no obvious bleeding in the vagina. The type of blood that has been stripped off early in the womb is accumulated in the uterine cavity. There are obvious symptoms of abdominal bleeding and obvious abdominal pain. This is because the placenta is peeled off from the center or from the central part. The placental edge is still attached to the uterine wall, causing blood to fail to flow out and accumulate between the placenta and the uterine wall. Can't relax. It is obvious that the placenta is stripped from the edge, blood can flow along the placenta and the uterine wall, there is no post-placental hematoma, so there is no internal bleeding, and abdominal pain is often not obvious, but it is easier to find clinically. Mixed bleeding, that is, both post-placental hematoma and vaginal bleeding.

Severe placental abruption is more common in recessive and mixed vaginal bleeding, and often has obstetric complications such as pregnancy-induced hypertension syndrome, chronic nephritis, and history of trauma. Presented as sudden severe abdominal pain. Persistent pain, accompanied by paroxysmal colic, some bloating, nausea, vomiting, severe paleness, dizziness, cold sweats, shock caused by decreased blood pressure, can cause fetal death, this situation requires immediate cesarean section Otherwise, the mother and child are in danger of life.

During pregnancy, especially in the third trimester, even if there is a small amount of bleeding or trauma in the vagina, you should go to the hospital for examination in time, and do not delay the timing of treatment. If mild placental abruption is detected early, treatment can be safe for mother and child in time.

There is another kind of viscous secretions in the vagina before and after labor. This phenomenon is called seeing red, which should be distinguished from vaginal bleeding. Seeing red is a normal phenomenon before delivery.

Causes of prenatal bleeding

The etiology of placenta previa is unknown and may be related to the following factors:

1. Endometrial lesions and dysplasia: According to statistics, 85 to 95% of women are menopausal, such as induced abortion, cesarean section, multiple births, or endometrial infections, which cause uterine decidual vascular hypoplasia;

2. Stunted fertilized eggs;

3. Abnormal placental development: such as multiple births, local or general malnutrition, sub-placenta, or membranous placenta;

4. Abnormal uterine morphology;

5. Others: Some believe that smoking and drug use cause a decrease in placental blood flow, hypoxia, and a compensatory increase.

Classification of prenatal bleeding

According to the relationship between the edge of the placenta and the cervix, it can be divided into three categories:

1. Complete placenta prevail, also known as central placenta previa, the placenta completely covers the inner cervix;

2. Partial placenta prevail, the placenta partially covers the inner cervix;

3. Marginal placenta prevails, the placenta is attached to the lower part of the uterus, and the edge does not exceed the inner cervix, including the lower placenta, that is, the placental margin is less than 7cra from the inner ostium.

In the diagnosis and classification of placenta previa, the following issues need to be paid attention to:

1. Timing of diagnosis: There is no unified opinion. It is generally believed that the placenta is basically positioned at 34 to 36 weeks of gestation. If the treatment is performed after 34 weeks of gestation, the placenta should be diagnosed at this time;

2. There are changes in classification, 5.3% in the second trimester, and only less than 10% of the full-term pregnancy still maintains the state;

3, foreign countries are divided into low, marginal and complete placenta previa.

Prenatal bleeding diagnosis

Clinical manifestations of prenatal bleeding

Typical symptoms are painless, unmotivated repetitive vaginal bleeding during the third trimester or at labor. It can be divided into completeness, bleeding can begin as early as 20 to 30 weeks of pregnancy; marginal, mostly after 36 weeks of pregnancy or at labor; part of the nature is in between. A few special cases have no bleeding during pregnancy. It is necessary to pay attention to the possibility of severe adhesion or implantation of placenta. On examination, the patient's anemia face is directly proportional to the amount of bleeding. If the placenta is located in the anterior wall, a placental murmur that is consistent with the mother's pulse can be heard at the joint of the pubic bone. Often accompanied by abnormal fetal position, such as gluteal position, when the head is first exposed, the head often does not float into the basin.

Vaginal examination for prenatal bleeding

Caution should be used as it can cause major bleeding and should be performed with blood transfusion, infusion, and preparation for cesarean section.

B B ultrasound examination of prenatal bleeding

The main means of diagnosis of placenta previa. Simple, economical and non-invasive, with an accuracy rate of over 90%. During the examination, the patient needs moderate bladder filling to make it easy to determine the placenta. If combined with implantation, sometimes there is a placenta sound image in the myometrium of the placenta attachment site. There are 5% to 10% false positives or false negatives.

Prenatal bleeding management

In recent years, positive anticipation therapy and timely cesarean delivery have significantly reduced maternal and perinatal mortality.

1. Active anticipation therapy : Try to make the fetus mature as long as it does not affect the life of the pregnant woman. During the expectation process, various effective treatments must be performed on the mother and the fetus must be closely monitored.

Bed rest and left lying position: The placenta previa may be bleeding at any time, and should be hospitalized for observation. During the bleeding, absolute bed rest is required; after hemostasis, it can only be slightly moved. Using the left lateral position can reduce the compression of the inferior vena cava by the enlarged uterus and improve the blood circulation of the uterine placenta. Pregnant women should remain mentally quiet and be given appropriate sedatives.

Avoid local irritation: People with suspected placenta previa should be prohibited from sex and vaginal examinations. B-ultrasound should be performed first, and vaginal examination should be considered if necessary. When inspecting, only a speculum is generally used. Exposure observation, except for cervical and vaginal wall diseases, if it is necessary to perform internal cervical examination, fluid replacement, blood matching, preparation for cesarean section, and performed by experienced physicians.

Oxygen absorption and correction of anemia: Pregnant women with placenta previa have varying degrees of anemia. The placenta is attached to the lower part of the uterus or the placenta is thin and the implantation surface is large. The blood circulation is poor. Intermittent oxygen inhalation can increase the blood oxygen concentration of pregnant women and fetuses. The diet of pregnant women with mild anemia is rich in nutrients, and blood-supply drugs should be given. Patients with moderate or higher anemia need multiple blood transfusions.

Tocolytic Inhibitor: Preplacental hemorrhage is due to the extension of the lower part of the uterus and dislocation with the attached placenta. The dislocation during the contraction is more obvious. Therefore, the application of tocolytic inhibitors during bleeding can effectively reduce bleeding and prolong the gestational week.

2. Timing of termination of pregnancy : Termination of pregnancy should be considered in the following circumstances.

If you have the condition to perform fetal lung maturity check, you can consider termination of pregnancy once the fetal lung matures;

If the fetal lung maturity test cannot be performed, the fetus is basically mature after 35 weeks of pregnancy, and the pregnancy can also be terminated;

Repeated bleeding may cause anemia shock in pregnant women.