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Bleeding from the vagina in the last stages of pregnancy
Last reviewed: 23.04.2024
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The most common cause of bleeding in the last period of pregnancy is the presentation and detachment of the placenta. This can lead to hemorrhagic shock, which requires intravenous fluid recovery and other measures before or during diagnosis. Other obstetric causes include childbirth (with expulsion of blood-mucus plug) with marginal placenta previa. Disseminated intravascular coagulation (DVS) is a rare but dangerous complication in placental abruption. As a result of the pelvic blood flow increasing during the last periods of pregnancy, previous asymptomatic lesions of the cervix and vagina (for example, polyps, ulcers), not related to pregnancy, begin to bleed.
Anamnesis
The risk factors for placental abruption are the previous placental abruption, the age of the mother over 35, many a history of the child, hypertension, smoking, substance abuse (especially cocaine), abdominal trauma, sickle cell anemia in the mother, thrombotic disorders, vasculitis and other vascular violations. Risk factors for placenta previa are: multiple births, multiple pregnancies, previous uterine surgery (especially caesarean section), and other uterine disorders that can lead to impaired implantation (eg, fibroids). Preposition of the placenta is usually diagnosed prenatally in the course of conventional ultrasonography.
Dark bloody discharge from the vagina with the presence of small clots and severe pain are characteristic for placental abruption. Bright strong bloody discharge from the vagina with moderate or minor pain in the uterine region is typical for placenta previa.
Clinical examination
Vaginal examination is not carried out until placenta previa is excluded. Vaginal examination can cause profuse bleeding in women with placenta previa. You can spend careful inspection in the mirrors. However, if there is a placenta previa, a study using mirrors rarely gives information that would change the clinical management of the patient.
Symptoms of hemorrhagic shock or hypovolemia are proportional to the degree of bleeding from the vagina as a result of placental abruption.
Testing
With a slight bleeding, the blood group and Rh-factor are determined in order to determine the necessity of introducing RhO (D) immunoglobulin. With significant bleeding, a general blood test is performed, prothrombin time, partial thromboplastin time, blood group and Rh-factor are determined. If there is a suspicion of detachment of the placenta, then determine the level of fibrinogen and fibrin degradation products for diagnosis of DIC syndrome.
Pelvic ultrasonography or fetal monitoring is performed, but they should not delay the adoption of obstetric decisions, because in such cases, urgent delivery is indicated. Fetal distress, proportional to bleeding from the vagina, involves a detachment of the placenta.
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Treatment of the bleeding from the vagina in the last stages of pregnancy
Treatment of bleeding from the vagina in the last stages of pregnancy
Treatment of hemorrhagic shock and DIC-syndrome is carried out in an emergency. With hemorrhagic shock, DVS-syndrome, placental abruption or placenta previa, the obstetrician determines the method and timing of delivery.