Bleeding during pregnancy - a sign that can occur regardless of the period of embryogenesis and indicates the changes occurring in the woman's body. It can be observed in spontaneous miscarriage, ectopic pregnancy, Rh-conflict, placenta previa and other conditions. This manifestation is able to develop against the background of general well-being or is accompanied by painful sensations in the lower abdomen, lower back, sacrum. Diagnosis of bleeding during pregnancy is carried out on the basis of data of gynecological examination, ultrasound assessment of the patient and fetus. The treatment of this pathological sign is determined by its cause and is appointed exclusively by a specialist.
Causes of bleeding during pregnancy
Bleeding during pregnancy can occur at any period of embryogenesis, it develops both against the background of physiological changes in the woman’s body and due to the formation of a specific obstetric pathology. In the early stages of half of the women there is a slight separation of blood due to the implantation of the ovum in the uterine cavity. Such bleeding during pregnancy is often regarded by the patient as menstrual, so she does not seek medical help, which in the future may make it difficult to determine the duration of embryogenesis. A similar symptom is possible with insufficient progesterone production in the early stages of gestation.
The most common cause of pathological bleeding during pregnancy in the first trimester is spontaneous miscarriage. This symptom appears both in case of just begun, and in case of complete abortion. At about 6 weeks after conception, a symptom occurs with ectopic attachment of the ovum. Also, bleeding during pregnancy at this time can speak of Rh-conflict, fetal fading. Similar manifestations are characteristic of women suffering from varicose veins that feed the uterus. In this case, bleeding during pregnancy is due to increased blood supply to the tissues.
Bleeding during second trimester pregnancy is much less common, approximately 5-10% of all cases of gestation. As a rule, the symptom is caused by pathological changes and in most cases indicates a spontaneous late abortion or isthmic-cervical insufficiency. Sometimes the separation of blood from the genital tract occurs during fetal fetal death. Bleeding during pregnancy in the third trimester is also always talking about the development of pathology of gestation. The most common cause is placenta previa. In this case, the embryonic organ completely or partially overlaps the uterine throat, and because of the high load on the lower segment, placental microbleaves occur, which causes a similar symptom.
Less commonly, bleeding during pregnancy in the third trimester is due to premature detachment of a normally located placenta. In this situation there is a high threat to the life of the fetus. The danger lies in the fact that initially develop internal bleeding during pregnancy or the formation of a hematoma, and only then the blood is poured out. The most rare, but most dangerous for the life of the mother and child, the cause of the development of this symptom is uterine rupture. Such a complication is diagnosed in the presence of a scar on the myometrium and overstretching of tissues, provoked by polyhydramnios, large fruit or multiple fetuses. Extremely rare bleeding during pregnancy occurs due to the integrity of the membranes or umbilical cord vessels.
Also, bleeding during pregnancy can be triggered by causes that manifest themselves at any time during embryogenesis. Such causes include benign neoplasms - fibroids, polypous growths in the cervical canal and uterine cavity. Often bleeding during pregnancy occurs in women with cervical erosion. Sometimes a symptom occurs due to increased blood circulation in the pelvic organs. The risk of developing a symptom is also present during violent sexual contacts, significant physical exertion, and concomitant cardiovascular diseases associated with weakening of the endothelium.
Classification and symptoms of bleeding during pregnancy
Depending on the origin of the bleeding, two groups can be distinguished:
- Physiological bleeding during pregnancy - arise due to the restructuring of the body, do not pose a threat to the health and life of the fetus or mother.
- Pathological bleeding during pregnancy - indicate its abnormal course, may be accompanied by a risk to the life and health of women and children, require immediate medical attention.
Clinic bleeding during pregnancy depends on the cause of this symptom. The excretion of blood from the genital tract in the early stages of embryogenesis, provoked by physiological changes, proceeds against the background of general well-being. Bleeding during pregnancy, developed due to the presence of polyps, erosion, fibroids in most cases also do not cause impairment of well-being. At the same time, there is a slight excretion of biological fluid - just a few drops, the symptom is short-lived. More abundant, similar to menstrual bleeding will be during pregnancy, associated with a deficiency of progesterone.
In case of development of bleeding during pregnancy, associated with her spontaneous interruption, the patient is worried about persistent or cramping pain in the lumbosacral region, abdomen. Additionally, nausea, dizziness, malaise, a slight increase in body temperature may occur. Bleeding during pregnancy in this case may be of varying intensity, often in the secretions there are pieces of tissue. With ectopic attachment of the ovum, as well as the rupture of the uterus, there is a serious threat to the life of the woman. In such a situation, internal bleeding initially develops during pregnancy, and only then pathological secretions from the external genital tract appear. There is a sharp pain in the abdomen radiating to the anal region, the lateral parts of the body. With significant blood loss occurs a state of shock with the threat of death.
Bleeding during pregnancy in the later stages is also not always accompanied by an expanded clinical picture. In the case of placenta previa, this is the only symptom that should cause alertness in a woman and become a reason for contacting an obstetrician-gynecologist. As for the premature detachment of a properly attached placenta, in this case, bleeding during pregnancy develops against the background of uterine hypertonus, there is pain in the abdomen, worsening of general well-being. During fetal cardiomonitoring, a violation of the heart rate and motor activity is observed.
Diagnosis and treatment of bleeding during pregnancy
A gynecological examination of the woman is carried out to identify the cause of bleeding during pregnancy. With changes in physiological origin, no abnormalities can be detected. In case of pathological bleeding during pregnancy, cervical opening is observed against the background of spontaneous abortion. Increasing the tone of the myometrium can talk about the beginning of placental abruption. From laboratory diagnostic methods, an analysis to determine the concentration of hCG (human chorionic gonadotropin) is used. With ectopic pregnancy and bleeding, this figure will be reduced. Instrumental diagnosis of bleeding during pregnancy is to conduct an ultrasound. Using this method, it is possible to assess the state of the myometrium and the embryo, the level of blood flow in the vessels, the exact localization of the placenta and (possibly) its starting detachment. Using CTG, the diagnostician can make a conclusion about the life of the fetus.
Treatment of bleeding during pregnancy also depends on the cause of the symptom. If there are no pathological changes or the manifestation is provoked by damage to the polyp, medical assistance is not required. In rare cases, the doctor recommends its removal. Expectant tactics applied in the case of cervical erosion. Her cauterization is carried out after childbirth. Bleeding during pregnancy on the background of the threat of miscarriage and placenta previa requires immediate hospitalization in an obstetric hospital, followed by the appointment of medical treatment. Sedative preparations, tocolytics are used to reduce uterine tone. Conducting pregnancy while requiring careful observation by a specialist.
Bleeding during pregnancy, caused by ectopic attachment of the ovum, rupture of the scar or complete spontaneous abortion, require hospitalization and surgical treatment. After removal of residual fetal tissues or emergency delivery, antibiotic therapy is prescribed. In this case, stopping bleeding during pregnancy is carried out in different ways, depending on its intensity, often ligation of the uterine arteries. In case of premature detachment of the placenta, an emergency cesarean section is indicated.
Prediction and prevention of bleeding during pregnancy
Bleeding during pregnancy is usually accompanied by a favorable prognosis. Timely medical care can save the life of the fetus and the woman. Death is extremely rare. Prevention of bleeding during pregnancy is the early detection of benign tumors and their treatment before conception. In order to prevent the development of a pathological sign, one should register as early as possible, take all necessary tests and immediately contact any obstetrician if there are any violations. Prevention of bleeding during pregnancy is also to avoid stress, physical exertion, violent sex.
Bleeding during pregnancy: whether to inform the doctor
Yes. Any bleeding during pregnancy should be immediately reported to the gynecologist.
Any vaginal blood discharge up to 24 weeks of gestation is considered a potential threat of miscarriage. After 24 weeks, this is called prenatal bleeding.
Those with a negative Rh factor, you must consult a doctor within 72 hours after the bleeding, because there are suspicions that the child’s blood may mix with yours. If mixing occurs, the maternal organism can begin to produce antibodies against positive rhesus of the baby’s blood.
Positive rhesus is much more common than negative. For the first pregnancy, mixing of blood does not have any consequences, but during subsequent pregnancies the body may decide that it is necessary to attack unfamiliar matter with antibodies, if the child again has a positive Rhesus.
The following are the most common causes of bleeding during pregnancy. Not all of them are scary and dangerous. During pregnancy, minor cramps and pulling sensations occur, and this is normal. But if the bleeding is accompanied by severe pain and cramps, immediately seek the help of doctors.
In case of implantation bleeding, when a fertilized egg is attached to the uterine mucosa, small spots or streaks of blood may appear. This usually lasts only a day or two, and occurs during the implantation period or during the period when menstruation should begin.
Some women mistakenly think that this is just a small period and they do not understand that they are pregnant.
Some women have what is called breakthrough or intermenstrual bleeding in the period when they were supposed to be menstrual. Thus, such secretions appear at 4, 8, and 12 weeks, respectively. They are often accompanied by sensations that you usually experience with menstruation, that is, back pain, cramps, heaviness in the lower abdomen, a feeling of bloating and fatigue.
Of course, due to the fact that you are pregnant, your period does not occur, although it seems to you that you should. During pregnancy, hormones prevent secretions, but sometimes, when the level of hormones has not yet reached its peak and cannot stop menstruation, a “breakthrough” occurs - breakthrough bleeding.
This may last up to 3 months, and after that the placenta takes responsibility for the production of hormones by the ovaries. There are women who have breakthrough bleeding almost all the time during pregnancy, and under the constant supervision of doctors, they freely give birth to healthy babies.
Threatened miscarriage or miscarriage
According to research, one third of all pregnancies end in miscarriage (the medical term is spontaneous abortion). It sounds scary, but do not despair, as this number includes miscarriages at very early stages, the first 12 weeks, when a woman may not even understand that she was pregnant at all.
This type of miscarriage often occurs due to damage to the fetus, that is, the woman's body rejects the non-viable fetus.
If you crossed the mark at 14-16 weeks, you can calm down.
The most reasonable way to refrain from announcements to the whole world about their pregnancy before reaching a 2-month period. You, of course, can be bursting with emotions and joy, but in case of a miscarriage, you will be twice as painful again to report a failed pregnancy. Empathy is important, but sometimes it can only exacerbate your grief about your broken dreams of being a mother.
Signs of miscarriage are bleeding, cramps, back pain and abdominal pain. Women often say that they "do not feel pregnant" when miscarriage or bleeding occurs. The main signs of pregnancy disappear - nausea, breast sensitivity and a swollen belly.
If you are bleeding and you feel all of the above, there is a risk that you have lost a child. If you are experiencing bleeding, but do not feel that the pregnancy has stopped, there is a great chance that this is a threat of miscarriage, but in general, the child is fine.
Miscarriage can also happen without bleeding, which is often called “missed abortion,” when the fetus dies, but is still delayed by your body inside. Signs of pregnancy in this case will disappear, but the cardiac arrest of the fetus can only be determined by ultrasound. A curette may be needed to remove the dead fetus.
Bleeding after intercourse
Bleeding after sex is one of the most common causes of bleeding during pregnancy. It is completely harmless and is caused by an increase in the blood supply and softening of the cervix. Although such bleeding is not a serious concern, you should still report it to your doctor. Be prepared for a very personal question about whether you have recently had sex.
This does not mean that you need to stop having sex, but you may have to convince your partner that he does not harm the child, that he is reliably protected in the uterus, which is much higher than the vagina.
An ectopic pregnancy occurs when a fertilized egg is attached not in the uterus, but outside, usually in the fallopian tube.
You may experience severe lower abdominal pain on one side, or twisting pain, as well as weakness and nausea. The pain may suddenly disappear if the tube is broken, but will return in a few hours or days, and the sensation will be even worse.
This situation is quite dangerous. An ectopic pregnancy can rupture the fallopian tubes and cause internal bleeding, which can lead to infertility. You may have to remove the fallopian tube and end the pregnancy, but this does not mean that you will have problems conceiving in the future, provided that your second ovary and fallopian tube are healthy.
Another question you may hear at the doctor's office is whether you were scanned and how the placenta is located.
Painless vaginal bleeding can result from abnormal placement of the placenta. Sometimes the placenta is located very low on the wall of the uterus, and sometimes right above the cervix. This is called placenta previa and it occurs in approximately 0.5% of pregnancies.
Placenta previa will inevitably lead to bleeding at some point in your pregnancy - usually after 20 weeks. There are various degrees of severity of this condition, but they all require repeated ultrasounds for an accurate diagnosis. To prevent a threat to the baby, you may be advised to stick to bed rest, suggest induction or cesarean section if the placenta continues to be attached to the cervix.
Another cause of bleeding in later pregnancy is placental abruption, when the placenta is partially or completely separated from the uterine wall. This occurs in about 1 in 200 pregnancies. Симптомы включают в себя общие сильные боли и сильное кровотечение.Bleeding can be visible or hidden in the uterus, which will be tight, tight, stiff to the touch and very painful.
If you smoke, have high blood pressure, kidney problems, or preeclampsia, you have a high risk of placental abruption. This condition requires urgent hospitalization, and depending on the severity of the bleeding, you may be prescribed bed rest, induction or cesarean section.
Uterine fibroids are masses of compacted muscles and fibrous tissue that can be inside or outside the walls of the uterus. They can be both problematic and unproblematic during pregnancy - this, first of all, depends on the location of the fibroids and on whether it increases or not.
There is no consensus among doctors about this, but it is known that hormones produced during pregnancy can cause both a decrease and an increase in myomas.
Myoma is best removed before pregnancy, as there is a chance that it will lead to an ectopic pregnancy, severe bleeding during pregnancy, or miscarriage.
However, many women give birth without any complications. If you have fibroids, it is important to contact a specialist to understand exactly your situation and determine the next steps. Avoid Internet self-medication, because the question is serious, and you should not trust it to the consideration of sofa experts.
What if I have bleeding
If the gestation period is more than 20 weeks, immediately consult a doctor if bleeding occurs. Do not use tampons in any case, if you experience bleeding during pregnancy, always take a gasket.
If the bleeding is minor and you have no pain, consult your doctor or nurse anyway. If the bleeding is severe (flow or clots) and is accompanied by abdominal cramps, back pain and pain similar to the sensations during menstruation, immediately call an ambulance.
Understandably, you are upset, but try to stay calm and remember that bleeding happens during pregnancy, this is not an anomaly.
The blood belongs to you, not the baby, so the continuation of a completely healthy pregnancy and the birth of a healthy baby is possible and most likely. Do not be surprised if with such complaints in the early stages (up to 12 weeks) you will be advised to just watch and wait.
What to do if a miscarriage occurs
If you are experiencing a miscarriage, unfortunately, nothing can stop or prevent this process. Losing a child is always pain, frustration and depression, but the best thing you can do is take care of yourself physically and emotionally. You are not guilty of having lost a child, and you cannot change anything, but there are things that will help you feel more comfortable physically:
- Bed rest
- Paracetamol / Panadein (drug for relieving spasms during menstruation)
- Hot water bottle or bottle of warm water on the belly
- Tea and partner support
Along with the secretions, various clumps of tissue, an undeveloped fetus may come out, but soon the bleeding will stop. If the blood does not stop, you should immediately seek medical attention.
Remember that in most cases, bleeding in early pregnancy occurs spontaneously, and after that, the pregnancy continues healthy and unharmed.
Causes of bleeding during pregnancy
The causes of bleeding in early pregnancy can be hormonal deficiencies (for example, the lack of some hormones), and ectopic pregnancy, and inflammation in the cervix. They may also appear due to the implantation of the embryo in the cervix. By the way, in the latter case - the woman feels absolutely normal, the discharge from her - a pale pink shade.
Spotting may also occur after intercourse: if irritation of the cervix and vaginal mucosa has occurred. In this case, you should not be afraid: this kind of bleeding is not afraid of either the baby or mommy.
But there are more serious causes of bleeding. They are very dangerous for both mom and the baby.
First, the cause may be a miscarriage. Most often, spotting is also accompanied by cramping lower abdominal pain. You can save a pregnancy, if you go to a doctor in time, and best of all - while there is a threat of miscarriage, go to the hospital to be under constant medical supervision. With the threat of miscarriage recommend bed rest, maximum calm and the absence of any stress.
Secondly, bleeding may also occur due to a vesicle skid - a condition where the growth of placental tissue begins. Bleeding in such cases is abundant, but painless. In this case, scraping is performed and 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. Pregnancy in any case will end in spontaneous miscarriage. After a miscarriage, a woman should always consult a doctor to prevent the development of post-hemorrhagic shock. Usually, in such situations, diagnostic and therapeutic curettage of the uterus is done so that there are no residues of the ovum, placenta, or ruptured vessels in it. After - the woman will be examined in order to establish the real cause of miscarriage.
Bleeding can occur if a woman does not notice a miscarriage. In this case, after rejection of the ovum, after some time, bleeding begins, caused by the remains of the embryo and its membranes in the uterus. A doctor in such a situation should contact immediately! He urgently will make scraping.
Possible causes of bleeding in late pregnancy
If the pregnancy is uneventful, the woman feels well and, according to ultrasound, CTG and other basic research, the child develops according to time, visits to the doctor are usually kept to the minimum necessary.
When only a few weeks remain before delivery, the bleeding that begins is a big surprise. What is it - a normal harbinger of childbirth or a dangerous condition, with which it is necessary to hurry to the hospital?
The opening of the uterus and the separation of the mucous plug may indeed be accompanied by secretions with abundant admixture of blood. If this happens 1-2 weeks before PDR, it means the birth has begun and will end with the birth of a long-awaited healthy baby.
But there may be other causes of bleeding associated with the pathology of pregnancy or future mother's diseases.
This diagnosis is indicated when the placenta is located in the lower segments of the uterus. Her presence near the inner throat or on it is a serious complication of pregnancy and is diagnosed in the early stages.
But in easier situations, if the placenta has formed below the bottom of the uterus, but the distance to the internal pharynx is 3 cm or more, the alarming symptoms may not be observed in earlier periods.
However, by the end of pregnancy, when the uterus is maximally stretched and the fetus's pressure on the vessels increases, bleeding may occur. His source will determine the doctor.
- Premature placental abruption
Even if the placenta is correctly and properly performed its function throughout pregnancy, the processes of premature aging, weakness of the mother’s blood vessels, large fetus or multiple pregnancies can lead to premature detachment (separation of the placenta or its part from the uterine wall).
This is a dangerous condition, accompanied by heavy bleeding. The blood supply to the fetus is disrupted, and this is a direct threat to the life of the baby. But there are medical techniques that allow for partial detachment to stop the bleeding and bring the pregnancy. It all depends on the location of the placenta and the degree of detachment.
This is a rare complication. Unable to withstand the growing pressure of the fetus or under the influence of external factors, the integrity of the uterus tissue can be broken, which is accompanied by sharp pain, bleeding, and threatens the life of the mother and fetus.
Depending on the size of the lesion, there is a “crack” (on the body of the uterus or in the lower segment), “incomplete rupture”, or complete separation of the uterus from the vaginal vaults.
The cause of this complication can be comorbid endometrial diseases, cicatricial changes after surgeries or cesarean section, external traumatic factors.
Uterine rupture requires urgent medical intervention.
Pressure (especially in the presence of a large fetus) on the cervical tissue can lead to bleeding at the end of pregnancy. The blood vessels are pressed, the blood supply to the tissue and its elasticity are disturbed, with the course of pregnancy these provoking factors increase and the result may be a rupture of the tissue of the cervix or vagina.
It is not as dangerous as rupture of the body of the uterus, but also requires urgent medical attention.
Fibroids must be diagnosed in advance and the doctor takes this factor into account when managing pregnancy.
Depending on the size and location, fibroids can be an obstacle to pregnancy. but can sometimes be the main cause of persistent bleeding during pregnancy.
However, for some types of nodes, the degenerative changes occurring mean the formation of cavities with hemorrhagic contents. When such a bubble breaks, the bloody contents exit. If the integrity of the vessels is preserved - the phenomenon is not dangerous.
Erosion of the cervix means that the mucous membrane is more friable, the vessels are dilated, and wounds or ulcerations may appear on this background. And even if a woman did not have a similar diagnosis before pregnancy, in the process of carrying a child under the influence of hormonal changes and a decrease in immunity, it can appear.
Loose mucosa and dilated vessels, experiencing the pressure of the growing uterus, can be a source of bleeding. As a rule, it is not abundant, but it is dangerous with secondary complications: infection, pain syndrome or unpleasant sensations in the genitals that can reflexively affect the tone of the uterus.
How to behave when bleeding is detected?
If a pregnant woman finds bleeding or mucous discharge with blood, this is a reason to go to the doctor, regardless of the duration of the pregnancy. And the danger to the life of the fetus in the later periods can be no less than at the beginning.
At the time of waiting for help, it is necessary to ensure the woman peace. She doesn’t have to go to the hospital to collect things herself, as movements can activate bleeding.
Are bleedings dangerous for a future baby?
Pregnancy is coming to an end, the fetus is fully formed, organ systems have begun to function. Some mothers believe that the threat to the health of the baby is gone.
However, the risk persists. It is much less than at the beginning of pregnancy and even after rapid premature birth the baby will have more chances to survive and stay healthy.
Excessive bleeding can also lead to hemorrhagic shock, it is dangerous for the woman and her baby. In addition, the violation of the integrity of tissues threatens sepsis, and this is also a risk to the life of both women and children.
What will help in the hospital?
A doctor in a hospital can determine the cause and amount of bleeding, and the tactics of medical measures will depend on it.
In some pathologies, urgent surgical intervention is necessary, in others, it will be possible to save the pregnancy and prepare the baby’s lungs for premature birth.
- Depending on the cause of bleeding and the localization of pathology, such techniques as suturing, drug treatment (vitamins, antispasmodics, etc.) can be applied.
- Strict bed rest allows you to control bleeding and prevent recurrence.
- With a partial detachment of the placenta, especially with its low localization, such an unexpected measure as the opening of the membranes of the fetus helps: the head of the child descends, pressing the detached fragment of the placenta.
This allows you to win days to carry out the necessary restorative therapy for the mother and prepare the child for birth.
- Medical interventions can stop and quite heavy bleeding.
In this case, immediately after the cessation of blood loss, therapy is carried out against hemorrhagic shock (blood transfusions or blood substitutes, anti-inflammatory drugs, administration of saline)
In the case when the bleeding cannot be stopped, or the lesions are large and do not give an opportunity to save the pregnancy, preterm labor is carried out. This is usually a caesarean section, but other options are possible, depending on the state of the mother, the position of the baby, the degree of cervical dilatation.
The baby, born prematurely, will be examined by neonatologists and placed under observation in the children's intensive care unit, if necessary sent to nursing.
Bleeding in the last weeks of pregnancy can be caused by a number of factors. It is only possible to accurately determine its cause and the degree of threat to the health of a woman or her unborn child after an in-hospital examination.
Depending on the situation, doctors will find an opportunity to save the pregnancy or an urgent delivery will be carried out, and the baby will be placed in the department of premature babies. A timely visit to the doctor will save the life of the mother and newborn.
Difference between dangerous bleeding and non-dangerous bleeding.
It is widely believed that in the initial stages of pregnancy, bleeding is a threat of miscarriage, but it is in the first trimester that the so-called "Non-hazardous" bloody issues. There are various signs by which one can judge the degree of danger of blood discharge during pregnancy:
- Gestational age. Up to three months of vaginal discharge can be both dangerous symptoms and a phenomenon accompanying normal physiological processes.
- The color of blood. Blood streaks in mucus, bright blood, brown clots, brownish or pinkish discharge — all this indicates different causes of bleeding and varying degrees of danger.
- Intensity. It is necessary to determine the amount of leaked blood - this can be both a bleeding and excessive bleeding. Also to this criterion include the duration of discharge - blood can be released once or last for some time.
- The presence of pain. If the bleeding is accompanied by pain of varying intensity - most likely it is a sign of a serious problem.
First trimester bleeding
In 1 trimester, uterine bleeding (colouration) does not pose a danger to pregnant women. They can be both uterine (“false menstruation”) and vaginal, with microtraumas, irritations, etc.
"False menstruation" occurs in a small number of pregnant women. There is a hormonal failure, and the maturation of the eggs does not stop with the onset of pregnancy. Most often this happens due to low progesterone levels. At the same time, several cycles of the ovaries function in the same rhythm, the egg matures and ovulation occurs, and in its term of the monthly cycle the egg together with a small amount of blood and mucus is removed from the uterus. During the "false menstruation" discharge, as a rule, less than during normal menstruation.
It happens that due to the lack of progesterone, there is a violation of the implantation of the ovum, which in turn is associated with a slower development of pregnancy. Then occasionally a small discharge of brown color or a small amount of blood occurs. With timely visit a doctor pregnancy can be saved, by adjusting the drug progesterone medication.
Vaginal bleeding. It happens that during pregnancy from the vagina appear blood discharge associated with the physiological characteristics of the woman's body. The most common cause is the profusion of blood vessels in the mucous membrane of the cervix and uterine pharynx. Under the influence of physical exertion or mechanical damage (for example, during sex), fragile capillaries are damaged and a small amount of blood is released. Data spotting completely safe, painless and short.
Bleeding 1 trimester, representing the danger
These include bleeding caused by ectopic pregnancy and miscarriage. In these cases, the selection of blood is abundant, accompanied by sharp or cramping pain. In an ectopic pregnancy, a woman’s condition rapidly deteriorates, which results in immediate surgery.
In case of spontaneous miscarriage, the pain can be of different intensity, there are brown clots in the discharge. Consultation with a physician is mandatory, as curettage is often necessary to remove coagulated blood, residues of the functional layer of the uterine mucosa and stop bleeding.
Second trimester bleeding
During this period, bleeding is not often observed, and mainly occurs with abdominal injuries as a result of a stroke or a fall. In such situations consultation of the doctor is necessary, even in the absence of visible secretions. The outflow of blood can occur in the uterine cavity, sublaberal space or in the abdominal cavity. Для избежания серьезных последствий необходимо оценить состояние и степень тяжести.
Кровотечения в третьем триместре
From the 28th week of pregnancy, any outflow of blood is a reason for immediate treatment in the antenatal clinic. The most frequent causes of bleeding of this period is the placenta previa or its premature detachment.
With placenta previa or its low location may cause bleeding due to ruptures of its vessels. As a rule, this condition is not accompanied by pain, but with severe bleeding, the health of the pregnant woman
it is getting worse, and without the necessary help, the consequences can be quite serious both for the woman and for the fetus.
Premature exfoliation of the placenta - the most dangerous complication during pregnancy. She is accompanied by severe pain and heavy intrauterine bleeding. The state of health of the pregnant woman quickly deteriorates, the skin turns pale and the pulse quickens, the blood pressure drops. In this case, an urgent surgical intervention is necessary - a cesarean section.
What to do when uterine bleeding during pregnancy
Firstly - necessarily visit a doctor. If the condition is threatening, then further treatment is carried out in the hospital. During the pre-treatment period, the main recommendation is complete rest, the position of the pregnant woman is lying on the left side, and preferably cold on the stomach.
For non-hazardous bleeding, treatment is carried out depending on their causes. Healing doctors usually prescribe Etamzilat or Dicynon to stop uterine bleeding, Progesterone for the normalization of hormonal balance and symptomatic treatment for bleeding, not related to pregnancy.
The causes of early pathology - up to 15 weeks
Sometimes a small spotting brown or dark discharge 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 ovum to the wall of the uterus. Implant bleeding may occur somewhat later, even at week 5. It is not dangerous and does not cause discomfort.
In the beginning of pregnancy, bleeding after intercourse is possible. If it is insignificant, you should not be afraid. But if those become regular and are accompanied by other negative feelings, there is a threat of abortion.
Consider the main causes of bleeding during pregnancy:
- Miscarriage. Spontaneous abortion in the period up to 28 weeks. It occurs for various reasons. Among them are genital pathology, endocrine and infectious diseases, fetal genetic abnormalities, stress, excessive exercise or injury. The risk of abortion is very high when bleeding occurs at the 8th week of gestation.
- Ectopic pregnancy. Occurs as a result of obstruction of the tubes, when the fertilized egg cannot penetrate into the uterus 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 who requires immediate surgery.
- Fading pregnancy. Usually occurs in the early stages. With missed abortion, the bleeding is weak, accompanied by minor pain in the lower abdomen. A woman is required to be hospitalized for curettage of the uterus and removal of the ovum.
- Bubble skid. With this pathology, bleeding is accompanied by the discharge of small bubbles. Shows vacuum aspiration, and sometimes removal of the uterus.
- Erosion of the cervix, fibroids, polyps. These tumors in the organ cavity are not directly related to pregnancy, but can cause bleeding at 3-4 weeks and later.
- Infectious diseases. They can not only cause severe bleeding, but also harm the development of the fetus. Therefore, such diseases require immediate treatment.
- Insufficient progesterone levels.
- Cervical cancer.
Some procedures, for example, umbilical cord blood sampling (cordocentesis) or the study of amniotic fluid (amniocentesis), can provoke small discharges mixed with blood.
With miscarriages, contractions of the uterus occur, which are trying to get rid of the fetus. One of the signs is the discharge with clots, and sometimes along with fragments of the tissue of the ovum. If the pregnancy could not be preserved, and spontaneous abortion took place, a curettage of the uterine cavity will be compulsory, since even small remnants of the ovum can cause an infection process and other complications. The presence of clots can also signal a missed abortion.
- At week 10, a pathological condition may occur with blood coagulation disorders.
- At week 11, the risk of abortion is reduced, but this does not mean that the appearance of bleeding should not alarm the woman. They may appear after violent sexual intercourse, physical injury or severe overheating, for example, after a visit to the sauna.
- At 13-15 weeks, the woman is recommended to undergo tests to identify possible fetal malformations. Such analyzes will avoid complications in the second half of pregnancy.
Impact of ultrasound research
Today, an integral part of compulsory screening is an ultrasound procedure. Some expectant mothers fear that the procedure may harm the baby. You can often hear that after the ultrasound a woman has bleeding.
Allocations in this case are insignificant, last no more than two days and do not harm either the mother or the unborn baby. They can cause hypersensitivity of the internal genital organs or accumulation of blood.
Bleeding in the second half of pregnancy
If the bleeding in the first half of pregnancy is associated with the threat of spontaneous miscarriage, in late periods it is most often associated with pathology of the placenta.
- Placenta previa
Occurs in 2-5% of pregnant women, when the placenta is not located correctly. Allocate full and partial presentation. In the first case, scarlet bleeding without pain is observed. In case of partial presentation, an opening of the membranus of the fetus is shown 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 the onset of preterm labor.
- Premature detachment of the placenta
Always accompanied by bleeding. Late toxemia, multiple fetus or large fetus, heart defects, physical trauma (fall), uterine malformations can cause detachment of the placenta. In women, the appearance of severe pain in the lower abdomen, increasing the tone of the uterus. Hypoxia occurs in the fetus due to insufficient production of oxygen and other elements useful for development.
The blood is bright scarlet, severe pain in the abdomen indicates excessive stretching and thinning of the walls of the uterus, the destruction of the muscle layer. Occurs when a vesicular drift or in the presence of scars on the uterus, remaining after the previous cesarean section. Doctors recommend not to become 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 genera. The cause may be damage to the umbilical cord or 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 poor bleeding? First of all, a woman should be calm and not panic. Not in all cases, such a violation leads to the death of the fetus.
Is it possible to keep pregnancy when bleeding?
Of course, yes, subject to timely registration in the antenatal clinic and immediate treatment for medical assistance. Even if the discharge is insignificant and the general state of health is good, it is necessary to consult a doctor as soon as possible.
To learn how to stop bleeding, you need to establish the cause of its occurrence. To do this, a woman is sent to take tests and undergo the following diagnostic procedures:
- general urine and blood tests
- blood test for HIV and syphilis,
- Ultrasound of the pelvic organs,
- a blood test for hCG,
- research of smear on flora from a vagina.
If ectopic pregnancy is suspected, diagnostic laparoscopy is performed.
The main task of treatment in the early stages of gestation is to stop bleeding and prevent miscarriage.
Treatment involves the appointment of:
- hemostatic drugs - Dicionon,
- antispasmodic, lowering the tone of the uterus - No-shpa,
- hormonal drugs that provide the level of progesterone necessary for pregnancy preservation - Duphaston, Utrogestan,
- sedatives (motherwort, valerian);
- Vitamin Therapy - Magne B6, Vitamin E, Folic Acid.
When missed abortion is shown compulsory cure. After the procedure, hormone therapy and medications aimed at restoring the functions of the circulatory system are prescribed. If a woman is found to have a negative Rh factor, after curettage, an anti-Rh immunoglobulin is administered to her in order to prevent Rh-conflict.
Treatment of ectopic pregnancy - only operational. During surgery, the fertilized egg fixed 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 shown complete rest. In some cases, it is recommended to comply with bed rest. Intimate life with the threat of miscarriage should be completely terminated. All prescribed medications must be taken for a long time, even in the absence of bleeding and satisfactory well-being. The exact dosage and duration of admission is determined by the attending physician.
Therapeutic measures in placenta previa depend on the intensity of discharge. If they are abundant, prescribe an immediate cesarean section, even with prematurity of the fetus. In the future, the woman is undergoing treatment aimed at restoring blood loss.
With scanty discharge limited to the opening of the fetal bladder. However, if this measure is not effective and the discharge does not stop, a cesarean section is also indicated.
Bleeding caused by placental detachment is more difficult to diagnose, since with this pathology internal bleeding is observed, combined with external bleeding. In 25% of cases, there is no external discharge at all. To stop the blood, a caesarean 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, renal failure. Reviews about it can be controversial. Indeed, taking Clexane increases the risk of miscarriage, so its use is permissible only under close medical supervision.
In addition to enhancing secretions, 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 in:
- spontaneous abortion,
- diabetes mellitus
- some diseases of the upper respiratory tract,
The drug is prescribed to replenish progesterone. This is a hormone necessary for a successful pregnancy. When bleeding during pregnancy duphaston prescribed in the first trimester.
Calculation of dosage is carried out individually, taking into account the hormonal disorders of the patient, the nature of the discharge and her overall well-being. The most typical dosage is 40 mg of a single dose of the drug and the further intake of 10 mg three times a day.
Admission Duphaston produce until the complete cessation of symptoms of threatened abortion. In the future, it is possible to change the dosage to maintain the normal course of the child bearing
Like most drugs Duphaston can cause side effects. It can be inflammation in the kidneys, constipation, hemorrhoids. In some cases, there may be negative reactions from the liver (signs of jaundice). With such side effects, the drug is canceled. It can be replaced by other drugs, for example, Utrozhestan. Duphaston has no negative effect on the development of the fetus.
Self-medication at home with unverified traditional medicine is unacceptable! To prescribe hemostatic drugs and other drugs can only the attending physician!
Every pregnant woman should carefully monitor their state of health. Especially attentive should be future mothers who are in the so-called risk groups.
Among the preventive measures aimed at avoiding abnormal discharge during the child's birth, the following can be highlighted:
- Maximum limitation of physical activity and emotional stress.
- Avoid cycling, weight lifting, fast running, strength sports, walking up the stairs.
- In the presence of certain indicators to minimize, and in some cases eliminate sex life altogether.
- Do not use tampons and do not douching, which can provoke increased secretions.
- Drink a sufficient amount of liquid (at least 8-10 glasses per day).
Important conditions for prevention are the prevention of abortions, proper protection, the treatment of gynecological diseases before conceiving a child, and the birth of children under 35 years of age.
Bleeding in early pregnancy, as well as in the third trimester, is completely treatable. Fulfillment of all the prescriptions of the attending physician will allow the woman to avoid negative consequences and give birth to a healthy, strong child.
Physiology of amenorrhea during pregnancy
After fertilization, a significant rearrangement of hormonal background occurs. The activity of the synthesis of sex hormones is shifted towards the production of progesterone. First, in the first trimester, it is produced by the corpus luteum of pregnancy in the ovary. Then this function takes over the placenta.
Increasing the level of progesterone does not allow ovarian follicles to produce new eggs, inhibits the proliferation of the endometrium. Due to this, the menstruation stops, and the fertilized egg gets the opportunity to firmly fix itself in the uterus and continue its development.
Obstetric blood loss
If a woman "in position" begins to release blood from the external genital organs, we are talking about obstetric bleeding. Whatever caused them.
Normally proceeding pregnancy almost always goes without blood until the birth.
The classification of conditions when blood is detected during pregnancy is based on the main criterion - the date of occurrence. Allocate:
- Bleeding in the early stages.
- Bleeding in late pregnancy.
- During childbirth.
- In the early postpartum period.
- In the late postpartum period.
Consider in more detail the bleeding in early and late gestation. They will differ from each other in causes, volume and danger to the fetus. In some cases, may pose an immediate threat to the life of the mother.
At the initial stages, especially in the first trimester, the interaction of the maternal organism and the fetus is only getting better. Plus, the embryo has to go through several critical periods, which often lead to a pregnancy failure.
Therefore, miscarriage leads among the causes of bleeding in the first trimester. The following list of factors provoking blood loss looks like this:
- Ectopic pregnancy.
- Trophoblastic disease (blistering).
- Cervical pregnancy.
- Bleeding from varicose veins of the vulva.
- Benign (polyps) and malignant neoplasms of the cervix.
As you can see, some of the causes are directly related to the pathology of gestation, others are of a slightly different nature.
In approximately 25% of all conceptions, the embryo does not tolerate the stage of differentiation. This phase of the laying of all organs and systems of the fetus. Errors often occur during this critical period, resulting in loss of viability of the embryo.
Sometimes it all happens during the time between the months. Then miscarriage can be confused with regulations that come with a slight delay and look more abundant than usual. Clots can depart.
Miscarriage may be incomplete and then dead tissues, blood clots will remain in the uterus. If at least a small fragment did not come out, then the uterus is not able to return to its previous volume. Bleeding can be profuse (profuse) in nature, bears a direct threat to the life of a woman.
Simplistically, this disease manifests pathology of the placenta, which increases significantly, but becomes more loose. In this case, bleeding during pregnancy is accompanied by an abortion clinic. Clots are distinguished from the external genital tract. The blood is dark. Chorionic villi may appear, resembling bubbles.
Trophoblastic disease requires skilled medical intervention.The embryo, if it was, dies at the very start of the disease.
One of the options ectopic attachment of the ovum. The cervix does not possess the necessary elasticity and cannot stretch. Its mucous membrane is very thin, the submucous layer is rich in vessels with arterial blood.
If it is not diagnosed in time, it can cause a very serious condition. Blood flows copiously, scarlet.
In the earliest terms, bleeding can proceed painlessly: the vessels of the cervix are destroyed under the influence of the growth of the chorionic villi, and not overstretching.
Varicose vulvar disease
One of the few cases when bleeding during pregnancy does not pose a direct threat to the fetus. Altered veins and nodes may bleed. Profusion is average, blood is dark, venous. Clots may be found.
To cause such a complication is capable of intercourse. The risk increases by the end of the first trimester, reaches a maximum by the third. Spontaneous onset is uncharacteristic.
Cervical polyps may bleed due to their looseness. The slightest impact on their surface causes capillary bleeding. Visually, this is defined as smearing.
The presence of a malignant tumor may have a similar clinic, so scanty, brown discharge should be a reason for diagnosis.
If during the first 12 weeks the bleeding during pregnancy is primarily dangerous for the fetus, then at a later date the risks to the mother increase significantly. In the second and third trimesters, two pathologies most often cause blood loss:
- Placenta previa (complete or incomplete).
- Premature detachment of a normally located placenta (PONRP).
These conditions are the most common cause of maternal mortality.
It usually occurs after 28 weeks or with the onset of labor. Sudden onset is inherent in this pathology. There is a significant amount of red blood on the background of the complete absence of pain. Leading causes:
- Detachment of the placenta from the lower segment of the uterine wall.
- Increased intrauterine pressure.
- Opening of the internal os, if it was covered by a fragment of the placenta.
In some cases, recurrent nature is noted with small portions of blood, in the form of drops. This option causes anemization of women, chronic placental insufficiency.
One of the complicating moments is the dense ingrowth of the villi into the muscle layer of the uterus. Then the amniotic fluid can enter the bloodstream of the mother and cause embolization (a kind of thrombosis of the blood vessels). This is an extremely dangerous, resuscitative state.
Incomplete presentation is easy to detect on ultrasound, so you can not neglect the timing of examinations in the antenatal clinic.
Sometimes you can come across another term: uteroplacental apoplexy. This is a serious complication that can develop due to a number of factors:
- Decompensation of hypertension.
- Exacerbation of pyelonephritis.
- Preeclampsia (severe gestosis of the second half of pregnancy).
- Chronic inflammation of the endometrium.
- Rhesus conflict.
These are the main reasons why severe blood loss begins, which can cause antenatal death of the fetus and dangerous anemia in the mother.
Depending on the severity of the condition, there are two degrees of PONRP:
- Easy Hemorrhages may be missing.
- Heavy As a rule, accompanied by blood loss.
It is important to know that external bleeding can either accompany PONRP or be absent in both cases.
If the blood is still gone, then hemorrhages have different intensity (from drops to jet), there are dark, loose clots. All this goes against the background of pain, exacerbation of the clinic of the provocative factor.
If any hemorrhages occur during pregnancy, you should immediately consult a doctor. Help provided in time can save both the mother and the fetus. Late treatment often leads to the removal of the uterus.
When brown smears have appeared or blood has gone in a pregnant woman, it is impossible to joke with this. It even makes sense to call an ambulance if it happened during non-working hours.
Therapy is primarily aimed at the prevention and correction of dangerous complications. These include:
- Acute and chronic anemia (anemia).
- Placental insufficiency.
- Disseminated intravascular coagulation syndrome (DIC).
- Soaking the walls of the uterus with blood (imbibition).
- Infectious processes.
Any of these conditions can cause fetal death, loss of fertility by the mother. Massive blood loss represents a real threat to the life of a woman.
The consequences of miscarriage and incomplete abortion can be eliminated only by scraping. After that, the uterus acquires the ability to contract, and thus the blood stops. When cervical pregnancy requires ligation of the uterine arteries, and only then - curettage. The neck is preserved.
Laparoscopic techniques allow stopping blood loss during tubal pregnancy. Varicose nodes are simply plugged, but serve as an indication for operative delivery (cesarean section).
Polyps are removed remotely by laser. Cancer processes in the first and second trimesters - an indication for extirpation of the uterus. In the third, a cesarean section is first performed.
Placenta previa can be tried to control with drugs. Even if surgery is needed, organ-saving interventions are carried out.
Against the background of the PWPP, depending on the degree and the reasons that caused it, urgent surgical intervention may be required, the timeliness of which affects at least two lives.
In reproductive (childbearing) age, a sign that puberty has passed without disturbance is a menstrual cycle, having the following characteristics:
- the duration of bleeding on average from three to seven days,
- interval between bleedings from twenty three to thirty three days,
- blood loss is normally not more than 150-200 ml of menstrual blood.
If at least one sign does not correspond to the average, you should consult a doctor for advice. Perhaps the presence of individual features of the development of the female body or disease.
Normally, the cycle is regulated by the hormones of the hypothalamus and pituitary, adrenal glands, the ovaries and the uterus. The failure of any link in this harmonious system inevitably leads to problems, first of the menstrual cycle, then of the childbearing function, and later health problems in general are possible.
That is why every woman with the onset of puberty and regular menstruation should, even if there are no complaints, visit the gynecologist at least once every six months for a routine examination. This is necessary in order to notice or pay attention to possible problems of women's health and avoid serious consequences.
Let's start with the duration of bleeding. The average duration of discharge should not exceed seven days. Otherwise, you should talk about hypermenorrhea or even menorrhagia - uterine bleeding. These symptoms should be immediately reported to the gynecologist. Prolonged blood loss can be a sign of serious hormonal disorders, tumors of the uterus or the central nervous system. The combination with a large amount of blood secreted can lead to serious consequences: anemia, asthenia, depletion of the body.
Too short period (less than twenty-two days) between bleeding is called polymenorrhea. In this case, the body is also subject to stress, loss of blood, exceeding the physiologically reasonable rate, which can also adversely affect not only reproductive, but also the overall health of the woman. In combination with long, abundant blood loss, short intervals between them lead quickly enough to anemia, disorders of childbearing and reproductive functions. A woman cannot have a normal sex life, therefore, getting pregnant will not work either.
The other side of the disorders in the hormonal sphere of the female body are rare bleeding. Menstruation does not occur more often than thirty-five days. This condition of menstrual disorder is called opsomenorrhea. As a rule, the rarity of menstruation is combined with the scarcity of discharge and their short duration. Monthly meager so that they are often mistaken for bleeding, but not for physiological bleeding.
It is necessary to pay attention to the fact that abundant, frequent, debilitating bleeding usually occurs in women of younger age in the period of formation of a normal, constant cycle. As a rule, these can be still non-giving girls - after the onset and gestation of a normal pregnancy, the cycle is normalized, the amount of blood lost corresponds to normal values.
Another category of patients with similar phenomena may be women who have diseases of the uterus or ovaries, that is, directly to the genital organs.
But the scarcity and rarity of the onset of monthly bleeding is most likely indicative of neuroendocrine disorders. Such problems of the menstrual cycle can be clinical symptoms of diseases of the central nervous system that regulate the hormonal processes of the female body. You can also suspect a tumor or ovarian disease.
It should be noted that the scarcity and rarity of the onset of menstruation often does not alarm women until such time as the question of pregnancy arises. There are problems with its occurrence and carrying. Often there are scanty periods during pregnancy, when a woman is not even aware of her condition, since she has short, rare bleeding that is mistaken for menstruation.
Pregnancy and scanty monthly
The maturation of the egg, its exit into the cavity of the fallopian tube to meet with the sperm and subsequent fertilization during the regular cycle - this is his main goal. If this does not occur, menstruation begins, and the entire mucous surface of the uterus prepared for the attachment of the ovum will be torn out.
When the pregnancy begins, the fertilized egg from the fallopian tube moves into the uterine cavity, where it attaches to the endometrium, a placenta forms, a normal pregnancy occurs. In this case, hormonal regulation is reorganized to create conditions for gestation, childbirth and subsequent lactation. Regular bleeding, referred to as menstruation or menstruation, stops.
But there is such a thing as scanty periods during pregnancy. Fetal egg must be fixed on the inner wall of the uterus - for this process it takes about seven to fifteen days. If such a period falls on the time corresponding to regular menstruation, then slight bleeding may occur. It is short-lived, scanty.
In addition, endometrial vessels may be damaged during implantation, which also leads to minor bleeding.
Some women may take them as a sign of normal menstruation and never suspect pregnancy. Especially this often happens if the pregnancy is not accompanied by symptoms of early toxicosis, the general condition of the woman does not change significantly.
Is it possible to assert that such phenomena are considered as a possible variant of the norm? Yes, if we are talking about a single, a maximum of two or three times in the first months of pregnancy. Minor damage to the blood vessels when attaching a fertilized egg to the endometrium and possible late reorganization of the hormonal regulation mechanisms are not dangerous for developing pregnancy.
However, if a woman was planning a pregnancy, she came, and bleeding is repeated regularly, you should immediately consult a gynecologist. Why is this necessary:
- pregnancy can be ectopic, which is a direct indication for its termination,
- the uterus may be in good shape, which also threatens with miscarriage in the early stages,
- pathologies of fetal development or its location in the uterus, which can lead to miscarriage, are not excluded.
Ectopic pregnancy - surgical diagnosis. The location of the growing ovum in the fallopian tube threatens to rupture it, bleed and even kill a woman. That is why it is necessary to be observed by a gynecologist from the earliest possible date of the onset of pregnancy. The presence of scanty, bloody discharge during gestation should alert the pregnant woman.
Finding the muscles of the uterus in a tone leads to the rejection of the ovum and its expulsion from the cavity of the reproductive organ - miscarriage. This is often preceded by non-abundant, possibly painful bleeding from the uterus, which is also often taken for menstruation.
Rejection of a small amount of blood is possible when attaching the ovum close to the entrance to the uterus, which does not contribute to the easy development of pregnancy. Therefore, the sooner such a condition is established, the more closely the observation of the expectant mother will be and the greater the chances of carrying the child.
The attachment and development of the fetus near the entrance to the uterus can contribute to an increase in its muscle tone, the possibility of infection penetration, and the lack of sufficient space for further normal growth of the fetus. It requires the consultation of specialists, observation in stationary conditions, medical support, limitation of physical and emotional stress.
A healthy woman is a sign of a nation’s health. Expectant mothers should not forget that it is necessary to be conscious, to be regularly monitored by a gynecologist, to celebrate the first day of the beginning of menstruation every month in the calendar, to know about the features of the female body. If you have any problems or questions, you should contact the relevant specialists, in any case not to postpone the visit to the doctor for a long time.