In women of reproductive age, the glands of the cervix and vagina produce a mucous secretion that performs protective functions. At the end of pregnancy, the nature of the discharge changes as the hormonal balance changes: the production of progesterone decreases, and estrogen and oxytocin increase. Mucous discharge may become thicker, lose transparency, acquire a yellowish or milky color, and small fragments of blood may be found in it. Often, spotting before childbirth frightens expectant mothers: isn’t this phenomenon an indispensable indication of a serious pathology?
Bloody discharge as a danger signal
An absolute danger is the presence of blood in the discharge:
- In the first trimester of pregnancy. At this stage, the appearance of brown or red discharge is a sign of a threatened miscarriage. When started on time adequate treatment the fetus can be preserved.
- In the second and early third semester of pregnancy. If you are less than 36 weeks pregnant, blood in your discharge may be a symptom of placenta previa (when it is located in the lower part of the uterus and blocks the birth path of the baby). Due to damage to the uteroplacental vessels, when the placenta ruptures or prematurely departs, bleeding occurs, sometimes very profusely. This pathology is dangerous for both the mother and the fetus and requires urgent medical intervention.
- If the discharge before birth contains scarlet blood in large quantities or large blood clots. From a medical point of view, this condition is classified as an emergency. In this case, you should immediately call an ambulance and go to the maternity hospital. Before the medical carriage arrives, it is advisable for a pregnant woman to move less so as not to provoke increased bleeding.
Physiological causes of bleeding
During the prenatal period, the presence of bloody discharge is not considered a pathology, and in most cases it is a sign that labor will begin very soon. However, everything is individual here. Women who actively discuss the topic of childbirth on forums write that for some, after they noticed blood in the discharge, contractions began within a few hours, for others - after a week or two.
Bloody discharge is often observed after the birth plug has passed or at the beginning of the dilatation of the cervix - due to the inevitable ruptures of small capillaries. Obstetricians note a frequent relationship between the color of the discharge and the time remaining before birth: the darker the color of the discharge, the sooner the woman will begin to give birth.
Other causes of bloody discharge before childbirth, which do not pose a danger to either the mother or the baby, may include: gynecological examination or careless sexual contact. In both cases, the appearance of traces of blood in the discharge is caused by mechanical irritation of the cervix, which in the prenatal period becomes loose, softened, and easily injured. Blood smears in the discharge may not appear immediately, but several hours after visiting a gynecologist or a couple of days after having sex.
It should be remembered
It is considered normal when the amount of blood in prenatal secretions small. These may be scanty, smearing traces or inclusions of small clots of brown, brown, pinkish or red color, or the mucus may have a uniform, faint pale pink or brownish color.
However, if you find even those listed on the safe list before giving birth, be on the safe side and contact your doctor. If necessary, he will refer you for an ultrasound or prescribe other unscheduled examinations.
Blood before childbirth is considered normal in two cases - if the process of childbirth begins with accompanying contractions or if the plug comes out. In these two cases, expectant mothers should not worry. You need to calmly collect your things, documents and go to the maternity hospital.
If bleeding begins before childbirth, it manifests itself in large quantities and has a scarlet color, you should immediately call ambulance, ask relatives to prepare things and, without making sudden movements, wait for the ambulance. And, already in the hospital, ask for help from a midwife or doctor.
Discharge before childbirth with blood - as a sign of the long-awaited beginning
Bloody discharge before labor may indicate the onset of labor. The uterus is ready for childbirth, and the mucous plug is expelled in a timely manner. In the lower abdomen, the expectant mother will feel a slight heaviness and a little pain, and then translucent or pink mucus can be observed. Pink color indicates the presence of droplets of blood, sometimes veins or round spots are visible.
Blood clots before childbirth indicate to women that their baby is preparing to be born. Expectant mothers do not need to worry if this happens on time. For some women, the mucous blood plug breaks at 38 weeks and they can expect to give birth for about 2-3 days. And sometimes the plug comes off just before birth at 40-41 weeks. Women in labor themselves may not see this traffic jam.
And it happens that after an examination by a gynecologist, minor discharge with blood appears. They are normal if the gestational age is closer to childbirth, this also indicates the preparation of the cervix.
What kind of bleeding before childbirth can be dangerous?
Excessive bleeding before childbirth, occurring ahead of schedule due to placental abruption or multiple pregnancies, can be dangerous. In these cases you should C-section. Placental abruption is not normal early and mainly arises either from the mother’s unhealthy lifestyle or pathologies.
Heavy bleeding is dangerous due to large blood loss in the mother and hypoxia in the fetus. To avoid problems and maintain your health and the health of your unborn child, you need to take care of yourself. Lead a healthy lifestyle, do not smoke or drink alcohol, and especially do not take drugs. And include more in your diet healthy vegetables, fruits and meat, spend more time on fresh air and take care of your nerves. Thus, the woman will take care of her unborn baby.
Thus, we can conclude that the appearance of blood before childbirth is not a reason to panic. It is worth paying attention to the timing and amount of allocations. At a later stage, blood may appear even after examination by a gynecologist. And if the blood began to flow before childbirth, and the woman is 38-40 weeks pregnant, the discharge means the beginning of labor and gives a reason to go to the maternity hospital with things.
According to statistics, this figure is 200 ml, which corresponds to 0.5% of total body weight. At the same time the body expectant mother prepares for blood loss in advance. Thus, already in the first trimester, the volume of circulating blood increases, and closer to childbirth, blood clotting increases, which insures the body from large expenses. In addition, already during childbirth, the woman’s body starts a mechanism that stops bleeding.
What happens at the physiological level?
After the birth of the child and the placenta, the placenta separates from the walls of the uterus, and a small wound forms in the place to which it was recently attached. It is at this very moment, which can last up to half an hour, that the body turns on protection against large blood loss.
When it leaves the uterus, it contracts and contracts, thus blocking blood vessels. Because of this, clots form in the vessels, which stops bleeding. Over the next two hours, the new mother's uterus should contract and contract. This is why women put ice on their stomach. After all, as you know, under the influence of cold, muscles continue to contract.
In what cases are we talking about bleeding?
If a woman has lost 500 ml of blood or more, doctors call it bleeding. To avoid such situations, it is important to follow all doctor’s instructions during pregnancy and not skip routine examinations. In 9 months, the doctor will draw up a complete picture of the condition of your body: how many pregnancies you had before this one, do you have any scars after a cesarean section, tumors, chronic diseases, problems with blood clotting, etc.
What can cause large blood loss?
Experts include these factors:
- Decreased uterine tone
- Premature placental abruption
- Cervical injuries that can occur if a woman starts pushing ahead of time
- Retention of part of the placenta in the uterus
- Bleeding disorder
To ensure that the birth of your baby goes without complications, listen to your doctor’s advice and remain calm. We wish you an easy birth!
Bleeding can complicate the course of childbirth, the postpartum period, and lead to severe endocrine pathology. Every year, 140 thousand women die from bleeding during childbirth. Half of them occur against the background of gestosis, a pathology of vital organs. TO fatal outcome are cited by underestimation of the severity of the patient’s condition, insufficient examination, inadequate and untimely therapy. What are the causes of obstetric bleeding, is there any prevention, what should be the therapy.
What is physiological blood loss
Most cases of pathological blood loss occur in postpartum period, after separation of the placenta. The volume programmed by nature, up to 0.5% of a woman’s body weight, does not exceed three hundred milliliters. From one hundred to one hundred and fifty of them are spent on the formation of blood clots in the placental area after separation of the placenta. Two hundred milliliters are secreted from the genital tract. This blood loss is called physiological - provided by nature without harm to health.
Why does it occur
Obstetric hemorrhages are usually divided into those that begin with the onset labor activity, in the afterbirth and early postpartum periods. Bleeding in the first stage of labor and in the second can be caused by premature abruption of a normally located placenta. In the third period there are many more reasons.
After the birth of the fetus, during the normal course of labor, the placenta separates and the placenta is released. At this time, an open placental area appears, which contains up to two hundred spiral arteries. The terminal sections of these vessels do not have a muscular membrane; blood loss is prevented only thanks to uterine contractions and activation of the hemostatic system. The following happens:
- After expulsion of the fetus, the uterus decreases significantly in size.
- A powerful contraction and shortening of muscle fibers occurs, which draw in the spiral arteries, compressing them with the force of myometrial contractions.
- At the same time, compression, twisting and bending of the veins occurs, and intensive formation of blood clots occurs.
In the area of the placental platform (the place of former attachment of the placenta) healthy women blood clotting processes are accelerated ten times compared to the time of thrombus formation in vascular bed. During the normal course of the postpartum period, the first thing that occurs is a contraction of the uterus, which triggers a thrombosis mechanism, which requires a decrease in the lumen of blood vessels and a decrease in blood pressure.
It takes about two hours for the final formation of a blood clot, which explains the observation time due to the risk of the described complication. Therefore, the causes of bleeding during childbirth can be:
- conditions that impair the contractility of the myometrium;
- pathology of the blood coagulation system;
- injuries birth canal;
- premature, disruption of the processes of its separation and excretion.
Bleeding can begin after the birth of the fetus with a decrease in myometrial tone, abnormalities in the location of the placenta, disruption of its attachment and incomplete separation from the walls in the third stage of labor. The likelihood of pathology occurring is higher with development the following complications:
- anomalies of labor;
- inappropriate use of uterotonics;
- rough handling of the third period.
The risk group includes women with previous gynecological diseases, genital surgeries, abortions, infantilism. IN succession period due to pathologies of the placenta, the strength of myometrial contractions may be impaired, and the operation of manual separation of the placenta disrupts the process of thrombus formation in the placental site.
Additional provoking factors are disruption of the integrity of the birth canal. In the first hours after childbirth, bleeding can be caused by low levels of fibrinogen in the blood, atony and hypotension of the uterus, retention of parts of the placental tissue and membranes.
How it manifests itself
Bleeding is the most severe complication of childbirth. Blood loss of 400-500 milliliters is pathological, and one liter is massive. Pathology accompanies abnormalities of placental attachment, retained placenta, rupture of soft tissue of the genital tract.
Premature abruption of a normally located placenta
If the measures taken remain ineffective, the issue of applying surgical treatment. When the uterus ruptures, internal bleeding develops. This condition is an indication for urgent extirpation or amputation of the organ.
Manifestations in the early postpartum period
Bleeding in the first two hours after birth occurs in five percent of all births. Predisposing factors may include previous inflammatory processes against the background of pregnancy, endometritis, abortion, history of miscarriage, presence of a scar on the uterus. The main causes are:
- retention of parts of the placenta;
- violation contractility myometrium;
- birth canal injuries;
- disorders of the blood coagulation system.
Read more about bleeding after childbirth.
Retention of parts of the placenta, membranes
Prevents contraction and compression of the uterine vessels. Pathology may arise due to the acceleration of the birth of the placenta by obstetricians, when its complete separation has not yet occurred, with the true attachment of one or several lobes. They remain on the wall while the main part of the child's place is born from the genital tract.
Pathology is diagnosed by examining the placenta, finding a defect in its lobules and membranes. The presence of defects is an indication for a mandatory inspection of the uterine cavity, during which the retained parts are searched and separated.
Hypotony and atony of the uterus
Damage to the neuromuscular apparatus of the uterus, dysregulation of muscle fiber contractions, malnutrition, oxygen starvation myometrial cells lead to a significant decrease or complete loss (, respectively) of uterine tone. Hypotonic bleeding during childbirth is a reversible condition, the first manifestations of which begin immediately after the separation of the placenta, and can be combined with a violation of the processes of its separation.
Big sizes organ, flabby consistency, unclear contours, profuse bleeding from the birth canal, which is accompanied by additional release of blood and clots during external massage of the uterus, are symptoms of hypotension. This condition direct reading for manual examination of the cavity, massage on the fist, administration of uterotonics, infusion therapy. If the measures taken are ineffective and blood loss is 1 liter, the issue of organ removal is decided.
There are two development options pathological condition– wavy and massive blood loss. With uterine atony, bleeding is continuous and quickly leads to hemorrhagic shock. In this condition urgent Care It turns out from the first seconds, with simultaneous preparation of the operating room. Consists of several stages:
- Restoring the volume of lost blood.
- Achieving adequate oxygen levels.
- Timely use of maintenance therapy - steroid hormones, cardiovascular drugs.
- Correction of biochemical, coagulation, vascular disorders.
The level of organization of the work of the maternity hospital, a clearly developed scheme of staff actions is the basis successful therapy. Prevention of bleeding during childbirth involves early identification of pregnant women in the appropriate risk group.
These measures make it possible to anticipate a serious complication and prepare for it in advance. With the first contractions, install an intravenous catheter, determine the main indicators of hemostasis, administer Methylergometrine when the fetal head erupts, and prepare a supply of medications. All events are held against the background intravenous administration necessary medications.
The infusion therapy protocol provides for the administration of Infucol in an amount equal to the volume of lost blood. In addition, crystalloids are used, fresh frozen plasma, erythromass.
Indications for the administration of red blood cells may also be a decrease in hemoglobin levels to 80 g/l hematocrit to 25%. Platelet mass is prescribed when the platelet level decreases to seventy. The volume of blood loss restoration is determined by its magnitude.
TO preventive measures include the fight against abortion, compliance with the protocol for managing women at the stage antenatal clinics, during childbirth, the postpartum period. A competent assessment of the obstetric situation, prophylactic administration of uterotonics, and timely surgical delivery make bleeding preventable.
Careful observation in the first two hours after birth, applying ice to the lower abdomen after discharge of the placenta, periodic gentle external massage uterus, accounting of lost blood, assessment general condition women avoid complications.
The process of labor pains does not always proceed in exact accordance with textbook descriptions in medical textbooks. Much depends on individual characteristics woman and her pregnancy.
Therefore, the appearance of bloody discharge already at the stage of contractions is not at all uncommon. Is this normal and what to do if they appear, we will tell you in this article.
Causes
Contractions are rhythmic contractions of the uterine muscles, the task of which is to lead to the dilatation of the cervix. This process is painful and quite long. The cervix needs to expand by 10-12 centimeters so that the baby's head can pass through. Often the period of contractions is accompanied by the manifestation various secretions, including bloody ones associated with the discharge of the mucus plug.
A clot of mucus with blood streaks closes tightly cervical canal cervix throughout pregnancy. But when active preparation begins female body By the time of childbirth, the cervix becomes softer, smoothes out, and the plug may begin to come off either entirely or in parts.
It may appear as light, yellowish, or pink mucus with small streaks of blood. Such discharge can appear not only at the “precursor” stage, but also during contractions.
There is no need to be scared - there is a completely natural and physiological process of opening the cervix for the subsequent release of the baby. It is only important to make sure that the discharge does not intensify and does not turn into scarlet blood.
Small blood or brown discharge may appear when contractions begin and after examination by a gynecologist. After a woman arrives at the maternity hospital, she will definitely be examined, and therefore such discharge should also not frighten or alarm.
Scarlet blood during contractions, heavy bleeding - a more alarming situation. This may result in premature placental abruption. Normally, the “baby place” leaves its place after the birth of the baby, in the subsequent period of childbirth. If earlier detachment occurs, this is fraught with bleeding, a state of acute hypoxia for the child, which can lead to irreversible changes in his brain and the entire central nervous system. The baby may die.
Bright red, scarlet blood during labor is not considered normal. Her appearance is a reason to call an ambulance if the woman is still at home, or immediately report it medical personnel, if the woman in labor is already in a maternity facility.
Actions
If heavy bleeding appears with the first contractions or a little later, you need to immediately go to the maternity hospital and immediately report this unpleasant news to the medical staff.
If placental abruption occurs, the woman will urgently undergo a cesarean section, since delay is unacceptable.
For moderate bloody (do not confuse with blood!) discharge, use pads, avoid getting water into the vagina, for example, while showering at home before going to the maternity hospital or reception department maternity hospital
Without a mucus plug, the baby has no mechanical barrier protection against viruses, bacteria and fungi. If aggressive flora or microorganisms enter the uterine cavity, an internal infection can develop quite quickly, which is extremely dangerous for the baby and the mother.
If bloody or scarlet discharge is accompanied by the release of a large amount of fluid, premature rupture of water is possible. In such a situation, you should also go to maternity hospital without waiting until the contractions become more intense. In the emergency department, you also need to immediately say that the fluid flowing out was bloody, pink, brown, or some other color. This will help doctors quickly choose the right tactics for labor management.
The main thing is not to panic or get nervous. Doctors have a lot of ways to deal with this or that emergency situation that arose during childbirth. Trust them.
For information on discharge, contractions and other precursors of labor, watch the following video.
