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Generic activity. Bloody discharge before childbirth Blood during childbirth

According to statistics, this figure is 200 ml, which corresponds to 0.5% of total body weight. At the same time, the expectant mother’s body 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 the 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!

The birth of a baby is a joyful event that you don’t want to overshadow with anxious thoughts. But knowledge about the complications that can accompany childbirth is necessary - first of all, in order not to get confused at a critical moment and to meet them fully armed. After all, the calmer a woman behaves, and the better she understands her condition, the greater the likelihood of a successful birth outcome for both mother and child. In this article we'll talk about one of the most dangerous complications - bleeding. It can develop during childbirth, in the early postpartum period, and even in the last weeks of pregnancy. The onset of bleeding poses a serious danger to the health (and sometimes to the life) of the mother and the unborn child.

Causes of bleeding

Most often, the immediate cause of bleeding is problems related to the condition of the placenta. Predisposing factors for them are:

Chronic inflammatory diseases of the uterine mucosa (endometritis), especially untreated or undertreated.
“Old” injuries of the pelvic organs and scars on the uterus (regardless of their origin).
A large number of abortions, miscarriages and (or) childbirth in a woman’s life, especially if they were complicated by inflammation. (If we take all cases of placenta previa as 100%, then 75% of them occur in multiparous women and only 25% in primiparous women).
Hormonal disorders, endocrine diseases.
Uterine fibroids and other diseases of the internal genital organs.
Heavy cardiovascular diseases, some kidney and liver diseases.
Injuries during pregnancy.
The woman is over 35 years old.

So what placental problems can cause bleeding?

Incorrect separation of a normally located placenta
1. Premature abruption of a normally located placenta. Placental abruption can occur in various areas. If the placenta detaches from the edge, then blood flows out of the external genital tract. In other words, in this case there is external bleeding; in such a situation, pain in the lower abdomen is insignificant or absent altogether. Placental abruption can also occur in the middle, then blood accumulates between the placenta and the wall of the uterus and a hematoma is formed; in this case pain syndrome more pronounced.
2. Difficulty in independent and timely separation of the placenta in the third stage of labor (tight attachment or accretion of the placenta - all or partly). Normally, after the baby is born, the placenta separates and is delivered. When the placenta separates, a large wound surface forms in the uterus, from which blood begins to ooze. This physiological (normal) bleeding stops very quickly due to contraction of the walls of the uterus and compression of the vessels located in them, from which, in fact, the blood flowed. If the process of placenta rejection is disrupted, then bleeding begins from the surface of the mucous membrane, which has already been freed from the placenta, and tightly attached fragments of the placenta do not allow the uterus to contract and compress the vessels. If a tight attachment of the placenta is suspected, a manual examination of the uterine cavity is performed. This is an operation that is performed under general anesthesia. If the placenta cannot be separated manually, it is said to be placenta accreta. In this case, an emergency hysterectomy is performed.
Incorrect placement of the placenta:
1. when they partially or completely block the internal os of the cervix.
2. Low location of the placenta when its edge is located closer than 5-6 cm from the internal os of the cervix.
3. Cervical placenta previa- a rather rare location of the placenta, when, due to the slightly open internal os of the cervix, it can partially attach to the mucous membrane of the cervix.

With the onset of labor (if not earlier, even during pregnancy), the incorrect location of the placenta definitely develops into its premature detachment. This occurs due to more intense stretching of the lower (compared to the upper and middle segments) parts of the uterus as pregnancy progresses and their rapid contraction during dilatation of the cervix during childbirth. Complete and cervical placenta previa are more complex and severe complications. The lower parts of the uterus are less adapted by nature to fully provide the baby with everything necessary. The developing fetus suffers more from a lack of primarily oxygen and, naturally, nutrients. When the placenta is completely or cervically attached, bleeding can begin spontaneously in the second trimester of pregnancy and be extremely intense. It should be especially emphasized that with complete placenta previa we can talk about independent childbirth not necessary at all, since the placenta tightly blocks the “exit”, i.e. cervix.

In this case, at the 38th week of pregnancy, a planned C-section. If bleeding occurs, then it is carried out. With marginal placenta previa, full labor, light bleeding and good condition mother and the newborn child may be given birth through the natural birth canal. However, the decision on the form of delivery always remains with the doctor. In rare forms of placenta previa, when it affects areas of the cervix, preference is given to cesarean section; Moreover, this situation may even result in the removal of the uterus, since this location of the placenta is PURELY combined with its ingrowth into the wall of the cervix.

Bleeding is accompanied by another, more rare complication - uterine rupture. This extremely serious condition can occur both during pregnancy and directly during childbirth.

Obstetricians specifically determine for themselves the time characteristics of the rupture (threatening, beginning and completed rupture) and its depth, i.e. how severe is the damage to the uterine wall (it could be a fissure, incomplete rupture or the most dangerous - complete, when a through defect is formed in the wall of the uterus with penetration into abdominal cavity). All these conditions are accompanied by varying degrees severe bleeding, sharp pain that does not stop between contractions. The contractions themselves become convulsive or, conversely, weaken; The shape of the abdomen changes, signs of child hypoxia increase, and the fetal heartbeat changes. At the moment of complete rupture of the uterus, the pain sharply intensifies, becoming “dagger-like,” but the contractions stop completely. A false impression of decreased bleeding may appear, since the blood no longer flows out as much as it enters the abdominal cavity through the rupture. The abdominal deformity remains, the child can no longer be felt in the uterus, but next to it, and there is no heartbeat. This critical condition: only immediate surgery can save the mother and baby (if he is still alive) and resuscitation measures. The operation usually ends with the removal of the uterus, since the torn, thinned, blood-soaked walls of the uterus are almost impossible to sew up.

The risk group for the probable occurrence of uterine rupture includes:

Pregnant women with an existing scar on the uterus (regardless of its origin: trauma, cesarean section, removed, etc.). It should be noted that modern cesarean section techniques are aimed at minimizing the risk of the above-described complications during repeated pregnancies. For this purpose, a special technique is used to cut the body of the uterus (transverse, in lower segment), which creates good conditions for subsequent wound healing and minimal blood loss in case of possible rupture during childbirth.
Multiparous women with complicated previous births.
Women who have had multiple abortions.
Women with complications after an abortion.
Patients with chronic endometritis.
Women in labor with a narrow pelvis.
Pregnant women with a large fetus.
Pregnant women with abnormal position of the fetus in the uterus
Women in labor with discoordinated labor (a condition when, instead of a simultaneous contraction during a contraction, each fragment of the uterus contracts in its own way).

If a woman knows that she belongs to one of these categories, she should notify her doctor about this. antenatal clinic, and obstetricians in the maternity hospital.

Why is bleeding dangerous?

Why do obstetric hemorrhages remain so dangerous today, despite all the achievements of modern medicine, the development of resuscitation techniques and a fairly large arsenal of means to replenish blood loss?

Firstly, bleeding is always a secondary complication of an existing obstetric problem. In addition, it very quickly becomes massive, that is, in a relatively short period of time the woman loses a large volume of blood. This, in turn, is explained by the intensity of uterine blood flow, which is necessary for normal fetal development, the vastness of the bleeding surface. What can be more successfully turned off by hand when the valve is broken: a single stream of water from a tap or a fan shower? Approximately the same can be said about bleeding, for example, from a damaged artery in the arm and bleeding during childbirth. After all, this is precisely the situation in which doctors find themselves trying to save a woman in labor, when blood is gushing from a large number of small damaged vessels of the uterus.

Of course, the body of a pregnant woman “is preparing for a normal small loss of blood during childbirth. The volume of blood increases (although this primarily meets the needs of the developing fetus, which needs more and more nutrition every day). The coagulation system is put on alert." the blood system, and when bleeding occurs, all its forces, without exception, “rush into battle.” At the same time, the increased coagulation ability of the blood develops into complete depletion - coagulopathy, there are no elements (special proteins) left in the blood that can form a blood clot and “close the hole.” The so-called DIC syndrome develops, all of which is aggravated by severe metabolic disorders due to the underlying obstetric complication(uterine rupture, premature or tight attachment, etc.). And until this is corrected primary complication, it is unlikely to cope with the bleeding. In addition, a woman’s strength is often exhausted due to pain and physical stress.

Features of labor management

If bleeding occurs during childbirth, work is carried out in several directions simultaneously. The anesthesiologist begins the infusion through large veins special blood replacement solutions and blood products. Thanks to this, substances and proteins responsible for blood clotting enter the bloodstream. To improve blood clotting, they begin to infuse fresh frozen plasma, then, depending on the volume of blood loss, red blood cells are poured into another vein; sometimes these blood products are injected in parallel into different vessels. The patient is also given hemostatic drugs and painkillers. Obstetricians determine the cause of bleeding and the type of surgery to be performed.

To maintain normal oxygen supply to tissues, inhalation of humidified oxygen through a mask is used.

The patient is connected to a monitor that constantly monitors her blood pressure, heart rate, blood oxygen saturation (saturation) and continuously takes an ECG. Simultaneously with the above measures, the patient is quickly put under anesthesia for further surgical treatment and transferring the woman to artificial ventilation lungs breathing apparatus. Practice has proven that blood transfusions in patients under anesthesia are safer than in conscious patients.

Of course, transfusion of blood and solutions will be successful only when the initial complication that caused the bleeding is eliminated. Therefore, the task of obstetricians is to identify this complication and determine a plan for treatment procedures, be it manual examination of the uterus, emergency caesarean section, hysterectomy, etc.

After the bleeding has stopped, the woman is transferred to the ward intensive care maternity hospital or to a specialized intensive care unit of a hospital under the constant supervision of medical personnel.

Remember that bleeding in pregnant women can occur not only during childbirth in a hospital, but also at home. When obstetric hemorrhage occurs, time becomes decisive, and in the case of childbirth outside the hospital, it, alas, works against us. Therefore, when planning a trip somewhere in the last weeks of pregnancy or, calculate in advance how long it will take you to end up in the hospital. Remember that with obstetric hemorrhage a condition occurs very quickly when, despite intensive therapy and external clamping of the abdominal aorta (and this is very difficult to do in pregnant women), the ambulance team and even the medical helicopter team may not be able to transport the patient to hospital is alive, since the main method of treatment against the background of intensive care remains surgery.

Is it possible to avoid bleeding?

The risk of bleeding can be significantly reduced with regular monitoring by a doctor at the antenatal clinic. If you have been injured pelvic organs- tell your doctor about it; if anything worries you about the “female” organs, be sure to notify your doctor as well; if you are sick, be cured to the end. You should not avoid ultrasound: it will not cause harm, but will help the doctor identify the problem in time. Try to fight unwanted pregnancies not by abortion, but by more “peaceful” means: this will save you from big troubles in the future. And don’t decide to have a home birth.

Dmitry Ivanchin,
anesthesiologist-resuscitator,
senior doctor of the surgical department
Emergency Medical Center
Moscow Health Committee

05.08.2007 19:53:02, Natasha

I gave birth at the age of 23, the pregnancy was without complications, everything was fine, the birth took place in 6 hours. 20 m., boy 4560, without breaks. And then the bleeding started, there was a manual examination, I lost 800 ml. I have a diagnosis varicose veins veins of the lower con. and pelvic organs. In the end, everything was fine, the uterus contracted well, the very next day it was 11 weeks, although hemoglobin was 73, but nothing. I have a question: what is the probability that there will be no bleeding during the second birth, how to avoid it?

08/26/2006 13:28:12, Maria

I'm 10 weeks pregnant. A couple of days ago, a spotting discharge of a dark brown color (brown) began, two days later the color changed to scarlet, I am in conservancy, the doctors say that there is real threat miscarriage. Why? After all, there is no pain in the lower abdomen or other discomfort! All tests show that the body is healthy and it has enough! An ultrasound showed hypertonicity of the uterine wall, although the fetus is healthy and feels normal. Tell me how serious this is, what to count on, and what could it even be?

06/23/2005 10:38:52, Oksana

Question to the author. Dmitry, please answer here or, even better, to my mailbox [email protected]
First pregnancy at 29 years old (mild), the condition is without pathologies, I do not belong to a risk group. Full-term birth at the Center for Births and Rehabilitation in August 2002. Bleeding, manual separation of part of the child's place under general anesthesia. For six months I had health problems, weakness, stitches did not heal, in general, a nightmare. How likely is it that the second pregnancy will end in such a birth? Would it be better, given your age - 32 years and a problematic first birth, to plan a cesarean section in the future to avoid complications? I really don't want to take risks. And I’m scared to give birth, but I want a second child.

There was bleeding and manual separation. Pavda was not in any intensive care unit; on the second day the baby was brought in (mother and child ward). One thing is not clear. How to plan for a second child? Will there be similar complications a second time? Judging by the article, most likely they will. But then what about the talk that the second birth is easier than the first?

Why scare people? It’s really very scary.

Discharge during the prenatal period is not always bad sign. Most often, this is a natural and understandable phenomenon, so there is no need to rush to the hospital immediately and worry. Each stage of pregnancy has its own type: from mucous to amniotic fluid. Most often, normal discharge tells the expectant mother that the long-awaited baby will be born very soon. But few people know which ones are normal and which ones signal health problems.

According to statistics, the following discharge appears before childbirth:

habitual mucous membranes;
amniotic fluid;
discharge after the plug comes out;
curdled white discharge before childbirth;
yellow, purulent with an unpleasant odor;
bloody (such as pinkish or brown discharge before birth).

During pregnancy, discharge of different colors and nature may appear.

Some of them are signs of pathological processes in the body, others are a completely natural phenomenon that indicates a woman’s preparation for the birth process.

Normal discharge

All normal discharge from women in labor should be clear or white, but odorless, in small quantities, and of a thick texture. In medicine they are called mucus.

The mucus plug accompanies pregnancy until the onset of delivery, since its function is to protect the fetus from infections from the outside. Gradually it becomes unnecessary and superfluous, so it comes out. We can say with complete confidence that heavy mucous discharge before childbirth indicates that there is no more than a week left before the baby is born.

Important! After the mucus has gone away, the expectant mother needs to be very careful: do not take a bath, do not intimate life, carefully monitor hygiene so as not to introduce harmful microbes into the uterus.

During contractions or immediately before them, water pours out. This is also a normal physiological process that directly signals the onset of labor. Water can drain like this:

all at once, that is, the woman acutely feels a transparent stream flowing out of her;
gradual “smudges” during the day.

Mucus plug

The liquid should be odorless and colorless, but may contain some white mucus. If the waters are green - this is a bad sign, immediate contact with a specialist is required.

Pathological discharge

Other discharges that are not mentioned above are considered pathological in medicine, that is, they indicate abnormal physiological processes in the body that can threaten the health of a pregnant woman or her child.

What should you pay special attention to?

spotting, including brown discharge before childbirth;
watery brown with an unpleasant odor;
gray with the smell of rotten fish;
watery green;
light, cheesy consistency (while the pregnant woman experiences constant itching in the perineum);
yellow mucus;
green slime.

Important! Pink discharge before childbirth, they are not always classified as bloody, if there are a few drops of blood in the discharge, this is a variant of the norm, when in reproductive organ Capillaries burst when the mucous plug comes out. If there is a lot of blood in the discharge, this is a very bad sign that requires hospitalization. But first things first.

Brown discharge appears in two cases:

microtrauma of the uterus;
placental abruption.

The most dangerous discharges are considered to be bloody or having bad smell

The first option is practically not dangerous; it may be associated with a trip to the gynecologist, where the woman was examined in a gynecological chair. Besides, Brown color acquires mucus if a woman is on recent months is sexually active during pregnancy.

Bleeding occurs for one reason - placental abruption. This case threatens the life of both the mother and her unborn child. If a woman notices blood from the vagina, she should immediately call an ambulance or get to the hospital herself as soon as possible.

The opaque color of leaking water, as well as their unpleasant odor, indicates that the fetus is experiencing hypoxia, that is, a lack of oxygen. If there is no smell, then there is a possibility that the baby has emptied in the womb.

The main sign of thrush is itching and light discharge, similar to cottage cheese. This disease needs to be treated urgently so that there is no risk of infection of the fetus, because candidiasis occurs in birth canal.

Another infection – bacterial vaginosis, the color of the mucus is gray, and the smell is very unpleasant.

Any yellow discharge is a symptom of sexually transmitted infections. A woman should urgently consult a doctor so that he can prescribe an examination, make a diagnosis and begin timely treatment. Otherwise, the child may also become infected through the birth canal.

Thrush discharge looks like cottage cheese

Reasons for appearance

Brown discharge before childbirth at the 38th week of pregnancy after a full examination by a gynecologist of the woman in labor is not dangerous and is due to the fact that the cervix has already fully matured, softened and become ready for delivery. Droplets of blood appear in the discharge a couple of hours after ingestion.

A woman may feel the release of the mucus plug, which was already mentioned above, or may not notice it at all. The mucus may also be a little pink, but this has nothing to do with the risk of miscarriage.

If the color of the discharge is orange, this is a signal from the body that the expectant mother is abusing vitamin-mineral complexes and there is an excess of such things in the body. Vitamin intake should be reduced or eliminated altogether.

You can judge a woman's health by the color of her discharge.

Any normal physiological discharge has virtually no color (transparent or light - cream, white) or odor. In all other cases, an infection is possible that can easily be transmitted to the child during childbirth from the mother. Therefore, it is so important to visit a doctor on time and cure the disease before giving birth.

What discharge indicates the onset of labor?

It is the discharge that is the first harbinger of labor, which appears even before contractions. What discharge before labor signals the onset of labor?

A clot of mucus or partial profuse discharge of a mucus plug. In this case, labor can begin in a couple of hours, or in a few days, but not later than in a week. The passage of the plug occurs when the cervix is completely ready for the birth of the baby.
Watery discharge, clear and odorless, slightly mixed with non-colored mucus. This happens just before contractions begin or even during them. Sometimes the bubble does not burst on its own, then it is punctured by a doctor in the maternity ward, when it becomes clear that the contractions are regular and not training. If the water is leaking, and there have been no contractions for a long time, you need to urgently go to the maternity hospital, otherwise the baby will begin to lack oxygen. If this happens, the liquid will be green or yellow.

A drooping belly is a sign imminent birth

We can say with confidence that labor begins:

drooping tummy;
a feeling of increasing pressure in the lower abdomen, as if something were pressing on the intestines with great force;
stopping weight gain;
changes in mood;
the appearance of frequent and painful spasms;
bowel movement.

Does not indicate the onset of labor:

irregular spasms;
if you change your position or start walking, the spasms stop;
movement of the fetus during spasms (this is reported to the doctor).

Important! By the 38th week, a woman should have her bags ready for the maternity hospital. If a woman doubts whether labor has begun or not, it is better to still get to the hospital; this is better than later giving birth at home or on the way to the maternity hospital.

When is hospitalization required?

If a woman has a pathological case, then the ambulance team should be called without delay. Critical situations include:

At severe pain in the back and lumbar area, consult a doctor immediately

If a woman in labor notices yellow or curdled discharge on her panties before giving birth at 8-9 months, you should not call an ambulance, nor should you treat yourself (especially with traditional medicine, which cause allergic reaction in the fetus), it is enough to visit a doctor as soon as possible. If this is not done, a possible infection will complicate childbirth and be transmitted to the baby either after the mucus plug comes out or during delivery.

Discharge before childbirth always tells a woman what processes are occurring in the body at a specific period of time. Is pathology developing or do you need to pack your bags for the maternity hospital? Do you need to call an ambulance to save the life of yourself and your child, or can you simply make an appointment with a doctor in the near future, who will prescribe treatment if necessary and tell you in more detail what is happening in the body.

The most dangerous are the bloody and green watery ones, since they directly indicate a problem that is occurring at that moment. Only transparent or light odorless ones are considered normal; they are harbingers of labor.

It is known that both normal childbirth and postpartum period accompanied by bleeding. The placenta (baby place) is attached to the uterus with the help of villi and is connected to the fetus by the umbilical cord. When it is naturally rejected during childbirth, capillaries and blood vessels rupture, which leads to blood loss. If everything is in order, then the volume of lost blood does not exceed 0.5% of body weight, i.e. for example, a woman weighing 60 kg should have no more than 300 ml of blood loss. But if there are deviations from the normal course of pregnancy and childbirth, bleeding that is dangerous to the health and even life of the woman may occur, in which the volume of blood loss exceeds acceptable standards. Blood loss amounting to 0.5% of body weight or more (this is on average more than 300–400 ml) is considered pathological, and 1% of body weight or more (1000 ml) is already massive.

All obstetric hemorrhages can be divided into two groups. The first combines bleeding that occurs in late pregnancy and in the first and second stages of labor. The second group includes those bleedings that develop in the third stage of labor (when the placenta leaves) and after the baby is born.

Causes of bleeding in the first and second stages of labor

It should be remembered that the onset of labor can provoke bleeding, which is by no means normal. The exception is streaks of blood in the mucus plug, which is released from the cervical canal a few days before birth or with the onset of labor. The water that breaks during childbirth should be clear and have a yellowish tint. If they are stained with blood, emergency treatment is necessary. health care!
Why might bleeding begin? The causes of blood loss can be different:

Bleeding in the third stage of labor and after it

Bleeding in the third stage of labor(when the placenta separates) and after childbirth arise due to anomalies in the attachment and separation of the placenta, as well as due to disturbances in the functioning of the uterine muscle and the blood coagulation system.

Disorders of placenta separation. Normally, some time (20–60 minutes) after the birth of a child, the placenta and membranes are separated, constituting the baby's place or placenta. In some cases, the process of separation of the placenta is disrupted and it does not come out on its own. This happens due to the fact that the placental villi penetrate too deeply into the thickness of the uterus. There are two forms of pathological placenta attachment: dense attachment and placental accreta. It is possible to understand the cause of the violations only by manually separating the placenta. In this case, the doctor, under general anesthesia, inserts his hand into the uterine cavity and tries to manually separate the placenta from the walls. With a tight attachment this can be done. And during accretion, such actions lead to heavy bleeding, the placenta is torn off in pieces, not completely separating from the wall of the uterus. Only immediate surgery will help here. Unfortunately, in such cases the uterus has to be removed.
Ruptures of the soft tissues of the birth canal. After the placenta has separated, the doctor examines the woman to identify ruptures in the cervix, vagina and perineum. Given the abundant blood supply, such ruptures can also cause heavy bleeding in childbirth. Therefore, all suspicious areas are carefully sutured immediately after birth under local or general anesthesia.
Hypotonic bleeding. Bleeding that occurs in the first 2 hours after birth is most often caused by a violation contractility uterus, i.e. her hypotonic state. Their frequency is 3–4% of the total number of births. The cause of uterine hypotension may be various diseases pregnant woman, difficult childbirth, weakness of labor, disturbances in the separation of placenta, premature abruption of a normally located placenta, malformations and inflammatory diseases of the uterus. With this condition, most often the uterus periodically loses tone, and the bleeding either intensifies or stops. If medical care is provided on time, then the body compensates for such blood loss. Therefore, in the first two hours after birth, the new mother is constantly monitored, because if bleeding occurs, you need to act as quickly as possible. Treatment begins with the introduction of contractile medicines and replenishing blood volume with solutions and components donated blood. At the same time, the bladder is emptied using a catheter, an ice pack is placed on the lower abdomen, an external internal massage uterus, etc. These mechanical methods are designed to reflexively “trigger” uterine contractions. If medicinal and mechanical methods of stopping bleeding are ineffective and blood loss increases, surgery is performed, trying, if possible, to avoid removal of the uterus.
Late postpartum hemorrhage . It would seem that when everything is fine with a woman and 2 hours after giving birth she is transferred to the postpartum ward, then all the dangers are over and you can relax. However, it also happens that bleeding begins in the first few days or even weeks after the baby is born. It may be caused by insufficient contraction of the uterus, inflammation, tissue injuries of the birth canal, and blood diseases. But more often this problem arises due to the remains of parts of the placenta in the uterus, which could not be determined during the examination immediately after birth. If pathology is detected, the uterine cavity is curetted and anti-inflammatory drugs are prescribed.

How to avoid bleeding?

Despite the diversity causes of bleeding, it is still possible to reduce the risk of their occurrence. First of all, of course, you need to regularly visit an obstetrician-gynecologist during pregnancy, who closely monitors the course of pregnancy and, if problems arise, will take measures to avoid complications. If anything worries you about the “female” organs, be sure to notify your doctor, and if you have been prescribed treatment, be sure to follow through with it. It is very important to tell your doctor if you have had any injuries, surgeries, abortions, or sexually transmitted diseases. Such information cannot be hidden; it is necessary to prevent the development of bleeding. Do not avoid ultrasound: this study will not cause harm, and the data obtained will help prevent many complications, including bleeding.

Follow the recommendations of doctors, especially if prenatal hospitalization is necessary (for example, with placenta previa), do not decide on a home birth - because in case of bleeding (and many other complications) you need immediate action, and help may simply not arrive in time! Whereas in a hospital setting, doctors will do everything possible to cope with the problem that has arisen.

First aid for blood loss

If you notice the appearance of bloody discharge (most often this happens when visiting the toilet) - do not panic. Fear intensifies uterine contractions, increasing the risk of miscarriage. In order to estimate the amount of discharge, thoroughly blot the perineal area, replace a disposable pad or put a handkerchief in your panties. Lie down with your feet up or sit with your feet on a chair. Call ambulance. Try not to move until the doctors arrive. It is also better to ride in a car lying down with your legs elevated. If there is heavy bleeding (when your underwear and clothes are completely wet), you should put something cold on your lower abdomen - for example, a bottle of cold water or something from the freezer (a piece of meat, frozen vegetables, ice cubes wrapped in plastic bag and a towel).

However, sometimes the safety of mother and baby can only be ensured with the help of medical intervention.

Changes may occur in your body indicating that a crucial moment is approaching. Women feel them a few weeks before giving birth - with varying degrees intensity - or not felt at all.

The duration of the difficult process of bringing a baby into the world can vary greatly. For the first birth, it averages 13 hours, for repeated births - about eight. Doctors consider the beginning of labor to be the dilatation of the cervix with regularly recurring contractions.

Over the past 50 years average duration this process was halved, sincein severe cases, a caesarean section is now performed in a timely manner. Spontaneous contractions often begin at night when the body relaxes. Many children prefer to look at this world for the first time in the dark. According to statistics, most births occur at night.

What exactly causes labor pains is a question to which the answer is not yet known. What is clear is that important role The child himself plays in this process. But exactly what mechanisms provide the decisive impetus remains a mystery.

Recent studies suggest that contractions begin under the influence of a protein substance produced by the child, the so-called SP-A protein, which is also responsible for the maturation of the lungs.

Consultation with a gynecologist. Braxton Hicks contractions are usually difficult to distinguish from real labor contractions. During the third trimester, false labor contractions become more intense and frequent if you are active or dehydrated. If you feel them, sit in a cool place, elevate your feet, drink something and rest. If the intervals between contractions increase and their intensity decreases, then they are false. If they become more frequent or severe (especially if they occur every 5 minutes), call your doctor. I always tell patients that no one has ever described their sensations as “spastic” while giving birth to a child. As a rule, the intensity of labor contractions, during which the child passes through the birth canal, is described as follows: “I can’t walk or talk.”

You've seen it in countless movies. Sudden realization: the woman in labor needs to be taken to the hospital URGENTLY! The woman becomes a real fury, spewing curses (“You did this to me!”). Doubled over in terrible pain, she stops moaning only to unleash another round of curses at her poor, panic-stricken husband, who suddenly forgets everything he learned in the Lamaze course, loses his bag prepared for the trip to the maternity hospital, and inevitably sends car straight into a traffic jam, where he ends up having to deliver the baby himself.

The truth is that most couples have plenty of time to realize that labor has actually begun. No one knows exactly what triggers this mechanism, but they are approaching quite quickly. Here are some signs that will tell you it's time to grab your bag and the baby in labor - and get in the car.

Labor begins - signs of labor

Most women give birth to their children earlier or later than the estimated date indicated on the exchange card.

Moreover, most often the deviation in both directions does not exceed ten days. Ultimately, the expected date of birth only plays the role of a guideline. Only 3% to 5% of children are born exactly on this day. If the doctor said that your baby will be born on December 31st, you can be sure: New Year's Eve you won't give birth.

Loose stool

This is due to hormonal changes caused by prostaglandins.

And this makes sense: your body begins to cleanse the intestines to free up more space inside the body for the baby.

Estimated date of birth (EDD)

This is the day your baby will be born with statistical probability. Most give birth somewhere between 37 and 42 weeks. Although many women don't give birth exactly on their expected date, you should definitely know it so you can be prepared. The closer it is, the more attention you need to pay to your bodily sensations and possible signals of the onset of labor. When you turn over the calendar and see the month in which the birth is due, you will feel excitement (and mild panic). Soon!

Contractions - first signs of approaching labor

In 70-80% of cases, the onset of labor announces itself with the appearance of real labor pains. They cannot be immediately distinguished from training ones, which you may have noticed for the first time a few weeks ago. At these moments, the abdomen hardens and the uterus contracts for 30-45 seconds.

The pain caused by contractions is well tolerated at first: you can even walk a little if you want. As soon as a certain regularity is established in the contractions, you will, without any prompting, put everything aside and listen to what is happening inside you.

As contractions gradually intensify, it is recommended to perform the breathing exercises that you were taught in childbirth preparation courses. Try to breathe as deeply as possible, inhale from your stomach. Your baby also has to do hard work during birth. And oxygen will be very useful to him for this.

Braxton Hicks contractions (preparatory). These contractions of the uterine muscles begin at early stages, although you may not notice them. You will feel tension in the uterus. Such contractions are brief and painless. Sometimes there are several of them, they follow each other, but usually they stop quickly. Closer to labor, Braxton Hicks contractions help prepare the cervix for the process.

Go to the clinic immediately!

Regardless of the onset of contractions, if the baby stops moving, the membranes are ruptured, or there is vaginal bleeding, you should immediately go to the clinic.

Braxton Hicks contractions are a “warm-up” before the real contractions begin. They can start and stop several times and often stop when you are active (for example, while walking). Early labor contractions will be uneven in intensity and frequency: some will be so strong that you will lose your breath, others will simply resemble spasms. The intervals between them will be either 3-5 or 10-15 minutes. If you talked to your doctor for 15 minutes discussing whether labor had started or not, and never stopped, it was most likely a false alarm.

Learn to recognize contractions

During the early stages of labor, contractions lasting about 30 seconds may occur every 20 minutes.

The first contractions are similar to spasmodic menstrual pain (radiating pain). The muscles of the uterus begin to contract so that the cervix opens to the full 10 cm.
Late contractions feel like severe menstrual pain or reach an intensity you never imagined.
When contractions become very strong and the rhythm of contractions becomes regular, it means it has begun for real!

There are no mandatory standards for when you can come to the maternity hospital. But if contractions occur every 5 minutes for an hour and make you freeze in pain, no one will prevent you from appearing in the maternity ward. Make an action plan with your doctor, taking into account the time it takes to travel.

If you live near a maternity hospital, wait until the contraction rhythm is 1 every 5 minutes for an hour, and then call and tell your doctor that you are going.
If the maternity hospital is 45 minutes away from you, then most likely you should leave when the contractions are less frequent.

Discuss this with your doctor in advance so you don't panic during labor. Remember that from the beginning active stage In most women, the cervix dilates by 1-2 cm per hour. So do the math: 6-8 hours before you start pushing. (But if at your last doctor’s appointment you were told that your dilation was 4 cm, it is better to come to the maternity hospital early.)

Consultation with a gynecologist. I caution expectant parents, especially if this is their first pregnancy, that there may be a few “false alarms.” My wife is an OB/GYN and she made me take her to the hospital 3-4 times while pregnant with each of our three children! If she couldn't tell for sure, who could? I always tell patients: it is better for them to come and be checked (if it is premature, they will simply be sent home) than to give birth on the side of the road.

Timing is everything

How to calculate the time and rhythm of contractions? There are two ways. Just pick one and stick with it and watch things unfold.

Method 1

Note the moment when one contraction begins and its duration (for example, from 30 seconds to 1 minute).
Then note when the next contraction begins. If it is not felt within 9 minutes, then the regularity of contractions is 10 minutes.
It can become confusing if contractions occur more frequently. Always note the time from the start of one contraction to the start of the next.
If a contraction lasts a whole minute, and the next one begins 3 minutes after the end of the previous one, then contractions occur once every 4 minutes. When their frequency increases, it is difficult to concentrate on counting. Ask someone close to you to count the contractions for you.

Method 2

Almost the same, but here you start counting the time from the end of one contraction to the end of the next.

Opening and effacement of the cervix

Imagine your cervix as a big, plump donut. Before childbirth, it begins to thin and stretch. Expansion (opening) and thinning (flattening) can occur over a period of weeks, a day, or a few hours. There is no standard for the time frame and nature of the process. As the due date approaches, your doctor will make conclusions about the condition of the cervix as follows: “Dilatation 2 cm, shortening 1 cm.”

Abdominal prolapse

This happens when the fetus descends to the entrance to the pelvis and, as it were, “gets stuck” there, i.e. no longer moves inside. During Braxton Hicks contractions, it moves even further into the lower pelvic region. Imagine the child moving into the “start” position. This process begins for all women in different time, for some - only before childbirth. For many, the message of fetal descent is both good and bad news. It’s now becoming easier to breathe and eat, but the pressure on the bladder and pelvic ligaments makes you run to the toilet more and more often. Some expectant mothers even begin to think that the baby might simply fall out, because it is now so low. During the exam, your doctor will determine how low in the pelvis your baby is, or what his “position” is.

Abdominal prolapse occurs when the child seems to “fall” and descends towards the entrance to the pelvis. Head first, the baby moves into the pelvis, thereby preparing to travel through the birth canal. However, for women who experience abdominal prolapse a few days or weeks before giving birth, this symptom is a “false clue”, and for some it does not happen at all until the start of active labor. Braxton Hicks contractions become stronger, the baby gradually moves lower into the pelvis, the pressure on the cervix increases, and it softens and thins.

Rupture of membranes

In 10-15% of cases, the onset of labor is heralded by premature rupture of the membranes, which occurs before the first contractions appear.

If the baby's head is firmly established in the pelvis, then the loss of amniotic fluid will not be so large-scale.

You will learn about ruptured membranes by copious discharge clear, warm fluid from the vagina.

Rupture of the amniotic sac does not cause any pain, since there are no nerve fibers in its membrane. Sometimes the amniotic fluid may be green in color: this means that the baby has already passed his first stool. Record the time of rupture of the membranes and the color of the discharged fluid, and inform the midwife or the maternity ward of the clinic. Here you will receive instructions on your next steps.

It is very rare that the amniotic sac ruptures in its upper part, with amniotic fluid draining out only drop by drop. Then they can easily be mistaken for urine or vaginal discharge, especially with slight weakness Bladder. If you suspect that amniotic fluid is breaking, call your doctor immediately or go to the maternity hospital. A short inspection will clarify the situation.

As a rule, rupture of the membranes does not lead to dramatic consequences. Usually, contractions occur spontaneously within the next 12-18 hours and labor occurs. naturally. In the absence of contractions, they are performed artificial stimulation with appropriate medications to reduce the risk infectious infection for mother and child.

Breaking of water

Sometimes the amniotic sac is referred to by the strange, biblical-sounding term “fetal sac.” When it bursts (either naturally or by a doctor), it means that labor will occur within 24-48 hours. As a rule, the doctor decides not to take risks and not wait more than 24 hours after opening the bladder, especially if the baby is born at term, because there is a danger of infection.

If your water breaks

When the amniotic sac bursts, it's like a small flood, and it's impossible to predict exactly when or where it will happen. In the third trimester, the amniotic sac, a soft and comfortable “place of stay” for the baby, already contains about a liter of amniotic fluid. (Pour a liter of water on the floor - this is what it might look like.) But remember:

For some women, the “leakage” is very small.
Fluid will continue to leak from the sac even after your water breaks because your body will continue to produce it.
Some women's water does not break spontaneously, and to stimulate labor, the doctor performs an amniotomy by piercing the sac with a long plastic hook.
The liquid should be colorless. If it is dark (greenish, brownish, yellowish), this may mean that the baby has defecated directly in the uterus (this type of stool is called meconium). This may be a sign of severe stress in the fetus. Call your doctor immediately.

Consultation with a gynecologist. Heavy vaginal discharge during late pregnancy is completely normal. V 10-20% of women at this stage are so significant that they have to wear pads all the time. Blood flow to the vagina and cervix increases in the third trimester, so vaginal secretion also increases. You may not immediately understand whether this is discharge or your water has broken. If you feel “wet,” dry yourself and walk around a little. If fluid continues to leak, call your doctor.

Signal bleeding is a symptom of the onset of labor

Usually, throughout pregnancy, the uterine os remains closed with viscous mucus, which protects the fetal bladder from inflammation. When the cervix shortens and the uterine pharynx opens, the so-called mucus plug comes out. This is also a sign of impending labor. However, labor pains do not necessarily occur on the same day. Sometimes it takes several more days or even weeks before real contractions appear.

Closer to childbirth, mucus may lose its viscosity and come out as a clear liquid. In most cases, this is accompanied by a small, so-called signal, bleeding. It is much weaker than menstrual and completely harmless. However, to be sure, you should talk to your doctor or midwife about this - you should make sure that the bleeding is not caused by other reasons that could threaten you and your baby. Very often, a woman does not notice the separation of the mucus plug at all.

Light spotting or spotting

They may appear due to changes occurring in the cervix as it prepares to open. Contractions soften the cervix and the capillaries begin to bleed. Contractions intensify and spotting occurs. Any pressure on the cervix may cause slight bleeding (due to exercise, sex, straining during bowel movements, or straining the bladder muscles). If you are unsure whether this bleeding is normal, call your doctor.

Removal of the mucus plug

The cervix softens and begins to open, releasing a mucus plug. Sometimes the mucus flows out slowly or the plug may come out in the form of a knotty thick flagellum. Until this moment, mucus acts as a protective barrier in the cervix and is constantly produced by the body, especially a lot closer to childbirth. It's not a sign of impending labor—some women produce mucus for weeks beforehand—but it's definitely a sign that something is starting to change.

Backache

Pain may occur if the baby is positioned facing forward rather than toward your back. If the baby does not turn to his back, they may get worse. Pain may also occur due to the pressure of his head on your spine when contractions begin.

Cozy nest: not only for birds

Pregnant women often have a strong desire to build a cozy nest even before the onset of labor. The surge of “nesting” energy, which contrasts so strongly with the debilitating fatigue of the last trimester, forces expectant mothers to arrange their habitat, turning it into a nice and clean “incubator”. Another sign that you have begun the “nesting” period is the speed with which you try to get everything done, and how demanding you make requests to your family. "Nesting" is usually expressed as:

painting, cleaning, arranging furniture in the nursery;
throwing away trash;
organizing things of the same type (food in the buffet, books and photographs on the shelves, tools in the garage);
deep cleaning the home or completing “renovation projects”;
purchasing and organizing children's clothing;
baking, preparing food and stuffing it around the refrigerator;
packing a bag for a trip to the hospital.

An important caveat: for some pregnant women, “nesting” never occurs, and if such impulses appear, the expectant mother feels too lethargic to do anything.

Symptoms of labor

False contractions are nagging pain lower abdomen, similar to pain during menstruation. If such contractions are not strong and not regular, there is no need to do anything special: this is only preparing the uterus for childbirth. The uterus seems to be testing its strength before the important work ahead, gathering itself and relaxing its muscles. At the same time, you can feel the tone of the uterus - sometimes it seems to gather in a lump and become harder. The uterus can become toned without pain, since the closer the birth gets, the more sensitive and irritable it becomes. This is fine.

The third important harbinger of labor may be the release of the mucus plug. This is a mucous content that “lives” in the cervix, as if clogging the baby’s “house”. The mucus plug may come off in the form of a thick and sticky discharge of a transparent pinkish color.

A woman may not feel the warning signs of labor, although most often the expectant mother still feels preparatory contractions.

A normal first labor lasts approximately 10-15 hours. Subsequent births usually take several faster than the first, but this does not always happen. I am an example of this exception, as my second labor lasted 12 hours longer (20 hours) than my first (8 hours).

If a woman’s amniotic fluid has broken, she must go to the clinic immediately. Amniotic fluid protects the baby, and he should not be long time without them. Therefore, if you feel lukewarm, clear water leaking out, call your doctor and get ready to go to the maternity hospital.

Usually, after your water breaks, contractions begin (or they suddenly intensify if you have been in labor before). If contractions have not started, most likely maternity hospital They will try to induce labor (with the cervix ready) so as not to leave the baby unprotected for a long time.

Labor usually begins with contractions. Typically, women often begin to feel pain in the lower abdomen and aches in the lower back about a couple of weeks before giving birth. But how then do you understand what it is: preparatory Braxton-Hicks contractions or the beginning of labor?! Such questions and concerns almost always arise among women who are faced, theoretically or practically, with the precursors of childbirth.

It is not at all difficult to distinguish preparatory contractions from the onset of labor! When your stomach starts to swell, be a little more attentive to yourself: is it as painful as usual? painful sensations a little drawn out, or does something else intuitively seem unusual to you?

If you feel that these painful sensations are regular (appear and disappear with little frequency), it makes sense to start timing, counting contractions and writing them down.

Let's say that at about 5 o'clock in the morning you decide that your stomach hurts a little in a special way or for quite a long time. Get a stopwatch (you have it in your phone) and start counting.

At 5 o'clock in the morning pain appeared, a contraction began, it lasted 50 seconds, then there was no pain for 30 minutes.

At 5:30 the stomach begins to pull again, the pain lasts 30 seconds, then nothing bothers you for 10 minutes, etc.

When you see that the pain regularly repeats, intensifies, the duration of contractions increases, and the interval between them decreases - congratulations, you have begun labor.