At the end of hemorrhages late pregnancy may include not only the genitals, but any type of bleeding in pregnancy, digestive, pulmonary, urological, etc.., But in this chapter we will talk mainly of blood loss home genital, which appear in the second half of pregnancy (over 22 weeks gestation), or when the estimated fetal weight exceeds 500 grams.
What are the causes of bleeding in the second half of pregnancy?
No pregnant woman should downplay any genital bleeding suffering, however small it may be, must immediately contact your obstetrician to assess the situation. Not all bleeding will have tragic consequences for the fetus or woman, so for example, there is little bleeding caused by excessive sensitivity to touch having the cervix when contact with the penis in a sexual relationship.
Another case of genital bleeding is within the normal is minimal bleeding which is usually observed when the woman starts labor , as a result of the modification of the cervix has started. However, in any case, the cause should be diagnosed properly to prevent possible risks.
The two most important causes of genital bleeding in late pregnancy are placental abruption and placenta previa (a condition in which the placenta is abnormally placed on the floor of the uterus).
What is placental abruption ?
We must first know what a placenta and what is, to understand the importance of these processes. Broadly speaking, we say that the placenta is what allows communication between the fetus and mother, being the Vehicle Power and fetal oxygenation. Therefore, any significant alteration of the placenta would impact on fetuses, even your life.
• The incidence of this problem varies about one case for every 225 births, accounting for approximately 25% of the causes of genital bleeding in pregnancy, and observed a prenatal mortality of 20%.
• In abruption, what happens is that the placenta begins to detach from the uterine wall before the fetus has left the uterus, at which vaginal bleeding occurs, causing a progressive decrease in oxygenation fetus.
• Other symptoms associated with major bleeding, can be painful palpation of the uterus, contractions of long duration and excessive intensity.
• Have been extensively studied risk factors to trigger this pathological abnormality, being clear association of high blood pressure chronically, or pregnancy-induced. Other authors advocate smoking , or drinking alcohol, excessively, but has not found conclusive about jobs.
Number of previous births
The frequency of placenta previa increases with a new pregnancy, to give us an idea, more than 80% of placenta previa seen in women who have already had children.
Elevated maternal age
It has been found higher incidence in mothers over 35, although it is not known whether this increase is accompanied because a greater number of previous children.
Previous cease recently
We observed an increased frequency only in those cases in which the woman, after having a birth occurs cesarean, becomes pregnant again in a very short period of time.
History of placenta previa
When a woman has had a previous placenta in a previous pregnancy, the rate of relapse (recurrence) is 5-8%.
What is placenta previa?
Placenta previa is defined as a situation in which the placenta is covering the cervix partially or completely. That is, the placement of the placenta was abnormally low, so that obstructs the way he should carry a fetus to exit the uterus.
While there may be uterine activity as contractions, classic is that we are facing a painless bleeding in the third trimester. The genital bleeding caused by placenta previa can be, at times, extremely serious and important, sometimes, it’s insidious and low with little impact to the mother and fetus, but without a doubt, is a situation that control and accuracy requires special attention in order to address any deficiencies that may arise.
The frequency with which we found a placenta previa ranges from one case per 125 births and one for every 300. We should clarify that the progressive growth of the uterus will cause in most cases that the implantation of the placenta go scrolling up, and get rid cervical orifice through which the child will have to leave. That is, a pregnant woman can be diagnosed with placenta previa and weeks after placement may have changed.
Below we detail the risk factors for placenta previa develops:
As for treatment, alternatives will be a function of maternal condition, fetal well-being and their lung maturity, thus defining the path to the C-section or, in certain cases, to the birth vaginally. For example, in a 32-week pregnant patient diagnosed with placenta previa occludes only a fraction of the os, and having a light bleeding, the right attitude should be allowed to continue the pregnancy and fetal development progress more, if instead, we have a woman who is undergoing a major bleeding, we must adopt a more critical attitude.
We can summarize as follows this chapter
Before bleeding, the patient should immediately inform your obstetrician, or failing that, go to a hospital.