If during the battle there is blood. Why can there be bleeding during the fights and what to do? What pre-soda discharge from the vagina are considered normal

Date: 03.11.2019

What often scares a young woman who first preparing to become a mother (or what is most often frightened)? The answer suggests the contractions. Waiting for pain can cause a large panic than the pain itself. And the closer the coin time, the obsessive the same fear. The most faithful means to get rid of fear - stop hiding from him and hide him from Himself, to meet him face to face, "talk" with him. Are you afraid of fights? So let's figure it out what it is.

What is contracted?

I am expressed by medical language, generic contractions are involuntary regular cuts in the uterus, along with attempts relating to generic expensive fruit.

Fights indicate the origin. (In addition to the fights, such symptoms may indicate such symptoms as the influence of the oily water and the extinguishing of the mucosa of the plug closing the magnitude of the cervix; the mucous plug can move in 2-3 days before delivery, so it does not always mean in the maternity hospital). Many works are written about what, in fact, provokes the beginning of childbirth. Discalcated in private, all researchers agree in the main thing: the organisms of the mother and the child, being in close cooperation, as if "agree", transmit the necessary impulses to each other.

Shortly before the start of birth of the placenta of the woman and the pituitary gland, the baby begin to produce specific substances (in particular, the prostaglandins and the hormone oxytocin), causing contraction of the muscles of the uterus, called the fights. During pregnancy, the cervix is \u200b\u200btightly closed. With the beginning of generic battles, its disclosure begins: the uterine zev gradually expands to 10-12 cm in diameter (full disclosure). Generic ways are preparing to "release" a child from the mother's womb.

Intrauterine pressure during battles increases, since the uterus itself is reduced in volume. Ultimately, this leads to the rupture of the fuce bubble and the fueling of the part of the oily water. If this coincides in time with the full opening of the uterine zoom, they talk about the timely powerful water, if the uterine zev at the time of the rupture of the fruit bubble was not revealed enough, such an extension is called early.

The first, preparatory, period of childbirth occupies, on average, 12 hours, if a woman gives birth for the first time, and 2-4 hours less for those who do not give birth. At the beginning of the second period of childbirth (the expulsion period of the fetus), swells are joined - the abdominal wall muscles and aperture muscles. In addition to the fact that different groups of muscles are involved in the fights and atiquities, they have another important difference: the contractions - the phenomenon is involuntary and uncontrollable, nor their power, nor frequency depend on the feminine, while the swells are subject to a certain extent submitting her will , she can detain them or strengthen.

What to wait for fights?

Feelings during battles are individual. Sometimes the first shocks are felt in the lumbar region, then apply to the stomach, become encumbling. The drawing sensations may arise in the most uterus, and not in the lower back area. Pain in the fights (if you cannot relax or find a comfortable position), it resembles pain, often accompanying menstrual bleeding.

However, it is not necessary to panic fence. Often you can hear from those who gave birth to women that the fights passed from them either in painlessly, or the pain was quite tolerable. First, during battles, the body allocates its own painkillers. In addition, painful sensations help to get rid of relaxation and proper breathing during pregnancy. Finally, there are medical methods of anesthesia, but they are recommended to be applied only in extreme cases, since they all have an impact on the kid to one degree or another.

Real (and not false - see below) "Cutting Forces" approach with regular frequency. Initially, the intervals between the fights are about half an hour, and sometimes more, the contraction of the uterus lasts 5-10 seconds. Gradually, the frequency, intensity and duration of bouts increase. The most intense and durable (and sometimes - although not always - painful) the last fights preceding the sweeps. When to go to the maternity hospital? In the case of the first birth (and if it is not far from the maternity hospital), you can wait until the gap between the fights is reduced to 5-7 minutes. If the clear interval between the fights has not yet been established, but the pain is enhanced and becomes more and more long, then it's time to go to the hospital. If childbirth is repeated, then with the beginning of regular battles, it is better to immediately go to the maternity hospital (often repeated births differ in rapidness, so it is better not to slow).

With the beginning of the fights may appear mucous membranes with a slight adoption of blood - this is the same mucous plug, which "clocked" the entrance to the uterus. Blood (in small quantity) enters the mucus due to smoothing and cervical disclosure. This is a natural process that should not be frightened, however, with abundant bleeding, an immediate survey is necessary.

True or false?

It should be borne in mind that after 20 weeks of pregnancy, some (not all) women appear so-called false fights, or brackstone Hicks, and for 2-3 weeks before the childbirth, women begin to feel foregraded contractions. Neither those nor others, in contrast to the true fights, do not lead to the disclosure of the cervix. There are stretching sensations in the bottom of the abdomen or in the lower back, the uterus as it mows - if you attach a hand to the stomach, you can distinct it clearly. The same, actually, occurs during the genital fights, so "Brexston-Hicks" and forerunners are often confused for the first time women. How to understand whether childbirth starts and it is time to go to the hospital, or are these only false contractions?

Brexstone Hicks fights, unlike true generic battles, rare and irregular . Reduction lasts up to minute, can be repeated after 4-5 hours.
False fights painless . Walking or warm bath is most often help to completely remove the unpleasant feeling.

The role of false kits until the end is not found out. Their appearance is associated with an increase in the excitability of the uterus, it is believed that they are shortly before delivery, precursor contractions contribute to the softening and shortening of its neck.

What to do during battles?

It was noted that the more pregnant woman is frightened, the smaller she knows what happens to her and what she is, the harder, the birth of her is longer and painful. Even in the very recent past, the phrase "preparation for childbirth" seemed to be complete nonsense in Russia. Fortunately, over the past decade, qualitative changes occurred in this area - there are many courses and schools on preparing for childbirth, where not only future mothers are preparing for this important event, but also future dads. Published enough books. And the main thing - the psychology changed. Now if not all, most women understand that it is necessary to prepare for childbirth, as any hard and important work. And the main purpose of such training is to get rid of fear and pain.

What do specialists usually recommend that the contractions have passed as easy and painless? As already mentioned, control the frequency and the power of the battle you can not, it does not depend on you. But you can help yourself and your child to survive these kids.

At first, when the fights just started, it is better not to lie, but to move: it will speed up the process of disclosure of the uterine zois, and therefore will reduce the time of birth.
Quietly focus and try to find the position of the body in which you are most comfortable. Do not hesitate if you want to stand on all fours, lie on a large inflatable ball or even ... dance. Believe me, to anyone and in the head will not come to condemn you for extravagance. Circular and squeezing motions of the pelvis helps to remove the tension and reduce the pain.
If it turns out, try between fights to sleep or at least "pretend to sleep" (this will help relax the body).
You can lie in ten minutes in the bath with warm water - of course, if you are not alone in the apartment and, if necessary, you can help.
Light stomaching palm tree strokes with pillows facilitates the fight at the beginning of the path. With the beginning of the fight you need to take a breath and direct the movement of the hands from the midline to the sides, on the exhalation of the hands moving in the opposite direction.
When enhanced, the fights well helps to remove the pain strong and frequent pressure by thumb on the point in the field of the front-top arms of the iliac bones (these are the most protruding part of the pelvis). Hands are conveniently located palms along the thighs.
The massage of the sacral zone of the spine is very useful. It is effective not only at the beginning of the bouts, but all that time until your body has expelled forces.

As the fights enhanced, the correct breathing becomes increasingly important. But the most important thing is to tune in, listen to your own feelings and ... remember the child. You both have a hard job, but it will be a meeting!

Tatyana Kipilinova

The first contractions I recognized with difficulty. The fact is that they were very similar to the "training" fights - the so-called "Brequeston-Hicks" fights, which almost every evening persecuted me from the 7th month. And I first could not understand - it is still or already the beginning of childbirth. Feels like the belly below, then "let go." The intervals between the fights were uneven: after 20 minutes, then after 5; But nevertheless, they walked regularly (longer than two hours) - this was affected by the decision to go to the hospital.

The first contractions were completely tolerant - just a sense of little discomfort. Between them were considerable intervals that gave the opportunity to relax, and I have already started doubting that I really give birth. Upon arrival in the maternity hospital, inspection showed a cervix for 1 cm. When a bubble puncture (by the way, it turned out to be completely not hurt), the fights went more efficiently, the pain became quite tangible, the intervals were about 5-10 minutes (opening 4 cm). I used to have quite painful periods, and this pain seemed like me like a menstrual. Over the next hours (the child moved to the exit), the pain becomes more and stronger. It was hard. I was a little helped by a waist massage, which my husband did, and the breath, about which I read in the books (the medical staff also suggested how to better breathe). When the pain became simply unbearable, attempts began (by the way, I had ever heard from others that, when you feel that the limit came and tolerate the pain no longer, it means that everything will be over). Cellies to recognize easily - involuntarily you start to sleep (this process I could compare with a call to the toilet). Speakers - the thing is also painful, but the cardiographic apparatus has become bad to listen to the heart of the child, and I had to give birth as quickly as possible. Therefore, about the fifth of the sweat, I already gave birth to my boy (not without epitime). We took the whole process for 12 hours (these were my first childbirth).

Anna Goncharov

The contractions were similar to very strong and painful menstruation. At first they were very weak, and I didn't even feel discomfort. It was like a very light (not painful) spasm inside the abdomen. Painful contractions were only four hours later. And it resembled it most painful menstruation. But it was very painful only about an hour. It was possible to endure, but with difficulty. The husband helped a lot. Even in the most busy moment, the pain was not permanent. Everything went approximately with a periodicity of 5 minutes. At first, the pain quickly increased, reached the maximum and then the same quickly disappeared. Each fight occupied two minutes. For a minute there were no three pains! It was worse for me at the time of the beginning of the new fight - when it still does not hurt, but you understand that everything went first. Conversable, but tolerant. And only one hour. As soon as I was allowed to sleep, pain stopped. There are no more pains that sometimes write (in the lower back, or somewhere else), I did not have.

By the beginning, I was already in the hospital, so I immediately went to the doctor, and the doctor confirmed that childbirth began. The doctor and midwife said when you can start to sleep. It was not hurt at all, and it's not hurt at all. Although they did a cut, but I did not notice this at all.

Birthually I remember very well, but the pain is forgotten very quickly. I remember rather with pleasure - and first of all, any funny moments. There was no feeling of horror and "never more" at all. Maybe because there was a good hospital and I gave birth with my husband!

Elizabeth aircraft

Unfortunately, I was psychologically not ready for childbirth. Therefore, already being in Rozale (I lay in the hospital on preservation), I felt that I had a very hard stomach hurts, and was afraid. Of course, "theoretically," I knew that I was fighting, but weakly imagined what it was. Of course, no about the counting of the intervals between the fights (it offered to make an obstetric, which was sitting next to the table and wrote something) could not be a speech. It seemed to me that I was dying, and I was as a weakening voice to make a cesarean cross section. The midwife for some reason was fun laughed. I ask: "What are you laughing?" And she: "According to my estimates, each second woman has asked to make Kesarean."

I suffered for about an hour. I was very insulted that the people who were around (nurses, midwives, head. Department and even some travelers who showed me as an example of the "old primary with a somewhat narrowed pelvis") took my suffering as proper and however It was trying to speak with me on some boring household topics (asked where I was working where I had such a strange surname and how I would call my future child). And when my belly began to hurt especially strongly, the midwife was suitable and the mockery (as I did it seemed to be described how I should breathe.

When there were attempts, it became easier and even, I would say, more interesting, because the "labor result" should have been about to appear. He appeared. It was 3 kg of 600 g.

Then I apologized to the doctors, but they laughed again and said that because I, almost everything. And I decided that I would be prepared for the next birth for a long time and seriously.

Blood before childbirth is considered the norm in two cases - if the process of generics begins with accompanying fights, or if a plug has moved. In these two cases, the future mothers should not worry. You need to calmly collect things, documents and go to the maternity hospital.

If the bleeding began before childbirth, it is manifested in large quantities and has a scarlet color, it is necessary to immediately cause an ambulance, ask for relatives to cook things and, without making harsh movements wait for the ambulance. A, already in the hospital, ask for help from the midwife or a doctor.

Selection before childbirth - as a sign of the long-awaited start

Options before childbirth can mean the beginning of labor. The uterus is ready for childbirth, the timely separation of the mucosa is occurring. At the bottom of the belly, the future mother will feel a little gravity and a little pain, and then you can observe a translucent mucus or pink. Pink color indicates the presence of blood droplets, sometimes bodies or round specks are visible.

Blood clots before childbirth indicate women on the fact that their kid is preparing to appear. Futive mothers do not need to worry if it happens on time. Some women have a mucosa blood plug leaves for 38 week, and they can expect childbirth about 2-3 days. And sometimes the cork moves immediately before childbirth for 40-41 weeks. The women in labor can not see this cork.

And it happens that after examination of the gynecologist, minor sections with blood appear. They are normal if the term of pregnancy is closer to childbirth, it also talks about the preparation of the cervix.

What bleeding before childbirth can be dangerous

It may be dangerous to be abundant bleeding before childbirth, which emerged earlier due time due to the detachment of the placenta or multiple pregnancy. In these cases, a cesarean cross section. The disclosure of the placenta is not the norm on an early term and mainly arises either from the wrong way of life of mom or pathologies.

Abundant bleeding is dangerous large blood loss in mom and hypoxy in the fetus. To avoid problems and maintain your health and health of the future child, you need to take care of yourself. Make the right way of life, nor smoking and not drinking alcoholic beverages, and even more so do not take drugs. And to include more useful vegetables, fruits and meat in the diet, to spend more time in the fresh air and take care of their nerves. Thus, the woman will show care towards his future baby.

Thus, it can be concluded that the appearance of blood before childbirth is not a reason to panic. It is worth paying attention to the period and the number of secretions. At the later date, the blood may appear even after examining the gynecologist. And if the blood went before birth, and the woman is located on the 38-40 week of pregnancy, allocations mean the beginning of childbirth and give rise to the hospital with things.

Bleeding can complicate the flow rate, postpartum period, lead to severe endocrine pathology. Every year, 140 thousand women are dying from bleeding during childbirth. Half of them arises against the background of gestosis, pathology of vital organs. The death rate of patients, insufficient examination, inadequate and late therapy leads to death. What are the reasons for obstetric bleeding, there is a prevention, which therapy should be.

What is physiological blood loss

Most cases of pathological bloodstures arise in the postpartum period, after separating the placenta. Natural programmed volume up to 0.5% of the body weight of a woman does not exceed three hundred milliliters. From a hundred to one hundred and fifty of them are spent on the formation of blood clots in the placental site after the separation of the last. Two hundred milliliters are distinguished from the genital paths. This blood loss is called physiological - the nature provided by nature without prejudice to health.

Why arises

Obstetric bleeding is made to divide on those that begin with the beginning of generic activities, in the last and early postpartum periods. Bleeding in the first period of birth and in the second can be provoked by a premature detachment of a normally located placenta. In the third period of the causes are much more.

After the birth of the fetus, at the normal course of labor, the placenta separation and the selection of the latch occurs. At this time, an open placental site appears, which contains up to two hundred spiral arteries. The final departments of these vessels do not have a muscle envelope, blood loss is prevented only due to the uterine contractions and activation of the hemostasis system. The following happens:

After expulsion of the fetal, the uterus is significantly reduced in size.
There is a powerful reduction and shortening of muscle fibers, which are drawn by spiral artery, squeezing them with the power of miciometry cuts.
At the same time, compression, twisting and inflection of veins, intensive formation of blood clots are performed.

In the area of \u200b\u200bthe placental site (the place of the former attachment of the placenta) in healthy women, blood coagulation processes are accelerated by ten times compared with the thrombosis time in the vascular bed. With the normal number of the postpartum period, the uterine is reduced, which launches the thrombing mechanism for which it is necessary to reduce the lumen of the vessels, reduced blood pressure.

For final formation, thrombus needs about two hours, which explains the observation time due to the danger of the appearance described. Consequently, the causes of bleeding during childbirth can be:

states that violate the contractile ability of myometrium;
pathology of blood coagulation system;
injuries of generic paths;
premature, violation of its separation and allocation processes.

Bleeding can begin after the birth of the fetus with a decrease in the tone of the myometrium, the anomalies of the placenta arrangement, impaired its attachment and the incomplete compartment from the walls in the third period of birth. The likelihood of pathology is higher in the development of the following complications:

anomalies of generic activities;
inadequate use of uterotonic;
gross third period.

The risk group includes women with transferred gynecological diseases, operations on genitals, abortions, infantilism. In the last period, due to the pathologies of the placenta, the strength of the contractions of myometrium may violate, and the operation on the manual branch of the placenta disrupts the process of thrombosis in the placental area.

Additional provoking factors are a violation of the integrity of the generic paths. In the first hours after delivery, bleeding can trigger the low fibrinogen content in the blood, atony and hypotension of the uterus, the delay in the parts of the placental fabric, the fetal shells.

As manifest

Bleeding is the most severe complication of childbirth. The blood loss 400-500 millilitres is a pathological, and one liter is massive. Pathology accompanies the anomalies of attachment of the placenta, the delay of the separated placenta, the gap of the soft tissues of the genital tract.

Premature detachment of a normally located placenta

If the measures held remained ineffective, they decide to apply operational treatment. When the uterus breaks, internal bleeding is developing. Such a state is an indication for an urgent exercise or an amputation of the organ.

Manifestations in the early postpartum period

Bleeding in the first two hours after childbirth arise in five percent of all cases of childbirth. The predisposing factors can be transferred inflammatory processes against the background of pregnancy, endometritis, abortions, unbearabing pregnancy in history, the presence of a scar on the uterus. The main causes of the occurrence are:

latency of parts;
violation of the contractile ability of myometrium;
injuries of generic paths;
disorders of the chopping system.

Read more about bleeding after delivery, read in.

Delay of the parts of the placenta, fetal shells

Prevents the reduction in the relief of the uterine vessels. Pathology may arise in connection with the forcing the birth of the placenta with obstetricians, when it has not yet happened to its full compartment, with the true attachment of one or more rally. They stay on the wall at a time when the main part of the kindergarten is born from the genital tract.

Diagnose pathology when examining the last, finding a defect in its slices, shells. The presence of defects is an indication for the mandatory audit of the uterine cavity, during which the search and separation of the delayed parts are carried out.

Hypotension and Atony Uterine

Damage to the neuromuscular apparatus of the uterus, violation of the regulation of muscle cuts, dysfunction of the nutrition, the oxygen starvation of the myometrium cells lead to a significant decrease in or complete loss (, respectively) of the uterus tone. Hypotonic bleeding in childbirth is a reversible state, the first manifestations of which begin immediately after separation of the lane, can be combined with violation of its branch processes.

Large sizes of the organ, dery consistency, fuzziness of contours, abundant bleeding from generic pathways, which are accompanied by additional discharge of blood and bunches with exterior massage of the uterus are symptoms of hypotension. Such a state direct reading for manual survey of cavity, massage on a fist, administration of uterotonic, infusion therapy. With the ineffectiveness of the events and blood loss, 1 liter decide to remove the organ.

There are two options for the development of the pathological condition - the wave-like and massive loss of blood. In atony, the uterine bleeding is continuous, quickly leads to hemorrhagic shock. At the same time, urgent help is from the first seconds, with simultaneous preparation of the operating room. Consists of several stages:

Restoring the volume of lost blood.
Achievement of adequate oxygen level.
Timely use of supporting therapy - steroid hormones, cardiovascular preparations.
Correction of biochemical, coagulation, vascular disorders.

The level of organization of the maternity hospital, a clearly spent personnel action scheme is the basis of successful therapy. Prevention of bleeding in childbirth provides for the advanced definition of pregnant women in the appropriate risk group.

These measures make it possible to foresee a difficult complication, prepare for him in advance. With the first fights to establish an intravenous catheter, determine the main indicators of hemostasis, introduce methyl ergometrin when teething the fetus head, prepare the supply of medicines. All activities are carried out against the background of intravenous administration of the necessary drugs.

The protocol of infusion therapy provides for the introduction of infoola in an amount equal to the volume of lost blood. In addition, crystaloids, freshly frozen plasma, erytomass are used.

Indications for the introduction of the erythrocyte mass can also be a decrease in the level of hemoglobin to 80 g / l of hematocrit up to 25%. The platelet mass is prescribed by reducing platelet levels to seventy. The volume of blood loss is determined by its value.

Preventive measures include the fight against abortion, compliance with the Women's Maintenance Protocol at the stage of women's consultations, in childbirth, postpartum period. Competent assessment of the obstetric situation, the prophylactic administration of uterotonic, timely operational delivery is made preventable bleeding.

Careful observation in the first two hours after childbirth, the applying of ice on the abdomen after the selection of the last, periodic gentle outer massage of the uterus, accounting for lost blood, the assessment of the general state of women allows you to avoid complications.

The appearance of the baby to the light is a joyful event that does not want to overshadow the disturbing reflections. But knowledge of those complications that may accompany childbirth are necessary - first of all, in order to be not confused at the critical moment and meet them in fulfillment. After all, the woman behaves calmer, and the better it is aware of its condition, the greater the likelihood of a safe outcome of childbirth and for mom, and for a child. In this article, we will talk about one of the most terrible complications - bleeding. It can develop during childbirth, in the early postpartum period and even in the last weeks of pregnancy. The starting bleeding is a serious health hazard (and sometimes for life) mother and not yet born child.

Causes of bleeding

Most often the direct cause of bleeding is the problems associated with the state of the placenta. Predisposing factors for them are:

Chronic inflammatory diseases of the mucous membrane of the uterus (endometritis), especially untreated or unclean.
"Old" injuries of the organs of a small pelvis and scars at the uterus (regardless of their origin).
A large number of abortions, miscarriage and (or) childbirth in the life of a woman, especially if they were complicated by inflammation. (If you take all cases of the prelation of the placenta for 100%, then 75% of them occur in repeated women and only 25% - at primordin).
Disorders of hormonal background, endocrine diseases.
Moma uterus and other diseases of the internal genital organon.
Heavy cardiovascular diseases, some diseases of the kidneys and liver.
Injuries during pregnancy.
Age of women older than 35 years old.

So, what placental problems can cause bleeding?

Incorrect branch of a normally located placenta
1. Premature detachment of a normally located placenta. Disposal of the placenta can occur on various sectors. If the placenta is peeled from the edge, then the blood flows out of the outer sex tract. In other words, in this case, there is an outdoor bleeding; In such a situation, the pain at the bottom of the abdomen is insignificant or absent at all. The disclosure of the placenta may occur in the middle, then the blood accumulates between the placenta and the wall of the uterus and is formed by hematoma; In this case, pain syndrome is more pronounced.
2. The difficulty of independent and timely separation of the placenta in the third period of birth (tight attachment or the increment of the placenta - throughout or partially). Norma after the birth of the baby there is a branch of the placenta and her birth. When separating the placenta in the uterus, an extensive wound surface is formed, from which blood begins to be frozen. This is physiological (normal) bleeding very quickly ceases to reduce the walls of the uterus and the reasons of the vessels located in them, of which, in fact, blood flowed. If the placenta rejection process is broken, then bleeding from the surface of the mucous membrane, and tightly attached fragments of the placenta do not allow the uterus to shrink and pour the vessels, with a suspicion of a dense attachment of the placenta produce a manual examination of the uterine cavity. This is an operation that is carried out under general anesthesia. If the placenta fails to be separated manually, they say about its increment. In this case, there is an emergency removal of the uterus.
Wrong placenta location:
1. When they partially or completely overlaps the inner zev of the cervix.
2. Low placenta locationWhen its edge is located closer than 5-6 cm from the inner zea of \u200b\u200bthe cervix.
3. Ceetering placenta - A rare placenta arrangement, when, due to a cervical inner zea, the cervix can partially attached to the mucous membrane of the neck.

With the beginning of childbirth (if not earlier, even during pregnancy), the wrong arrangement of the placenta unequivocally develops into its premature detachment. This is due to the more intense, as the pregnancy of the lower stretching (compared to the upper and average segments) of the uterus departments and the rapid reduction of them when the cervix is \u200b\u200bdisclosed in childbirth. The full and cervic preposition of the placenta is more complex and hard complications. The lower uterine departments are less adapted by nature for full-fledged babies to all necessary. A developing fruit suffers more from the lack of primary oxygen and, naturally, nutrients. With a full or cinema attachment of the placenta, bleeding can begin spontaneously in the second trimester of pregnancy and be extremely intense. It should be especially emphasized that with the complete prelation of the placenta, it is not necessary to talk about independent kinds at all, since the placenta is tightly overlapping "out", i.e. cervical neck.

In this case, at the 38th week of pregnancy, a planned caesarean section is carried out. If bleeding arose, then it is carried out. With the edge of the prelationship of the placenta of full-fledged activity, non-human bleeding and good condition of the mother and a born child, it is possible to carry out birth through natural generic paths. However, the decision of the form of the Rhodework always remains for the doctor. With rare shapes of the placenta, when it affects the cervical sections, preference is given to Cesarean section; Moreover, this situation may even end with the removal of the uterus, since such a layout of the placenta is purely combined with rustling in the wall of the cervix.

Bleeding is accompanied by another, more rare complication - tarrow of the uterus. This is extremely difficult condition may occur both during pregnancy and directly during childbirth.

The obstetres especially determine for themselves the temporary characteristic of the rupture (threatening, which began and the gap) and its depth, i.e. How much damage the wall of the uterus (this can be a crack, an incomplete gap or the most dangerous - complete, when through the uterus is formed through a cross-cutting defect with penetration into the abdominal cavity). All these states are accompanied in varying degrees to pronounced bleeding, a sharp pain that does not stop between the battles. The fights themselves become convulsive or, on the contrary, weaken; The form of the abdomen changes, the signs of the child's hypoxia increase, the palpitation of the fetus changes. At the time of the complete rupture of the uterus, the pain increases sharply, becoming a "darge", but the fights stop completely. There may be a false impression of reducing bleeding, since blood no longer flows outwards, but it enters the abdominal cavity through the gap. The deformation of the belly is preserved, the child is not enough in the uterus, and next to her, he has no heartbeat. This is a critical condition: save the mother and baby (if he is still alive) can only immediately surpass and resuscitation activities. The operation usually ends with the removal of the uterus, as the torn, thinned, soaked the walls of the uterus the uterus is almost impossible.

The risk group according to the likely occurrence of the uterus, belongs:

Pregnant women with an existing scar on the uterus (regardless of its origin: injury, caesarean section, remote, etc.). It should be noted that modern methods of cesarean section aims to make a maximum decrease in the risk of the emergence of the complications described above during repeated pregnancies. For this purpose, a special method of cutting the body of the uterus (transverse, in the lower segment) is used, which creates good conditions for the subsequent healing of the wound and the minimum blood loss with a possible break in childbirth.
Multiplaying women with complicated course of previous births.
Women who have repeatedly made abortions.
Women with complications after abortion.
Patients with chronic endometritis.
Rozhenniks with a narrow pelvis.
Pregnant women with large fruit.
Pregnant women with the wrong position of the fetus in the uterus
Hoeers with discoordinated generic activity (condition when, instead of a simultaneous reduction during contraction, each fragment of the uterus is reduced in its own mode).

If a woman knows what applies to one of the named categories, she must warn about it and his doctor in women's consultation, and obstetricians in the maternity hospital.

Than dangerous bleeding

Why are obstetric bleeding and today remain dangerous, despite all the achievements of modern medicine, the development of resuscitation techniques and a sufficiently large arsenal of means for replenishing blood loss?

First, bleeding is always a secondary complication of an obstetric problem. In addition, it is very quickly moving into a discharge of massive, that is, in a relatively short period of time, a woman loses a large amount of blood. This, in turn, is explained by the intensity of the uterine blood flow, which is necessary for normal future development, stiffness of a bleeding surface. What is more successful and overlapping with your hand when the valve is torn: a single jet of water crane or a fan shower? Approximately the same can be said about bleeding, for example, from a damaged artery on hand and bleeding in childbirth. After all, it is in such a situation that doctors trying to save the girlfriend when blood flies from a large number of small damaged vessels of the uterus.

Of course, the body of a pregnant woman "is preparing for a normal light loss of blood in childbirth. The amount of blood increases (however, it first of all meets the needs of a developing fetus, which every day requires more and more nutrition). Cutting the" combat readiness " The blood system, and in the event of bleeding, everything without exceptions is "rushing into battle". At the same time, the increased rolling ability of blood develops into complete exhaustion - coagulopathy, there are no elements (special proteins) in the blood, capable of forming a thrombus and "closure". The so-called DVS syndrome develops. All this is exacerbated by severe metabolic disorders due to the main obstetric complication (bursting of uterus, premature or tight attachment, etc.). And until it is adjusted exactly this primary complication, cope with bleeding is unlikely. To The forces of women often turn out to be on the outcome due to pain and physical tension.

Features of childbirth

In case of bleeding in childbirth, work is conducted in several directions at the same time. Anesthesiologist is bent through large veins of special bloodstream solutions and blood preparations. Due to this, substances and proteins responsible for clotting blood flow into the bloodstream. To improve blood clotting begin to pour freshly frozen plasma, then, depending on the volume of blood loss, the erythrocyte mass is poured into another vein, sometimes these blood products are injected in parallel in different vessels. The patient also introduces hemostatic drugs and painkillers. Obstechers determine the cause of bleeding and type of the upcoming operation.

To maintain the normal supply of oxygen tissues, the inhalation of moistened oxygen is used through the mask.

The patient is connected to the monitor, which constantly controls its blood pressure, the heart rate, blood oxygen saturation (saturation) and continuously removes the ECG. Simultaneously with the above measures, a rapid administration of a patient in anesthesia is performed for further surgical treatment and the translation of a woman on artificial ventilation of the lungs by the breathing apparatus. The practice is proved that the transfusion of blood to patients under anesthesia is safer than patients in consciousness.

Of course, the transfusion of blood and solutions will be successful only when the initial complication that caused bleeding was eliminated. Therefore, the task of obstetrics becomes identifying this complication and the definition of a plan for therapeutic manipulations, be it a manual examination of the uterus, an emergency caesarean section, the removal of the uterus, etc.

After the blood is stopped, a woman is translated into the ward of intensive therapy of the hospital or in a specialized hospital resuscitation department for continuous monitoring of medical personnel.

Remember that bleeding in pregnant women can occur not only during childbirth in the hospital, but also at home. In the occurrence of obstetric bleeding, time becomes decisive, and in the case of labor outside the hospital, it, alas, works against us. Therefore, by planning a trip somewhere in the last weeks of pregnancy or, calculate in advance what time you can be in the hospital. Remember that when obstetric bleeding is very quickly the state occurs when, despite the intensive therapy and the fulfillment of the external relocation of the abdominal part of the aorta (and in pregnant women it is very difficult), the "ambulance" team and even a medical helicopter brigade may not be understood Hospitals are alive, as the main method of treatment against the background of intensive therapy remains operational intervention.

Is it possible to avoid bleeding?

It is possible to significantly reduce the risk of bleeding with a regular observation of a doctor in a female consultation. If you had the injuries of the pelvic organs - tell me the doctor; If you are worried about anything from the "female" authorities, too, be sure to inform your doctor; If you are sick - cure to the end. It is not necessary to avoid ultrasound: it will not harm, but will help the doctor to identify the problem in time. Try to fight unwanted pregnancies not abortion, but more "peaceful" means: it will save you in the future from big trouble. And do not solve homework.

Dmitry Ivanchin,
anesthesiologist resuscitation
Senior doctor of the operational department
Emergency medical center
Moscow Health Committee

08/05/2007 19:53:02, Natasha

I gave birth at 23, pregnancy was without complications, everything was fine, the birth was held for 6h. 20 m., Boy 4560, without breaks. And then the bleeding began, was a manual inspection, lost 800 ml. I have a diagnosis of varicose veins of the lower con. and small pelvis organs. As a result, everything is fine, the uterus declined well, the next day was 11 weeks., True hemoglobin 73, but nothing. I have a question: what is the probability that during the second birth of bleeding will not be, how to avoid it?

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

I have a period of 10 weeks. A couple of days ago, the cargoes started with a dark brown color (brown), two days later the color changed to scarlet, lying on the preservation, doctors say that there is a real threat of miscarriage. Why? After all, there are no pain in the bottom of the belly there is no other discomfort! All tests show that the body is healthy and it all grabs everything! The ultrasound showed the hyperton wall of the uterus, although the fruit is healthy and normally feels. Tell me how it's all serious, what to calculate, ITHO it can be at all?

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

Question to the author. Dmitry, answer, please, here or, even better, on my box [Email Protected]
First pregnancy at 29 years old (light), condition without pathologies, I do not care about risk. Birth in time in the CPSIR in August 2002. Bleeding, manual separation of a part of the kindergarten under general anesthesia. Half a year there were health problems, weakness, seams did not heal, in general, a nightmare. How is the likelihood that the second pregnancy will end with such childbirth? Will it be better, taking into account age - 32 years and the problem of the first childbirth, plan further cesarean to avoid complications? I really do not want to risk. And give birth scary, but I want the second child.

There was bleeding and manual compartment. Pavda was not in any resuscitation, on the second day already brought a child (the Chamber of Mother and Child). It is not clear one. How to plan a second child? Will such complications be the second time? Judging by the article - most likely there will be. But how then talk about the fact that the second birth is lighter than the first?

Why scare people then? It is really very scary.

Imprint of centuries The appearance of a child was considered a great sacrament. Owning grandmothers in Russia enjoyed special honor, and not every woman could become a hanging: she had to have impeccable health, her children should have been healthy, her thoughts should have been clean.

Even during pregnancy, the advocate was taught the future mother by an old question, who read the children in the womb: "From you, my light, my droplet, I myself will warm all the trouble. There will be a dome to you love my, the cradle is all patience, and the prayer is a consolation. Waiting for you, my light, like a land of dawn, like grass of dew, like rain flowers. "
The sound of these gentle words had a beneficial effect on the kid, and to the mother, creating the right attitude before the upcoming births.

Births are the culmination of pregnancy and in most cases proceed as a normal physiological process.

The future mother wants to know about the birth. All: learn signs of fights, beginning of childbirth, symptoms of battles and childbirth, when they begin at what moment you need to hurry into the maternity hospital, as far as the childbirth is painful and how long they last.

Each girlfriend is an individual, and childbirth proceeds in different ways, but almost all the fempics are experiencing the main signs: the uterus is reduced during battles; smoothed, the neck of the uterus is thinned, then reveals; The child turns and moves along the generic paths; You give birth to a child, then placenta, umbilical cord and fetal shells. The whole process takes from several hours to days (occasionally or more) and is the beginning of motherhood, and for a child - the transition to autonomous existence.

In this process, everything is important: the mechanism of childbirth, physiological features, sensations and experiences of the mother, its psychological state.

The beginning of childbirth is not always clear, especially the signs of childbirth at the primary mothers. Specialists believe that the initiator of the beginning of childbirth is the child. By the 40th week, and sometimes before, due to the rapid growth of the child, the number of accumulating waters decreases, the baby is harder to move more and more difficult. The placenta is aged, and the baby receives an insufficient nutrient and oxygen.

The child is experiencing very unpleasant feelings, it is activated by the bark of adrenal glands and a large number of cortisol is distinguished - stress hormone. In response, the hormonal balance in the mother's body changes. As a result, the uterus becomes very sensitive to biologically active substances generated by the placenta and the pituitary gland. It begins to shrink - regular contractions appear, followed by childbirth.

The body of the future mother also occurs changes: the number of estrogens preparing the uterus to childbirth is increasing, and, as a result, the cervix is \u200b\u200bshortened and softened, the uterus begins to cut regularly.

Signs of rank began

The pain in the lower back, the sensations of the growing pressure in the groin area is accompanied by a sense of fatigue and severity. You can not find any convenient posture for a long time. This pain is different from conventional lower back pain and can resemble premenstrual pain. This feature may arise a few days before delivery, often in combination with other signs.

The frequent emptying of the intestine can be mistaken for the usual disorder, but in this case it is caused by prostaglandins, causing emptying of the intestinal tract to free the additional space for the movement of the child down.

Selection of blood mucus

During the entire pregnancy in the cervix, a thick mucus contains a thick mucus, which can stand out at the end of pregnancy, when the cervix begins to fill and reveal. In rare cases, it may look like a mucosa "plug", more often the mucus is more liquid and may contain streams of blood. The appearance of blood can occur a few days before delivery, but it may happen after the start of the battle.

At the end of pregnancy, bloody discharges often appear after the vagina examination, since this procedure often causes some bleeding from the cervix. It is easy to make a mistake and take these allocations for a sign of childbirth. If this blood is pink or bright red and mixed with mucus - it is undoubtedly a harbinger of childbirth, after inspection - blood drilled.

Progressive cuts of uterus

Fights that become longer, stronger and more often, are harbingers of childbirth. At the beginning of childbirth, the fights are usually felt as a pulling pain, which is in the lower back. As the generations are developed, the contractions become painful. The cuts of the uterus shock muscle fibers of the uterus, stretch the neck of the uterus and expel the fruit of the uterus.

Opening of a fruit bubble

The opening of the fruit bubble, also called the disorder of the oily waters, can occur until the bouts start in 10-12% of cases. Then the amplifying contractions begin shortly after the deposition of water or during the day. In most cases, the fruit bubble does not open until the development of the labor process. When a bubble bursts, a sudden "cotton" can occur, accompanied by a flux of arrogant water, or may occur gradual, uncontrolled leakage of fluid. Opening of the fruit bubble can be felt like urination.

If you have moved the water before the battles start, tick the time, color, smell and describe the amount of fluid (stream or stream). Normally, liquid is clean and virtually odorless. The green color of the oilopal waters indicates the presence of meconium (original feces), which can cause stress states in a child and demand to take urgent measures. Do not in this case use tampons to keep the stream. Urgently notify your doctor. Depending on your condition and position of the child, the doctor will decide - to wait for regular contractions or urgently stimulate childbirth. In some cases, if the child at the time of the waters did not have time to block the exit from the cervix, the biposts are possible.

In the early opening of the frenx bubble, due to the danger of infection, you should not use the bathroom, it is better to take a shower. With strong battles of increasing risk of infection in the uterus, it was not found, so the bath, if it is necessary during delivery, should be postponed before the onset of strong bages.

Remind: If you feel regular contractions (after 15-20 minutes by a duration of 20-30 seconds), as well as in the case of leaking or pouring the accumulating waters, you should immediately lie down to bed and call the "ambulance" or to go to the hospital independently.

In some cases, the signs of so-called "imaginary delivery" may appear:

- spasms are irregular, their frequency and voltage do not increase;

- the pain appears rather in put up than in the field of the sacrum;

- Spasms disappear during driving or after changing positions;

- The movements of the fetus are enhanced during spasm. Such contractions usually accompany the moment when the child enters the pelvis area.

Remember: You should not fear that you disturb your doctor or your loved ones. If you have signs of approaching childbirth at any time of the day and night you should go to the maternity hospital. In this case, it is better to be restrained.