Blood during childbirth. Bloody discharge during childbirth

Blood before childbirth is considered the norm in two cases - if the process of childbirth begins with accompanying contractions or if the cork has come off. In these two cases, expectant mothers should not worry. You need to calmly collect things, documents and go to the hospital.

If bleeding begins before childbirth, it manifests itself in large quantities and has a scarlet color, you should immediately call an ambulance, ask relatives to prepare things and, without making sudden movements, wait for an ambulance. And, already being in the hospital, ask for help from a midwife or doctor.

Discharge before childbirth with blood - as a sign of a long-awaited start

Discharge before childbirth with blood can mean the onset of labor. The uterus is ready for childbirth, there is a timely discharge of the mucous plug. lower abdomen future mom will feel a little heaviness and a little pain, and then you can observe translucent mucus or pink. Pink color indicates the presence of blood droplets, sometimes streaks or round spots are visible.

Blood clots before childbirth indicate to women that their baby is preparing to be born. Expectant mothers do not need to worry if this happens on time. For some women, the mucus plug comes off at 38 weeks, and they can expect to give birth for about 2-3 days. And sometimes the cork leaves immediately before childbirth at 40-41 weeks. Women in labor themselves may not see this plug.

And it happens that after an examination by a gynecologist, slight discharge with blood appears. They are normal if the gestation period is closer to childbirth, this also indicates the preparation of the cervix.

What kind of bleeding before childbirth can be dangerous

It can be dangerous profuse bleeding before childbirth, which arose prematurely due to detachment of the placenta or multiple pregnancy. In these cases, you should cesarean section. Placental abruption is not normal early term and mostly arises either from the wrong way of life of the mother or pathologies.

Abundant bleeding is dangerously large blood loss in the mother and hypoxia in the fetus. To avoid problems and preserve your health and the health of your unborn child, you need to take care of yourself. News correct image life, nor smoke or drink alcohol, and even more so do not take drugs. Include more in your diet healthy vegetables, fruits and meat, spend more time outdoors and take care of your nerves. Thus, a woman will take care of her unborn baby.

Thus, we can conclude that the appearance of blood before childbirth is not a reason to panic. It is worth paying attention to the period and amount of allocations. At a later date, blood may appear even after an examination by a gynecologist. And if the blood went before childbirth, and the woman is at 38-40 weeks of pregnancy, the discharge means the beginning of childbirth and gives a reason to go to the hospital with things.

The birth of a child is a natural phenomenon, but complications are possible during childbirth, including sudden bleeding. This condition always threatens the life of the mother and child, and therefore requires mandatory emergency medical care.

The main task of the doctor at the first stage is to determine the source of bleeding. Often the only way to stop blood loss is surgery.

Causes of bleeding during childbirth

The main cause of bleeding during childbirth are pathologies of the placenta and predisposing diseases.

Violations in the work of the placenta can be different. Most often, its premature detachment occurs in a normal location. The placenta can exfoliate in different places, but if this process started from the edge, then external bleeding is inevitable. In this case, the pain is practically not felt. With detachment of the middle part, a hematoma is formed and severe pain occurs.

With blood loss, a woman and a child develop a rapid heartbeat, chills, and decrease blood pressure. This phenomenon is typical for any severe bleeding. Against this background, the blood supply to the fetus drops significantly, which is fraught with its death. With such a development of events, a decision can be made on a caesarean section.

Sometimes the cause of uterine bleeding becomes a pathological accretion of the placenta to the walls of the uterus. The chorionic villi penetrate so deeply into the myometrium that at the last stage of childbirth, the placenta is not able to independently separate from the walls of the uterus, which cannot contract. In this case, medical intervention is carried out under general anesthesia. If the bleeding cannot be stopped, then the woman's life is in serious danger. For doctors, this condition is a direct indication for the removal of the uterus.

Sometimes bleeding occurs due to abnormal placement of the placenta:

• cervical presentation, in which the placenta adheres to the cervix;
• , which partially or completely blocks the entrance to the cervix of the uterus;
• too close placement of the placenta to the cervical os.

Cases of cervical presentation are particularly complex, but also quite rare. At the same time, all of these pathologies lead to premature exfoliation of the placenta, therefore, already at the 38th week, a caesarean section is recommended for such women.

Rupture of the uterine wall is considered a serious consequence of childbirth. It can occur both during childbirth and during childbearing and is accompanied by severe pain. If a caesarean section is not performed on time, then the life of the mother and child cannot be saved. With timely medical care, with a high degree of probability, such a uterus is removed due to the impossibility of fusion of the gap.

risk factors for the occurrence uterine bleeding are the following reasons:

• history surgical interventions on the uterus;
• a large number of births, abortions or miscarriages;
• inflammation of the genital organs;
• , multiple pregnancy;
• incorrect location of the fetus in the uterus;
• pathology of the endocrine glands;
• , preeclampsia;
• , alcohol intake, drug addiction (especially cocaine use).

In addition to these factors, direct trauma to the abdomen, due to violence or an accident, fear, stress, and rapid effusion can provoke the development of bleeding. amniotic fluid with polyhydramnios. The age of the woman also plays an important role. In women over 35, bleeding during childbirth occurs more often than in younger women.

Why is bleeding during childbirth dangerous?

Despite progress being made in modern medicine, as in ancient times, obstetric bleeding during childbirth is considered the same dangerous phenomenon.

In itself, bleeding is a secondary sign of a complication that has arisen. Blood loss for a short time can turn into massive bleeding, in which a woman loses significant amounts of blood. This condition threatens the life of the mother. A child with a similar course of childbirth does not receive the necessary amount of oxygen and important elements. Subsequently, these children may experience certain health problems.

They are characterized by an extensive bleeding surface, while the blood comes out of many small and large damaged vessels of the uterus. Doctors can find it very difficult to deal with such a problem.

Physiologically, the body of the expectant mother is preparing for the upcoming birth, which involves a certain amount of blood loss. The volume of blood in a pregnant woman increases every month, which is primarily necessary to meet the needs of a growing fetus, and then compensates for losses during childbirth.

Also, during the period of gestation, the blood coagulation system is on alert, and then its activity can turn into complete exhaustion, or coagulopathy. This phenomenon is observed in women who have had extragenital diseases, while their blood does not contain proteins that form a blood clot in the vessels during bleeding, subsequently DIC develops. The situation is aggravated by changes in metabolism, which are associated with the main complication: rupture of the uterine wall, premature detachment of the placenta or its incorrect accretion. Bleeding can be stopped only when the primary complication is detected and corrected.

Obstetric bleeding can begin not only in the hospital, but also at home. The decisive moment for saving the life of a woman with severe bleeding is the time for hospitalization. The main treatment for these conditions is intensive therapy and surgical intervention.

How to avoid bleeding during childbirth?

It is impossible to fully predict how the birth will go, but you can reduce the likelihood of blood loss with regular visits to the antenatal clinic. The local gynecologist should be aware of a history of trauma to the pelvic organs.

Even at the stage, it is necessary to cure extragenital diseases, inflammatory processes genital organs and disorders menstrual cycle. During the survey and registration, as well as during pregnancy, the doctor determines the risk group for uterine bleeding.

Any signs of concern should also be reported promptly. Do not avoid prescribed tests and ultrasound research, they are safe and will help to recognize the problem in time, as well as to predict the development of events. For example, placenta previa is determined before the 14th week of pregnancy using ultrasound diagnostics.

About danger possible bleeding the doctor notifies the pregnant woman and her relatives. For the prevention of significant blood loss during childbirth, at the stage of pregnancy, blood pressure is constantly monitored, preeclampsia is treated, the tone of the uterus is removed, physical exercise and sex life. To track the change in the position of the placenta, ultrasound is performed monthly.

All pregnant women should be aware of the dangers of "home birth". Even the most successful pregnancy can end in bleeding. In this case, the time to rescue is calculated in minutes.

During the period of bearing a child, a woman should especially carefully monitor changes in the body. The greatest concern is the first trimester, when there is a risk of miscarriage, and the last month. Allocations before childbirth - physiological feature, indicating the preparation female body to the arrival of the baby.

But it is important to assess the nature of these secretions, since the color and smell may indicate the presence of complications. It is possible to preserve the health of the baby and avoid problems during childbirth with the help of their timely detection.

woman on last month pregnancy, it is important to know what discharge should be before childbirth. This will help to distinguish the physiologically ongoing process of preparing the body from pathological conditions. Normally, abundant mucus appears first, then a cork comes out and water pours out. The fact that not everything is in order is evidenced by bloody, cheesy white and greenish discharge with bad smell.

Pink discharge before childbirth appears because the outgoing plug that previously covers the cervix may contain a small amount of blood. The mucus is slightly stained with it, but does not contain blood streaks. If the color turns red, this indicates an early detachment of the placenta or its presentation. Both are dangerous for the child, so immediate health care.

Brown, pink, brown discharge before childbirth is not bleeding. They are mixed with mucus, insignificant and appear, as a rule, less than a day before the birth of the child. At this time, you can start preparing for departure to the hospital: collect all the necessary things and documents, warn close relatives.

If the discharge before childbirth is white, similar to cottage cheese and has a sour smell, then, most likely, it has spread into the vagina fungal infection- milkmaid. The disease must be treated urgently, since it greatly complicates the process of childbirth for the mother and can harm the health of the child. Candidiasis in a woman in labor reduces the elasticity of the vagina and increases the risk of ruptures.

Greens and yellow discharge before childbirth also indicate infection (about trichomoniasis, gonorrhea, chlamydia) or inflammatory processes in the pelvic organs. In any case, immediate medical attention is required.

Mucus secretions

The mucus released before childbirth is thick, viscous, transparent or white with a slight tint. You can take a small amount of mucus with two fingers, when they are separated, its consistency (ductility, viscosity) will be clearly visible.

Mucous discharge before childbirth indicates the maturation of the cervix. They are most noticeable after waking up, when a woman is moving from horizontal position to vertical. After some time, the discharge begins to darken, become brown - this means that there are several hours left before the birth of the child.

Mucus plug exit

During pregnancy, the cervix is ​​blocked by a mucous plug that protects the fetus from infection. By the end of gestation, the walls become elastic and open. Under the action of hormones, the cork softens and comes out.

It is impossible to predict at what time this will happen: for some women, two weeks before giving birth, for others, a few hours.

If the mucous plug comes off all at once, outwardly it resembles an egg white or a jellyfish. Often this process goes unnoticed because it occurs while going to the toilet or taking a shower.

In addition, the cork can come out gradually, within one or two days, then it looks like the usual clear or white discharge before childbirth.

After the discharge of the mucous plug, you can not take a bath, you need to refrain from sexual intercourse, be more attentive to intimate hygiene, change your underwear more often. The uterine cavity during this period becomes open to infection.

Outflow of amniotic fluid

Unlike the mucous plug, the discharge of amniotic fluid cannot be overlooked. They are a liquid, the volume of which is from 0.5 to 1.5 liters. Normally, it is transparent, has a slightly sweet smell or doesn't smell. Sometimes, along with the waters, particles of a lubricant come out that protect the integument of the child in the uterine cavity. They look like white small flakes.

The process of discharge of amniotic fluid also occurs in different ways. Sometimes the liquid pours out all at once, this often happens after going to the toilet or with a sharp change in body position. In other cases, it gradually leaks. How exactly this will happen depends on the location of the bladder rupture - near the cervix or above.

If the amniotic fluid is yellowish or greenish color, cloudy, this may indicate that:

• the child experiences oxygen starvation;
• there is a presentation of the fetus;
• placental abruption began.

Blood discharge, discoloration amniotic fluid require an immediate call for an ambulance. Trying to get to the hospital on your own can be harmful and complicate the situation even more.

When should you see a doctor?

You should go to an obstetrician-gynecologist if you have a discharge that differs from the usual daily one. The specialist will be able to accurately determine their nature and say if everything is in order. If the discharge is white, curdled, yellow or green with an unpleasant odor, then a visit to the doctor is a must.

infectious disease in later dates pregnancy is dangerous for the health of the child and adversely affects the process of childbirth. After the cork is released, the pathogenic microflora can easily enter the uterine cavity.

An immediate call to the ambulance team is necessary when bleeding develops. Copious excretion bright scarlet blood is dangerous for the life of mother and child.

You should seek the help of doctors if the discharge is accompanied by cramping pain in the lower abdomen. This is most likely a sign of the beginning. labor activity. And this can happen even before the discharge of amniotic fluid.

By the end of the term, a pregnant woman should know which discharge before childbirth is the norm. Physiological changes of such a plan by the end of the term consist of three stages: mucus secretion (maturation of the cervix), discharge of the cork and amniotic fluid. In all cases, you need to pay attention to the color, structure and smell of the discharge.

Among women reproductive age glands of the cervix and vagina produce a mucous secretion that performs protective functions. At the end of pregnancy, the nature of the discharge changes as the hormonal balance changes: the production of progesterone decreases, and estrogen and oxytocin increase. Mucous discharge may become thicker, lose transparency, acquire a yellowish or milky color, and small fragments of blood may be found in them. Often spotting before childbirth scares expectant mothers: is this phenomenon an indispensable evidence of a serious pathology?

Bleeding as a danger signal

The undoubted danger is the presence of blood in the secretions:

• In the first trimester of pregnancy. At this time, the appearance of discharge, colored brown or red, is a sign of a threatened miscarriage. With timely started adequate treatment, the fetus can be saved.
• In the second and beginning of the third semester of pregnancy. At a period of less than 36 weeks, blood in the discharge may be a symptom of placenta previa (when it is located in the lower part of the uterus, and blocks the birth path of the child). Due to damage to the uteroplacental vessels with an anguish or premature discharge of the placenta, bleeding occurs, sometimes very profuse. This pathology is dangerous for both the mother and the fetus, and requires urgent medical intervention.
• If the discharge before childbirth contains scarlet blood in in large numbers or large blood clots. From a medical point of view, this condition is classified as an emergency. In this case, you should immediately call an ambulance and go to the hospital. Before the arrival of a medical carriage, it is advisable for a pregnant woman to move less so as not to provoke increased bleeding.

Physiological causes of bleeding

AT prenatal period the presence of spotting is not considered a pathology, and in most cases it is a sign that childbirth will begin very soon. However, everything is individual here. Women who actively discuss the topic of childbirth on the forums write that after they noticed blood in the secretions, some had contractions after a few hours, while others after a week or two.

Bloody issues often observed after the discharge of the birth plug or at the beginning of the opening of the cervix - due to the inevitable rupture of small capillaries. Obstetricians note a frequent relationship between the color of the discharge and the time remaining before childbirth: the darker the color of the discharge, the sooner the woman will begin to give birth.

Other causes of spotting before childbirth that do not pose a danger to either the mother or the baby can be gynecological examination or careless sexual contact. In both cases, the appearance of traces of blood in the secretions is caused by mechanical irritation the cervix, which in the prenatal period becomes loose, softened, and easily injured. Blood smears in the secretions may not appear immediately, but several hours after visiting the gynecologist or a couple of days after having sex.

Should be remembered

It is considered normal when the amount of blood in prenatal secretions small. These may be scanty, smearing marks or blotches of small brown, brown, pinkish or red clots, or the mucus may have a uniform, faint pale pink or brownish color.

However, if you find even those listed in the safe list of spotting before childbirth, play it safe and contact your doctor. If necessary, he will refer you to an ultrasound or prescribe other unscheduled examinations.

Bleeding can complicate the course of childbirth, the postpartum period, and lead to severe endocrine pathology. Every year, 140,000 women die from bleeding during childbirth. Half of them occur against the background of preeclampsia, the pathology of vital organs. Underestimation of the severity of the condition of patients, insufficient examination, inadequate and untimely therapy lead to a fatal outcome. What are the causes of obstetric bleeding, is there any prevention, what should be the therapy.

What is physiological blood loss

Most cases of pathological blood loss occur in the postpartum period, after the separation of the placenta. The volume programmed by nature up to 0.5% of a woman's body weight does not exceed three hundred milliliters. From one hundred to one hundred and fifty of them are spent on the formation of blood clots in the placental site after separation of the placenta. Two hundred milliliters are excreted from the genital tract. This blood loss is called physiological - provided by nature without harm to health.

Why does

Obstetric bleeding is usually divided into those that begin with the onset of labor, in the afterbirth and early postpartum periods. Bleeding in the first stage of labor and in the second can be triggered by premature detachment of a normally located placenta. In the third period, there are many more reasons.

After the birth of the fetus during the normal course of childbirth, the separation of the placenta and the release of the placenta occur. At this time, an open placental platform appears, which contains up to two hundred spiral arteries. The end sections of these vessels do not have muscular membrane, blood loss is prevented only due to uterine contractions and activation of the hemostasis system. The following happens:

1. After the expulsion of the fetus, the uterus is significantly reduced in size.
2. There is a powerful contraction and shortening of the muscle fibers, which draw in the spiral arteries, compressing them with the force of contractions of the myometrium.
3. At the same time, compression, twisting and bending of the veins, intensive formation of blood clots takes place.

In the area of ​​the placental site (the place of the former attachment of the placenta) in healthy women, blood coagulation processes are accelerated ten times compared to the time of thrombus formation in the vascular bed. In the normal course of the postpartum period, the first contraction of the uterus occurs, which triggers the thrombosis mechanism, which requires a decrease in the lumen of the vessels, a decrease in blood pressure.

It takes about two hours for the final formation of a thrombus, which explains the observation time due to the risk of the described complication. Therefore, the causes of bleeding during childbirth can be:

• conditions that violate the contractility of the myometrium;
• pathology of the blood coagulation system;
• injury birth canal;
• premature, violation of the processes of its separation and isolation.

Bleeding can begin after the birth of the fetus with a decrease in the tone of the myometrium, anomalies in the location of the placenta, violation of its attachment and incomplete separation from the walls in the third stage of labor. The likelihood of pathology is higher with the development of the following complications:

• anomalies of labor activity;
• inadequate use of uterotonics;
• rough handling of the third period.

The risk group includes women with previous gynecological diseases, operations on the genitals, abortions, infantilism. In the subsequent period, due to pathologies of the placenta, the force of contractions of the myometrium may be impaired, and the operation manual separation placenta disrupts the process of thrombus formation in the placental site.

Additional provoking factors are violation of the integrity of the birth canal. In the first hours after childbirth, bleeding can be provoked low maintenance fibrinogen in the blood, atony and hypotension of the uterus, retention of parts of the placental tissue, membranes.

How does it manifest

Bleeding is the most severe complication of childbirth. Blood loss of 400-500 milliliters is pathological, and one liter is massive. Pathology accompanies anomalies of placental attachment, retention of the separated placenta, rupture of the soft tissues of the genital tract.

Premature detachment of a normally located placenta

If the measures taken remain ineffective, the issue of applying surgical treatment. When the uterus ruptures, it develops internal bleeding. This condition is an indication for urgent extirpation or amputation of the organ.

Manifestations in the early postpartum period

Bleeding in the first two hours after childbirth occurs in five percent of all cases of childbirth. Predisposing factors may be inflammatory processes during pregnancy, endometritis, abortion, miscarriage in history, the presence of a scar on the uterus. The main causes of occurrence are:

• delay parts of the placenta;
• violation of the contractility of the myometrium;
• birth canal injuries;
• blood coagulation disorders.

Read more about bleeding after childbirth.

Retention of parts of the placenta, fetal membranes

Prevents contraction, clamping of the uterine vessels. Pathology may occur in connection with the forcing of the birth of the placenta by obstetricians, when it has not yet been completely separated, with the true attachment of one or more lobules. They remain on the wall at a time when the main part of the child's place is born from the genital tract.

Pathology is diagnosed when examining the placenta, finding a defect in its lobules, membranes. The presence of defects is an indication for a mandatory revision of the uterine cavity, during which the search and separation of the delayed parts is carried out.

Hypotension and atony of the uterus

Damage to the neuromuscular apparatus of the uterus, dysregulation of muscle fiber contractions, malnutrition, oxygen starvation of myometrial cells lead to a significant decrease or complete loss (respectively) of uterine tone. Hypotonic bleeding during childbirth is a reversible condition, the first manifestations of which begin immediately after the separation of the placenta, can be combined with a violation of the processes of its separation.

Big sizes body, flabby consistency, fuzzy contours, copious bloody discharge from the birth canal, which are accompanied by additional release of blood and clots during external massage of the uterus are symptoms of hypotension. This condition is a direct indication for manual examination of the cavity, massage on the fist, the introduction of uterotonics, infusion therapy. With the ineffectiveness of the measures taken and blood loss of 1 liter, the issue of removing the organ is decided.

There are two development options pathological condition- undulating and massive blood loss. With atony of the uterus, bleeding is continuous, quickly leading to hemorrhagic shock. In this state urgent care turns out from the first seconds, with simultaneous preparation of the operating room. Consists of several stages:

1. Restoration of the volume of lost blood.
2. Achieving adequate oxygen levels.
3. Timely use of maintenance therapy - steroid hormones, cardiovascular drugs.
4. Correction of biochemical, coagulation, vascular disorders.

The level of organization of the work of the maternity hospital, a well-established scheme of personnel actions is the basis of successful therapy. Prevention of bleeding during childbirth provides for the early identification of pregnant women in the appropriate risk group.

These measures make it possible to anticipate severe complication prepare for it in advance. With the first contractions, install an intravenous catheter, determine the main indicators of hemostasis, introduce Methylergometrine when the fetal head erupts, and prepare a supply of medicines. All events are held in the background intravenous administration necessary drugs.

The protocol of infusion therapy provides for the introduction of Infucol in an amount equal to the volume of blood lost. In addition, crystalloids are used, fresh frozen plasma, erythromass.

Indications for the introduction of erythrocyte mass can also be a decrease in hemoglobin to 80 g/l hematocrit to 25%. Platelet mass is prescribed when the level of platelets drops to seventy. The amount of blood loss recovery is determined by its size.

To preventive measures include the fight against abortion, compliance with the protocol for managing women at the stage of antenatal clinics, in childbirth, and the postpartum period. Competent assessment of the obstetric situation, prophylactic administration of uterotonics, timely operative delivery make bleeding preventable.

Careful observation in the first two hours after delivery, application of ice on the lower abdomen after the placenta is discharged, periodic gentle external massage of the uterus, recording of lost blood, assessment general condition women avoid complications.