“Every patient with bleeding in the first quarter should see a gynecologist to assess the viability and status of gestation. It is imperative to perform a pelvic examination and ultrasound transvaginal, “the gynecologist. Thanks to ultrasound specialist can see the embryo and check your heartbeat. “If at eight weeks gestation is observed by ultrasound a living embryo with positive heartbeat, means that in 95% of cases the pregnancy continues without problems,” explains Dr. Teresa Gomez, a gynecologist at the Teknon Centre Barcelona . As the pregnancy progresses, the risk of abortion decreases, with the fetal loss rate of 1% if a live fetus is observed at 14 or 16 weeks.
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Bleeding in the first trimester of pregnancy
Approximately 25% of pregnant women experience some degree of bloodstained or bleeding during the first trimester, so it is considered relatively frequent. It may be due to several causes: abortion (complete, incomplete with heavy bleeding and deferred without bleeding); threatened abortion (with or without pain or contractions without cervical dilation, with or without pain or bleeding, scanty bleeding); ectopic pregnancy (the embryo implants outside the uterus); Gestational trophoblastic disease (bleeding is usually painless); vaginal ulcerations; bleeding cervicitis (inflammation of the cervix infection); and erosions or polyps in the cervix.
“Any bloody vaginal discharge or uterine bleeding to occur in the first trimester of pregnancy is considered a threatened abortion. There is no correlation between the amount of bleeding and the cause that causes it, “says Dra. Teresa Gomez. The bleeding that accompanies the threat of abortion is almost always low, ranging from a brown to a bright red nose bleeding and may occur repeatedly in the course of many days. Usually it appears before uterine cramping or pelvic pain. However, not always there is vaginal bleeding means that subsequently trigger an abortion because the bleeding may be secondary to hematoma is reabsorbed over time or a small unfolding of membranes in the uterus that evolves smoothly.
Regarding the treatment to be followed in the case of threatened abortion and if the scan shows a living embryo with a heartbeat, relative rest is recommended (you should not be in bed all day but you have to avoid certain efforts as weight bearing, walking much or be long standing). In some cases the ultrasound treatment and background data progesterone is administered, depending on the clinic. If an abortion is diagnosed, the treatment varies depending on the amount of bleeding, symptoms (especially pain) and ultrasound diagnosis. “You can keep watchful waiting and waiting for the complete evacuation spontaneously, or can be performed curettage under anesthesia with intent to evacuate the uterus,” says the specialist.
Bleeding in the second and third trimesters
This is a relatively common bleeding and increased risk of perinatal mortality in the second quarter than in the third quarter. The most common causes are: abruption (usually manifests with dark blood, although it may also be red, and usually accompanied by discomfort or severe abdominal pain due to contractions), usually it occurs in the third quarter but submitted at any time after 20 weeks; and placenta previa (usually produces a hemorrhage of red blood, fresh, no abdominal pain). “Should have bleeding in the second or third trimester should go immediately to a hospital to be evaluated properly,” advises the gynecologist. Once in the center, you will conduct a physical examination to assess whether the bleeding comes from the uterine cavity and observe the state of the cervix. In addition, you will practice immediately ultrasound to determine the location of the placenta and check whether there is an abruption. “It is important, at the same time, a study of fetal well-being, as there may be fetal distress that can sometimes be severe,” said Dra. Teresa Gomez.
Treatment will depend primarily on the underlying cause of it, the general condition of the mother and the existence of fetal distress. “If a significant fetal distress is detected, regardless of the amount of bleeding or cause that causes it, the most appropriate behavior is the practice of cesarean section,” says gynecologist. Given an abruption or previous marginal placenta (placenta reaches the edge of the neck but does not cover it), if there is no fetal distress and favorable obstetric conditions (adequate uterine contractions, cephalic fetal presentation, multiparity, little bleeding) occur , you can try a vaginal birth but always under strict control.