Contractions and bleeding. Emergency: bleeding during childbirth. Outflow of amniotic fluid

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 the crucial moment is approaching. Women feel them a few weeks before giving birth - with varying degrees of intensity - or do not feel at all.

The duration of the difficult process of the birth of a baby can be very different. For the first birth, it averages 13 hours, for repeated - about eight. The beginning of childbirth among physicians is considered to be the opening of the cervix with regularly repeated contractions.

Over the past 50 years, the average duration of this process has been halved, asin severe cases, a caesarean section is now done in a timely manner. Often spontaneous contractions 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, the answer to which is not yet known. What is clear is that the child himself plays an important role in this process. But which mechanisms give a 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.

Gynecologist's consultation. Usually, Braxton-Hicks contractions are difficult to distinguish from real labor. In the third trimester, false labor pains become more intense and more frequent if you live an active life or if you are dehydrated. If you feel them, sit in a cool place, put your feet up, drink something and rest. If the intervals between contractions increase, and their intensity decreases, then they are false. If it gets more frequent and worse (especially if it happens every 5 minutes), call your doctor. I always tell patients that no one has ever described their feelings as "spastic" when giving birth. As a rule, the intensity of labor pains, in which the child passes through the birth canal, is described as follows: "I can not walk and talk."

You have seen it in countless films. 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 issue another batch of curses at her unfortunate, panic-stricken husband, who suddenly forgets everything he learned in Lamaz's courses, loses the bag prepared for the trip to the maternity hospital, and inevitably sends the car straight into a traffic jam, where he eventually has to deliver himself.

The truth is that most couples have plenty of time to realize that labor has actually begun. No one knows for sure what triggers this mechanism, but they are approaching fast enough. Here are some signs that tell you it's time to grab the bag and the woman in labor - and get into the car.

Childbirth begins - signs of childbirth

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. In the end, the estimated 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 that you will not give birth on New Year's Eve.

loose stool

This is due to hormonal changes caused by prostaglandins.

And it makes sense: your body is beginning to cleanse the colon to make more space inside the body for the baby.

Estimated date of delivery (ED)

This is the day your baby is statistically likely to be born. Most give birth somewhere between 37 and 42 weeks. Although many women do not give birth exactly on the expected date, you should definitely know it in order to 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. Turning over a sheet of the calendar and seeing the month in which the birth is due, you will feel excitement (and a little panic). Soon!

Contractions - first signs of approaching labor

In 70-80% of cases, the onset of labor declares itself with the appearance of real labor pains. They are not immediately distinguishable from the training ones that 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 initially well tolerated: you can even walk a little if you want. As soon as a certain regularity is established in contractions, you will put everything aside without any prompting and will listen to what is happening inside you.

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

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

Immediately to the clinic!

Regardless of the onset of contractions, when the baby stops moving, the rupture of the sac, or vaginal bleeding, you should immediately go to the clinic.

Braxton Hicks contractions are the warm-up before real contractions start. They can start and end several times and often stop when you are active (for example, when you are walking). Early labor pains will be uneven in intensity and frequency: some will be so strong that they will take your breath away, others will just resemble spasms. The intervals between them will be either 3-5 or 10-15 minutes. If for 15 minutes you talked with the doctor, discussing whether labor began or not, and never interrupted, this is most likely a false alarm.

Learn to recognize contractions

In the initial stage 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 all 10 cm.
Late contractions feel like strong menstrual cramps or reach an intensity that you could not even imagine.
When the contractions become very strong, and the rhythm of contractions is regular, it means that it has begun for real!

There are no mandatory rules for when you can come to the 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, then wait until the rhythm of contractions is 1 every 5 minutes for an hour, and then call and tell your doctor that you are going.
If the hospital is 45 minutes away from you, then most likely you should leave even when the contractions are less frequent.

Discuss this with your doctor ahead of time so you don't panic during labor. Remember that with the onset of the active stage, the cervix in most women opens at 1-2 cm per hour. So count: 6-8 hours before the start of attempts. (But if you were told at your last doctor's appointment that you were 4 cm dilated, it's best to arrive early at the hospital.)

Gynecologist's consultation. I warn expectant parents, especially if this is the first pregnancy, that there may be a few "false alarms". My wife is an OB/GYN and she made me bring her to the hospital 3-4 times while pregnant with each of our 3 kids! If she couldn't recognize for sure, then who could? I always tell patients that it's better to have them come and get checked out (if it's premature, they'll just be allowed to go home) than to give birth on the side of the road.

Time is everything

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

Method 1

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

Method 2

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

Opening and flattening the cervix

Imagine your cervix as a big, plump donut. Before childbirth, it begins to thin and stretch. Expansion (opening) and thinning (smoothing) can occur within a few weeks, one day or several hours. There is no standard time frame and nature of the process. As the date of delivery approaches, your doctor will make conclusions about the condition of the cervix in this way: "Disclosure 2 cm, shortening 1 cm."

Prolapse of the abdomen

This happens when the fetus descends to the entrance to the small pelvis and, as it were, “gets stuck” there, i.e. no longer moves inside. With Braxton-Hicks contractions, it shifts even more into the lower pelvis. Imagine that the child moves into a "starter" position. This process begins for all women at different times, for some - just before the very birth. For many, the news of a fetal drop is both good news and bad news. Breathing and eating is now easier, but the pressure on the bladder and pelvic ligaments makes it necessary to run to the toilet more often. For some expectant mothers, it even begins to seem that the child can simply fall out, because he is now so low. During the exam, your doctor will determine how low the baby is in the pelvis, or what their "position" is.

The prolapse of the abdomen occurs when the child seems to "fall", descends to the entrance to the small pelvis. Head first, the baby moves into the pelvis, thereby preparing for the journey through the birth canal. However, for women who experience tummy tuck days or weeks before delivery, this symptom is "false evidence," and for some it doesn't happen at all until the onset 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 the fetal bladder

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

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

You will know about the rupture of the amniotic sac by the abundant discharge of a clear, warm liquid from the vagina.

The rupture of the fetal bladder 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 child has already allocated his first stool in them. Record the time of rupture of the amniotic sac and the color of the discharged fluid, report this to the midwife or the maternity ward of the clinic. Here you will receive instructions on your next steps.

Very rarely, a rupture of the fetal bladder occurs in its upper part, while the amniotic fluid leaves only drop by drop. Then they are easy to mistake for urine or vaginal discharge, especially with a slight weakness of the bladder. If you suspect that amniotic fluid is breaking, call your doctor right away or go to the hospital. A short inspection will bring clarity to the situation.

As a rule, rupture of the fetal bladder does not lead to dramatic consequences. Usually, in the next 12-18 hours, contractions spontaneously occur, and childbirth occurs naturally. In the absence of contractions, they are artificially stimulated with appropriate medications to reduce the risk of infection for the mother and child.

Outflow of waters

Sometimes the fetal bladder is called the strange, biblical-sounding term "fetal sac." When it bursts (naturally or pierced by a doctor), this means: childbirth will occur within 24-48 hours. As a rule, the doctor decides not to risk not waiting more than 24 hours after the bubble has opened, especially if the baby is born at term, because. there is a risk of infection.

If the waters broke

When the fetal bladder bursts, there is something like a small flood, and it is impossible to predict exactly when and where this will happen. In the third trimester, the amniotic sac, the soft and comfortable "place" of the baby, already contains about a liter of amniotic fluid. (Pour a liter of water on the floor - something like this might look like.) But remember:

some women have very little "leakage".
Fluid will continue to flow out of the amniotic sac even after the waters have broken because your body will continue to produce it.
In some women, the water does not break spontaneously, and to stimulate the process of childbirth, the doctor performs an amniotomy by piercing the bag 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 right in the uterus (such an original stool is called meconium). This may be a sign of severe stress in the fetus. Call your doctor right away.

Gynecologist's consultation. Abundant vaginal discharge in late pregnancy is absolutely normal. V 10-20% of women at this stage they are so significant that they have to wear pads all the time. The blood flow to the vagina and cervix increases in the third trimester, so the vaginal secretion also increases. You may not immediately understand whether it is discharge or water has departed. If you feel "wet", dry off and walk around a bit. If fluid continues to leak, call your doctor.

Signal bleeding - 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. With the shortening of the cervix and the opening of the uterine os, the so-called mucous plug comes out. This is also a sign of approaching childbirth. However, labor pains do not necessarily occur on the same day. Sometimes it takes a few more days or even weeks before the onset of real contractions.

Closer to childbirth, the 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. And yet, to be sure, you should talk to your doctor or midwife about this - you need to make sure that the bleeding is not caused by other causes that could threaten you and your baby. Very often, a woman does not notice the separation of the mucous plug at all.

Small spotting or spotting

May appear due to changes occurring in the cervix - it is preparing for disclosure. The contractions soften the cervix, the capillaries begin to bleed. Contractions intensify and bleeding occurs. Any pressure on the cervix can cause some bleeding (due to exercise, sex, straining to have a bowel movement, or tension in the bladder muscles). If you're not sure if this bleeding is normal, call your doctor.

Removal of the mucous plug

The cervix softens and begins to open, while the mucous plug is released. Sometimes the mucus flows out slowly or the plug can come out in the form of a knotty thick flagellum. Up to this point, mucus acts as a protective barrier in the cervix and is constantly produced by the body, especially a lot of it closer to childbirth. It's not a sign of upcoming labor - some women have mucus a few weeks before - but it's definitely a sign that something is starting to change.

Backache

Pain may occur if the child is facing forward, and not towards your back. If the baby does not turn to the back, they may intensify. Pain can also occur due to the pressure of his head on your spine at the start of contractions.

Cozy nest: not only for birds

Pregnant women often have a strong desire to make a cozy nest even before the onset of childbirth. The surge of "nesting" energy, so contrasting with the exhausting fatigue of the last trimester, is forcing expectant mothers to equip their habitat, turning it into a nice and clean "incubator". Another sign that you have begun a period of "nesting" is the speed with which you try to do all the work, the exactingness with which you make requests to your family. "Nesting" is usually expressed as:

painting, cleaning, arranging furniture in the nursery;
throwing away rubbish;
organizing things of the same kind (food in the buffet, books and photographs on the shelves, tools in the garage);
general cleaning of the house or the completion of "renovation projects";
buying and laying out children's clothes;
baking, cooking and stuffing it in the refrigerator;
packing bags for a trip to the hospital.

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

Labor symptoms

False contractions are a pulling pain in the lower abdomen, similar to pain during menstruation. If such contractions are not strong and not regular, you do not need to do anything on purpose: this is just preparing the uterus for childbirth. The uterus, as it were, tries its hand before the upcoming important work, gathering and relaxing its muscles. At the same time, you can feel the tone of the uterus - sometimes it seems to be going into a lump, it becomes more solid. The uterus can come into tone without pain, since the closer the birth, the more sensitive and irritable it becomes. This is fine.

The third important harbinger of childbirth may be the discharge of the mucous plug. This is the mucous content that "lives" in the cervix, as if clogging the "house" of the baby. The mucous plug may come out in the form of thick and sticky secretions of a transparent pinkish color.

A woman may not feel the harbingers of childbirth, although most often the expectant mother still feels preparatory contractions.

A normal first birth lasts approximately 10-15 hours. Subsequent births usually proceed somewhat faster than the first, but this is not always the case. I am an example of such an exception, since my second birth lasted 12 hours longer (20 hours) than the first (8 hours).

If a woman's amniotic fluid has broken, then you should immediately go to the clinic. The amniotic fluid protects the baby, and he should not be without them for a long time. Therefore, if you feel lukewarm transparent water flowing out, call the doctor and get ready for the maternity hospital.

Usually, after the waters have broken, contractions begin (or they increase dramatically if you have been in labor before). If contractions do not start, most likely in the maternity hospital they will try to induce labor (with the cervix ready) so as not to leave the baby for a long time without protection.

Labor usually starts with contractions. Usually, women often begin to feel pain in the lower abdomen and an ache in the lower back about a couple of weeks before giving birth. But how then to understand what it is: preparatory contractions of Braxton-Hicks or the onset of labor ?! Such a question and concerns almost always arise in women who, theoretically or practically, face the harbingers of childbirth.

It’s not at all difficult to distinguish preparatory contractions from the onset of labor! When your stomach starts to sip, be a little more attentive to yourself: is it such a pain as usual, perhaps the painful sensations dragged on a little, or something else intuitively seems unusual to you?

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

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

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

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

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

In women of reproductive age, the glands of the cervix and vagina produce a mucous secret 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 a large amount of scarlet blood 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

In the 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 discharge is 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, which do not pose a danger to either the mother or the baby, may be a gynecological examination or careless sexual contact. In both cases, the appearance of traces of blood in the secretions is caused by mechanical irritation of 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 is 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.

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 appears 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. In the lower abdomen, the expectant mother will feel a slight heaviness and a little pain, and then translucent or pink mucus can be observed. 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

Dangerous can be heavy bleeding before childbirth, which occurred prematurely due to placental abruption or multiple pregnancy. In these cases, a caesarean section should be performed. Detachment of the placenta is not the norm at an early stage and mainly arises either from the mother’s wrong lifestyle 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. Lead a correct lifestyle, no smoking or drinking alcohol, and even more so do not take drugs. And include more healthy vegetables, fruits and meat in your diet, 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.

PREGNANCY IS THE BEST GIFT OF NATURE.

Pregnancy, childbirth, motherhood - this is the greatest happiness that happens to a woman! Nothing to be afraid of! Everything goes the way you set yourself up, with what thoughts you approach everything. Pregnancy will be easy even with severe toxicosis, swelling and a huge belly, if you take it all as natural. Under no circumstances should you feel sorry for yourself. You need to love yourself, pamper yourself, protect yourself. In no case should you complain about the tummy, that it interferes, it’s hard with him. He must be praised, rejoiced at him, looked with tenderness in the mirror. During pregnancy, diseases that did not bother you before can make themselves felt: diseases of the cardiovascular system, respiratory and excretory. Observations show that the most severe complications occur in the second half of pregnancy. This makes it necessary to establish a special regimen for women from the very beginning of pregnancy. Any strong mental excitement or physical stress can adversely affect a woman's health. This should be taken into account by her husband, all her relatives and colleagues. Normal pregnancy proceeds without bloody discharge from the genital tract. Any bleeding during pregnancy and childbirth is a complication and poses a threat to the fetus and mother. Every woman admitted to the clinic with complaints of spotting should be carefully examined. The main task for the doctor is to determine the source of bleeding (pathology of the placenta or local changes).

CAUSES OF BLEEDING DURING DELIVERY.

LOCAL: cervicitis, ectopia of the mucous membrane of the cervix, cervical cancer, injuries and infections of the genital tract;

PLACENTA PATHOLOGY: premature detachment of a normally located placenta (this is a detachment of a normally located placenta before the birth of the fetus), placenta previa and vasa previa, pathological attachment of the placenta.

PREVIOUS PLACENTAL DEPARTMENT(30%) is usually diagnosed on the basis of the clinical picture, which includes: bleeding from the genital tract, abdominal pain, tension and tenderness of the uterus. A mild form of the pathology can only be diagnosed by examining the placenta after its birth or by ultrasound, which reveals the normal location of the placenta and retroplacental hematoma. Ultrasound is of particular importance in the conservative treatment of premature placental abruption. The prognosis largely depends on the timely diagnosis of these complications.

Etiology and risk factors in premature placental abruption.

1. A large number of births in history; 2. Overstretching of the uterine wall (polyhydramnios, multiple pregnancies); 3. Preeclampsia and arterial hypertension; 4. Age (risk increases with age); 5. Direct trauma to the abdomen (accident, physical abuse); 6. Smoking; 7. Drug addiction, especially cocainism; 8. Drinking alcohol; 9. Uterine fibroids, especially the location of the node in the area of the placental site; 10. Rapid discharge of amniotic fluid with polyhydramnios; 11. Nervous - mental factors (fear, stress).

a. Bleeding from the genital tract is observed in 80% of cases; b. Pain is a common symptom that occurs due to stretching of the serous membrane of the uterus. Appears suddenly, localized in the lower abdomen and lower back, constant; v. Soreness and tension of the uterus are more often observed in more severe cases; d. With the formation of a retroplacental hematoma, the uterus increases. This can be detected by re-measuring the circumference of the abdomen and the height of the fundus of the uterus; e. Signs of intrauterine fetal hypoxia are often observed; e. Premature abruption of the placenta can cause preterm labor.

Terms and methods of delivery in premature placental abruption.

1. With mild premature detachment of the placenta, if the condition of the pregnant woman is stable, independent childbirth is allowed. In other cases, emergency delivery is required. 2. If premature detachment of the placenta occurred during childbirth, the condition of the woman in labor and the fetus is satisfactory, the BCC is replenished and the birth proceeds normally, it is not required to accelerate their course. 3. For rhodostimulation and reducing the flow of thromboplastin into the blood, an amniotomy is performed. 4. Preferably delivery through the birth canal. 5. Cesarean section is performed with intrauterine hypoxia of the fetus and the absence of conditions for rapid delivery through the natural birth canal, with severe detachment with a threat to the life of the mother, with the immaturity of the cervix.

Complications in premature detachment of the placenta.

1. Hemorrhagic shock. 2. DIC - syndrome. 3. Kuveler's uterus with extensive hemorrhage into the wall of the uterus. 4. Ischemic necrosis of internal organs, acute renal failure. 5. Due to hypoxia - congenital anomalies in the fetus. Prognosis: premature detachment is classified as a severe obstetric complication. Perinatal mortality reaches 30%.

PLACENTA PRESENTATION(20%) - a pathology in which the placenta is partially or completely located in the lower segment of the uterus (in the area of \u200b\u200bthe internal uterine os, i.e. on the path of the fetus being born) There are: complete placenta previa, partial placenta previa, marginal and low-lying (i.e. 2 cm above the internal pharynx).

Etiology and risk factors for placenta previa.

The etiology of placenta previa is unknown. Risk factors are divided into uterine and fetal. Uterine factors include atrophic and dystrophic processes in the endometrium, accompanied by a violation of the conditions of implantation. Sometimes the occurrence of placenta previa is due to the characteristics of the fetal egg itself. Due to the later appearance of the proteolytic activity of the trophoblast, the fetal egg descends into the lower sections of the uterus, where nidation occurs. Thus, the villous chorion grows in the region of the internal pharynx. Causes: 1. Chronic endometritis; 2. Pathological changes in the endometrium after surgical interventions (abortions, diagnostic curettage of the uterus, caesarean section, conservative myomectomy, perforation of the uterus); 3. Uterine fibroids; 4. Anomalies in the development of the uterus; 5. Infantilism; 6. A large number of births in history; 7. Smoking; 8. Purulent - septic complications in the postpartum period; 9. Diseases of the cardiovascular system, kidneys, diabetes.

Diagnosis of placenta previa is based on clinical data. Complaints about the appearance of scarlet spotting from the genital tract, weakness, dizziness are characteristic. Note the high standing of the presenting part of the fetus, its unstable position, often oblique or transverse position. Breech presentation is often accompanied by a clinic of threatened miscarriage, fetal hypotrophy. In 95% of cases, placenta previa can be diagnosed using ultrasound. Vaginal examination is carried out only with a prepared operating room.

Terms and methods of delivery in placenta previa.

With severe bleeding that threatens the life of the mother, regardless of the gestational age, an emergency delivery by caesarean section is performed. In the absence of severe bleeding and with a gestational age of 36 weeks or more, after confirmation of the maturity of the lungs of the fetus, delivery is carried out in a planned manner. With partial placenta previa and a mature cervix, childbirth through the natural birth canal is possible. If the lungs of the fetus are immature or the gestational age is less than 36 weeks and there is no bleeding, conservative treatment is carried out. It is necessary to limit physical activity, refrain from sexual activity and douching, maintain hemoglobin.

Complications in placenta previa. 1. Hemorrhagic shock; 2. Massive bleeding during pregnancy, during delivery and in the postpartum period; 3. Placental insufficiency; 4. Placenta accreta, especially in the area of the scar on the uterus, which can lead to blood loss and hysterectomy.

Prognosis: maternal mortality in placenta previa is close to zero. Perinatal mortality does not exceed 10%. The main cause of death in children is prematurity. With placenta previa, the risk of congenital malformations is high.

VESSEL PRESENTATION- this is a condition when a segment of the vessels of the umbilical cord, going inside the germinal membranes, is located above the internal pharynx. Rupture of blood vessels causes bleeding from the genital tract and intrauterine hypoxia. A test for denaturation with alkalis is made - 2-3 drops of an alkali solution are added to 1 ml of blood. The erythrocytes of the fetus are more resistant to hemolysis, so the mixture retains its red color. The erythrocytes of the pregnant woman are hemolyzed, and the mixture turns brown.

Complications in presentation of vessels.

Bleeding occurs from the vessels of the fetus, so fetal mortality exceeds 75%, mainly due to blood loss. Treatment: emergency caesarean section if the fetus is viable.

PATHOLOGICAL PLACENTA ATTACHMENT OR PLACENTA INJECTION- this is a pathological attachment of the chorionic villi to the wall of the uterus, their ingrowth into the myometrium or penetration through the thickness of the myometrium. Risk factors for pathological attachment of the placenta in placenta accreta.

1. Surgical interventions on the uterus in history; 2. Placenta previa; 3. Smoking; 4. A large number of births in history; 5. Inflammatory processes in the uterus; 6. Pathology of the endocrine glands Treatment: curettage of the uterine cavity or hysterectomy.

BLEEDING FROM THE CERVICE. 1. Carry out a cytological examination of a smear from the cervix; 2. Electrocoagulation or tamponade is used to stop bleeding; 3. Discharge from the cervical canal is examined for bacteria and viruses.

POLYPS OF THE SCREW OF THE UTERINE. 1. Bleeding usually stops on its own; 2. The cause of bleeding is trauma to the polyp; 3. If the bleeding does not stop, the polyp is removed and sent for histology.

BLOODY DISCHARGE FROM THE REGENITAL TRACT IN THE FIRST PERIOD OF LABOR are usually due to dilatation of the cervix and are mucus stained with blood.

INJURY TO THE EXTERNAL GENITAL OR VAGINA- there is usually an indication of trauma in the anamnesis.

PREVENTION AND INFORMATION FOR PATIENTS.

Primary prevention begins in the antenatal clinic with the identification and treatment of extragenital diseases, menstrual disorders, inflammation of the reproductive system, prevention of unplanned pregnancy and the identification of risk groups for bleeding. Mandatory ultrasound at 9, 16-24, 32-36 weeks of pregnancy. The localization of the placenta is determined during each study, starting from the 9th week of pregnancy. The diagnosis of presentation is established after the end of the placentation process at 14 weeks of gestation. It is necessary to warn the pregnant woman and her relatives about the danger of bleeding. It is necessary to constantly monitor blood pressure, treat preeclampsia, relieve uterine tone, correct hemostasis, exclude physical activity, sexual activity, and ultrasound monitoring every month in order to trace the migration of the placenta. If bleeding occurs, hospitalization is recommended.

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 a muscular membrane, blood loss is prevented only due to uterine contractions and activation of the hemostasis system. The following happens:

After the expulsion of the fetus, the uterus is significantly reduced in size.
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.
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;
birth canal injuries;
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 past gynecological diseases, genital surgery, abortion, infantilism. In the subsequent period, due to pathologies of the placenta, the force of contractions of the myometrium may be impaired, and the operation for manual separation of the 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 by a low content of fibrinogen in the blood, atony and hypotension of the uterus, retention of parts of the placental tissue, and fetal 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 were ineffective, the question of the use of surgical treatment is decided. When the uterus ruptures, internal bleeding develops. 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.

The large size of the organ, flabby consistency, fuzzy contours, profuse bloody discharge from the birth canal, which are accompanied by additional secretion 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 options for the development of a pathological condition - undulating and massive blood loss. With atony of the uterus, bleeding is continuous, quickly leading to hemorrhagic shock. In this state, emergency care is provided from the first seconds, with simultaneous preparation of the operating room. Consists of several stages:

Restoration of the volume of lost blood.
Achieving adequate oxygen levels.
Timely use of maintenance therapy - steroid hormones, cardiovascular drugs.
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 foresee a serious complication, to 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 activities are carried out against the background of intravenous administration of the 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, fresh frozen plasma, erythromass are used.

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.

Preventive measures include the fight against abortion, compliance with the protocol for managing women at the stage of antenatal clinics, during 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 childbirth, applying ice to the lower abdomen after the discharge of the placenta, periodic gentle external massage of the uterus, recording lost blood, and assessing the general condition of the woman can avoid complications.