Blood before childbirth is the norm or danger. Emergency: Bleeding during childbirth Blood during childbirth for women

The process of labor pains does not always proceed in strict accordance with textbook descriptions in medical textbooks. Much depends on the individual characteristics of the woman and her pregnancy.

And therefore, the appearance of spotting already at the stage of contractions is not at all uncommon. Is this normal and what to do if they appear, we will tell in this article.

The reasons

Contractions are rhythmic contractions of the uterine muscles, the task of which is to lead to the opening of the cervix. This process is painful and quite long. The cervix needs to expand by 10-12 centimeters so that the baby's head can pass. Often, the period of contractions is accompanied by the manifestation of various secretions, including bloody, associated with the discharge of the mucous plug.

A clot of mucus with blood streaks tightly closes the cervical canal of the cervix throughout the entire pregnancy. But when the active preparation of the female body for childbirth begins, the cervix becomes softer, smoothed out, the cork can begin to move away either entirely or in parts.

It may look like light, yellowish or pink mucus with small streaks of blood. Such secretions can appear not only at the stage of "harbingers", but also during contractions.

There is no need to be scared - there is a completely natural and physiological process of opening the neck for the subsequent exit of the baby. It is only important to make sure that the discharge does not increase, does not turn into scarlet blood.

Small bloody or brown discharge may appear when contractions have begun and after a gynecologist's examination. After the woman arrives at the maternity hospital, she will definitely be examined, and therefore such discharge should also not be frightening and alarming.

Scarlet blood during contractions, copious bleeding - a more alarming situation. This can lead to premature placental abruption. Normally, the "children's place" leaves its place after the birth of the baby, in the subsequent period of childbirth. If an earlier detachment occurs, this is fraught with bleeding, a state of acute hypoxia for the child, which can lead to irreversible changes in his brain and the entire central nervous system. The baby may die.

Bright red, scarlet blood at the stage of contractions is not considered the norm. Her appearance is a reason to call an ambulance if the woman is still at home, or immediately inform the medical staff about this if the woman in labor is already in the obstetric facility.

Actions

With the appearance of copious blood discharge with the first contractions or a little later, you should immediately go to the hospital and report this unpleasant news to the medical staff right from the doorway.

If placental abruption occurs, the woman will urgently undergo a caesarean section, since delay is unacceptable.

For moderate bloody (do not confuse with blood!) Discharge, use pads, avoid getting water into the vagina, for example, while taking a shower at home before going to the hospital or in the emergency room of the maternity hospital.

Without a mucous plug, a baby has no mechanical barrier protection against viruses, bacteria and fungi. If aggressive flora or microorganisms enter the uterine cavity, an internal infection can develop quite quickly, which is extremely dangerous for the baby and for the mother.

If bloody or scarlet discharge is accompanied by the separation of a large amount of fluid, premature discharge of water is not excluded. In such a situation, you should also go to the maternity hospital as soon as possible, without waiting until the contractions become stronger. In the emergency department, you also need to immediately say that the flowing fluid had a bloody, pink, brown or other shade. This will help doctors quickly choose the right tactics for conducting childbirth.

The main thing is not to panic and not be nervous. Doctors have a lot of ways to cope with this or that emergency situation that has arisen in childbirth. Trust them.

For discharge, contractions and other harbingers of childbirth, see the following video.

During the entire pregnancy, a woman had to face more than once a change in the nature of vaginal discharge. Firstly, it is strongly influenced by the hormonal background of a pregnant woman, which constantly changes over time. Secondly, it is very often during this period that thrush worsens or manifests itself for the first time, annoying with curdled secretions with a characteristic sour smell. Thirdly, it is likely that there was a threat of disruption indicated by . And it is these secretions that expectant mothers are most afraid of.

Now, at the end of the term, it is almost possible to breathe easy: the release of blood before childbirth in the vast majority of cases will mean their imminent start. But it is still too early to completely relax: even on the eve of the birth of the baby, premature detachment of the placenta may begin.

Bloody discharge before childbirth - a sign of their onset

One of the most reliable signs of incipient labor is, which is always accompanied by discharge. The cork can move away already in childbirth (then the woman will not notice this) or come out at the same time as a whole clot, for example, while taking a shower, which can also be left unattended.

But also often the mucous plug comes off in parts, gradually, and at the same time the woman notices white-yellow mucous discharge on the underwear, which may contain streaks of blood - pinkish, brown or brown. This is a sure sign that there is not much time left before meeting with the most desirable creature. From the moment the mucous plug begins to discharge, the mother should stop any activities that may lead to the penetration of the infection into the womb (sexual intercourse, taking a bath and bathing in stagnant water).

Almost all women discussing spotting before childbirth on the forums confirm that within a day or two from the moment small amounts of bloody mucus were found on their underwear, they had childbirth. At the same time, obstetricians note that the darker the blood, the less left to walk with a belly. Please note that it can take from several hours to 2 weeks before delivery.

Other Safe Causes of Prepartum Spotting

The discharge of the mucous plug is the most likely cause of bleeding before childbirth, which is an absolute physiological norm. But there may be other safe reasons for the phenomenon that alarms you.

A pregnant woman can observe a slight discharge of blood from the vagina after examination on a gynecological chair, and it is not at all necessary immediately after a doctor's appointment, and possibly even within a few hours after that.

Similarly, after intercourse, and it is quite normal - for two days after sex. The reason for the appearance of bloody discharge in both of these cases is the mechanical irritation of the cervix, which is already preparing for the beginning of its opening.

When to go to the hospital

We pay special attention to the fact that spotting before childbirth in all the cases described above should not be plentiful. Normally, these are scanty smearing marks or small inclusions, more often brownish, but may also be red. If bleeding has begun, then you must go to the hospital without delay, without wasting a second! It is also necessary to see a doctor if, after the beginning of the discharge of the mucous plug, the discharge of blood began to increase or the child changed his motor activity.

Bloody discharge before childbirth, observed 2 weeks before their expected start and earlier, also cannot be ignored: be sure to notify your doctor about this.

Specially for Elena Kichak

It is known that both normal childbirth and the postpartum period are accompanied by spotting. The placenta (baby place) is attached to the uterus with the help of villi and is connected to the fetus by the umbilical cord. When it is naturally rejected during childbirth, capillaries and blood vessels rupture, which leads to blood loss. If everything is in order, then the volume of lost blood does not exceed 0.5% of body weight, i.e. for example, a woman weighing 60 kg should not have more than 300 ml of blood loss. But with deviations from the normal course of pregnancy and childbirth, bleeding that is dangerous to the health and even the life of a woman can occur, in which the volume of blood loss exceeds the permissible norms. Blood loss of 0.5% of body weight or more (more than 300–400 ml on average) is considered pathological, and 1% of body weight or more (1000 ml) is already massive.

All obstetric bleeding can be divided into two groups. The first combines bleeding that occurs in late pregnancy and in the first or second stage of labor. The second group includes those bleeding that develop in the third stage of labor (when the placenta departs) and after the baby is born.

Causes of bleeding in the first and second stages of labor

Bleeding in the third stage of labor and after them

• Violations of the separation of the placenta. Normally, after some time (20–60 minutes) after the birth of the child, the placenta and fetal membranes that make up the child's place or afterbirth are separated. In some cases, the process of separation of the placenta is disturbed, and it does not come out on its own. This happens due to the fact that the villi of the placenta penetrate too deeply into the thickness of the uterus. There are two forms of pathological attachment of the placenta: dense attachment and its increment. It is possible to understand the cause of violations only when performing manual separation of the placenta. In this case, the doctor, under general anesthesia, inserts his hand into the uterine cavity and tries to manually separate the placenta from the walls. With tight attachment, this can be done. And with an increment, such actions lead to profuse bleeding, the placenta comes off in pieces, without completely separating from the uterine wall. Only an immediate operation will help here. Unfortunately, in such cases it is necessary to remove the uterus.
• Ruptures of soft tissues of the birth canal. After the placenta has separated, the doctor examines the woman in order to identify ruptures of the cervix, vagina and perineum. Given the abundant blood supply, such tears can also cause heavy bleeding during childbirth. Therefore, all suspicious places are carefully sutured immediately after childbirth under local or general anesthesia.
• Hypotonic bleeding. Bleeding that occurs in the first 2 hours after childbirth is most often due to a violation of the contractility of the uterus, i.e. her hypotonic state. Their frequency is 3-4% of the total number of births. Hypotension of the uterus can be caused by various diseases of a pregnant woman, difficult childbirth, weakness of labor, violations of the separation of the placenta, premature detachment of a normally located placenta, malformations and inflammatory diseases of the uterus. In this condition, most often the uterus periodically loses its tone, and the bleeding either increases or stops. If medical care is provided on time, then the body compensates for such blood loss. Therefore, in the first two hours after childbirth, the newly-made mother is constantly monitored, because in the event of bleeding, you need to act as quickly as possible. Treatment begins with the introduction of contracting drugs and replenishment of blood volume using solutions and components of donor blood. At the same time, the bladder is released with a catheter, an ice pack is placed on the lower abdomen, an external and internal massage of the uterus is performed, etc. These mechanical methods are designed to reflexively “start” uterine contractions. If medicinal and mechanical methods of stopping bleeding are ineffective and blood loss increases, an operation is performed, possibly trying to avoid removal of the uterus.
• Late postpartum hemorrhage. It would seem that when everything is in order with a woman and 2 hours after giving birth she is transferred to the postpartum ward, then all the dangers are already behind and you can relax. However, it also happens that bleeding begins in the first few days or even weeks after the baby is born. It may be due to insufficient contraction of the uterus, inflammation, trauma to the tissues of the birth canal, and blood diseases. But more often this problem occurs due to the remains of parts of the afterbirth in the uterus, which could not be determined during the examination immediately after childbirth. If pathology is detected, curettage of the uterine cavity is carried out and anti-inflammatory drugs are prescribed.

How to avoid bleeding?

Follow the recommendations of doctors, especially if prenatal hospitalization is necessary (for example, with placenta previa), do not decide on home birth - after all, in the event of bleeding (and many other complications), immediate action is needed, and help may simply not be in time! Whereas in a hospital setting, doctors will do everything possible to cope with the problem that has arisen.

First aid for blood loss

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.

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:

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;
• 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, 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 its complete separation has not yet occurred, 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 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 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:

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 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.