2024-03-07 00:04:51
[Chinese Health Network article / Zhang Meiling, attending physician of the Department of Obstetrics and Gynecology, Cathay General Hospital]Ms. Wang, 40, has been infertile for many years and successfully conceived through in vitro fertilization. She is currently 25 weeks old. Recently, she has a sinking feeling in her abdomen and vaginal secretions containing blood. After hospital examination, ultrasound revealed that the internal os of the cervix had been dilated, and the length of the cervix was 1.2 cm. Fetal monitor examination revealed frequent small contractions of the uterus, so hospitalization was immediately arranged for tocolysis treatment and steroids were given to prevent premature birth of the fetus. complication.
Bleeding in early pregnancy, rule out fatal ectopic pregnancy first!Must-read fetal safety guidelines for older pregnant women
Causes of bleeding during pregnancy
There are many reasons for bleeding during pregnancy, which are divided into three months of pregnancy. There are different reasons for early, middle and late pregnancy. Bleeding in early pregnancy must first rule out life-threatening ectopic pregnancy. When the pregnancy test is positive, the doctor will try to calculate the number of weeks of pregnancy. Many pregnant women delay the detection of the embryo sac due to irregular menstrual cycles, but if the ultrasound is in the 6th month of pregnancy, If the uterine cavity embryo sac has not been seen for more than 2 weeks or 2 weeks following a positive pregnancy test, it may be accompanied by trace bleeding. You must be careful regarding whether it is an ectopic pregnancy or a very early miscarriage.
In addition, infertile patients must pay special attention because most patients will receive two or more embryos for implantation. Although normal embryo sacs can be seen in the uterine cavity, if ultrasound finds abnormal images outside the uterus, A concurrent ectopic pregnancy must be suspected. When the embryo sac has been seen in the uterine cavity, the cause of vaginal bleeding may be embryo atrophy (only the embryo sac but no embryo), urgent miscarriage (the embryo has a heartbeat), expired abortion (the embryo has no heartbeat), or even embryonic abnormalities (such as hydatidiform mole). ), it may also be other gynecological reasons such as cervical polyps, erosion, tumors or vaginitis, etc., or even non-obstetric and gynecological reasons, such as hematuria or hemorrhoid bleeding, etc. Therefore, internal diagnosis of the vagina and cervix is the most early stage Necessary tests for differential diagnosis of pregnancy bleeding.
After the causes of early bleeding are eliminated, mid-term bleeding is mostly caused by premature birth or bleeding during pregnancy, which is related to the placenta of advanced age. There may be no abdominal pain or accompanied by lower abdominal pain. If the pregnant woman has a history of premature birth of the previous pregnancy, this pregnancy should be paid close attention to in advance and can be regularly When receiving an ultrasound examination, in addition to confirming information regarding the fetus, the position of the placenta and the length of the cervix are also very important. If the placenta is located low, very close to or even covering the internal os of the cervix, it is placenta previa, and it is more likely to cause abdominal pain from time to time. Bleeding; in addition, if the cervix is shortened and the length is less than 2.5 cm, or if the internal opening of the cervix is found to be dilated and forms a V or U shape, it is a high-risk group for premature birth, which may be accompanied by a small amount of bleeding. With fetal monitor examination, It can determine whether pregnant women have uterine contractions and premature labor.
Bleeding in late pregnancy is similar to mid-pregnancy. Since the fetus has grown to a certain number of weeks and weight, when there is bleeding, it is necessary to determine whether it is a sign of labor. As long as placenta previa is ruled out, the cervix can be checked internally to see if it begins to change. And cooperate with the fetal monitor to detect whether the uterus is contracting. The so-called normal bleeding related to childbirth, commonly known as redness, is caused by the softening and thinning of the cervix, which produces a large amount of secretions mixed with bloody mucus caused by rupture of the capillaries of the cervix. It is different from prepartum bleeding. If the amount of bleeding is very large, it may be Sequelae of placenta previa or placental abruption.
If the length of the cervix is shortened in the second trimester of pregnancy, it will have a great impact on the fetus. If it is not treated in time and the result is premature birth, the fetus cannot usually be saved before 23 weeks. After 23 weeks, extremely low birth weight and extreme premature birth can also cause complications in organs (such as the nervous system). , respiratory system, eyes) serious sequelae, so under safe and appropriate conditions, the treatment goal is to stay in bed until the more mature cycle (following 34 weeks). If bleeding in late pregnancy is due to redness caused by labor signs and has reached 34 weeks, and the cervix has begun to change, you can be hospitalized to wait for delivery without having to undergo abortion; if bleeding is diagnosed as placental abruption or placenta previa, it is an emergency and should be treated immediately Perform fetal assessment and preparation for possible birth.
Clinicians will arrange appropriate examinations and treatments based on the possible causes of bleeding and the pregnant woman’s gestational age at that time.
What to do if you have bleeding during pregnancy
Clinicians will arrange appropriate examinations and treatments based on the possible causes of bleeding and the pregnant woman’s gestational age at that time. In the early stages of pregnancy, ultrasound is used to confirm the embryo implantation position, fetal size and heartbeat, and following ruling out ectopic pregnancy, you will generally be given oral tocolytic pills through Medicare or injectable tocolytic injections at your own expense; if cervical polyps or tumors are found, consider Follow up or remove it under safe conditions; in addition to hemostasis, cervical erosion may also be due to cell lesions, and a smear or biopsy can be performed.
Pregnant women should not have sex in early pregnancy, nor should they do strenuous exercise. They should supplement with adequate folic acid and get more rest. In addition, fetal chromosomal abnormalities may also cause bleeding in the early and mid-term, so it is recommended that every pregnant woman undergo Down’s syndrome screening (early Down’s syndrome screening items include fetal nuchal translucency measurement, the detection rate is higher than mid-term Down’s syndrome screening High), or more accurate non-invasive prenatal chromosomal testing (NIPT); and for elderly/high-risk groups, if the risk of water rupture is 0.1% to 0.2%, it is recommended to further undergo amniocentesis. Bleeding from bacterial vaginosis is pinker and has a foul smell, and must be treated as soon as possible, otherwise it will increase the risk of premature birth, early water rupture, or postpartum pelvic inflammation.
If the length of the cervix is shortened in the second trimester of pregnancy, it will have a great impact on the fetus. If it is not treated in time and the result is premature birth, the fetus cannot usually be saved before 23 weeks. After 23 weeks, extremely low birth weight and extreme premature birth can also cause complications in organs (such as the nervous system). , respiratory system, eyes) serious sequelae, so under safe and appropriate conditions, the treatment goal is to stay in bed until the more mature cycle (following 34 weeks). If bleeding in late pregnancy is due to redness caused by labor signs and has reached 34 weeks, and the cervix has begun to change, you can be hospitalized to wait for delivery without having to undergo abortion; if bleeding is diagnosed as placental abruption or placenta previa, it is an emergency and should be treated immediately Perform fetal assessment and preparation for possible birth.
Prenatal care for elderly pregnant women
Pregnant women of advanced age refer to pregnant women over 34 years old. In today’s society, more and more people are marrying and having children later in life, and pregnancy at advanced age is becoming more and more common. Pregnancy is more likely to be complicated by miscarriage, premature birth, chromosomal abnormalities, high-risk pregnancies (such as high blood pressure, diabetes or thyroid disease), placenta previa or placental abruption, etc. As you get older, your fetus may become heavier. However, the tissue elasticity of the maternal birth canal becomes worse with age, leading to dystocia, poor postpartum uterine contraction, severe postpartum hemorrhage, birth canal laceration, or an increased chance of caesarean section, etc. .
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In order to have a safe and smooth pregnancy, elderly people should have a health check-up before planning a pregnancy to find out whether they have anemia, hypertension, diabetes, endocrinology, autoimmune diseases, gynecological tumors, etc., and whether they need treatment first; if If you are obese, it is recommended to lose weight; infertile patients undergoing artificial reproduction or in vitro fertilization are also at high risk of pregnancy complications and must cooperate with obstetricians to closely follow up; in addition, folic acid can be supplemented for more than 3 months before pregnancy to protect future fetal development. ; Nutrition during pregnancy must also be balanced, and attention should be paid to one’s own weight and ultrasound to assess whether the fetal weight is growing normally to avoid overweight of the pregnant woman or the fetus. After the second trimester, pregnant women should continue to pay attention to fetal movements. Once abdominal pain, vaginal bleeding, watery or foul-smelling vaginal discharge occurs, they should seek medical treatment as soon as possible to avoid delays.
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Source: Chinese Health Network
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