Bleeding During Pregnancy
Bleeding may occur at any stage of pregnancy and, while it can be very alarming, it may or may not be an indication of a serious complaint. The point in time during the pregnancy that the bleeding occurs, the amount of blood caused by the bleeding, and the presence of pain are all indicators of seriousness of the situation.
During the first trimester, bleeding may be caused by pregnancy loss, an ectopic pregnancy, the implanting of the placenta in the uterus or infection. In later pregnancy, after 20 weeks gestation, bleeding may be the result of placenta previa in which case the placenta is either near or covering the cervical opening, or by placental abruption where the placenta detaches from the uterus prematurely. The bleeding can also be a result of unknown causes.
What Is Placenta Abruption And What Causes It?
When the placenta prematurely detaches from its implantation in the uterus, the separation is called placental abruption. The placenta is filled with many blood vessels which allow for nutrition to pass to the baby from the mother. These vessels will bleed if the placenta begins to detach from the uterine wall during pregnancy. The larger the area of detachment, the more blood there will be. This condition occurs once in every 120 births and is also called abruptio placenta.
With the exception of direct trauma to the uterus, as there may be in a motor vehicle accident, the cause of placental abruption is unknown. Certain conditions are associated with it such as hypertension, cigarette smoking, a previous pregnancy with placental abruption as well as a multiple pregnancy. It is considered dangerous because there is a risk of hemorrhaging to the mother and, in the rare extreme cases, other complications such as shock from the hemorrhage, serious blood clotting (disseminated vascular coagulation-DIC), damage to the kidneys or brain as a result of poor blood flow, stillbirth and postpartum hemorrhaging.
The Symptoms Of Placental Abruption
Placental abruption is characterized by dark red vaginal bleeding with pain during the third trimester. It is also possible for the condition to appear during labor. The symptoms vary and include vaginal bleeding, abdominal pain, uterine contractions that do not relax, blood present in the amniotic fluid, feeling nauseated and thirsty, feeling faint and a decrease in the movements of the baby. Since symptoms of placental abruption are similar to other conditions, the diagnosis of a physician is necessary.
Determining The Severity Of The Condition
The doctor will make a diagnosis often based upon the symptoms as well as the amount of blood and pain present. An ultrasound may indicate the location of the bleeding and is useful to check on the baby's condition as well. Placental abruption is classified in the following manner: Grade 1, which is a small amount of bleeding from the vagina and some contractions without signs of fetal distress or hypotension in the mother; Grade 2, in which there is increased bleeding, uterine contractions and some signs of fetal distress indicated by fetal heart rate; and Grade 3 which includes moderate to severe bleeding or concealed bleeding, tetany (uterine contractions which do not relax), abdominal pain, low blood pressure and the death of the baby.
Treating Placental Abruption
Treatment is determined based upon overall health, medical history, extent of the placental abruption, tolerance for medications or procedures and the woman's opinions as well. There is no way to reattach the placenta and once the condition is diagnosed, the treatment is dependent upon the grade and stage. Caesarean delivery is performed in most cases of placental abruption and since there is often a large loss of blood, a transfusion may be necessary as well.