Preface
Vaginal bleeding during pregnancy is an indication of abnormal pregnancy. To avoid endangering mother and fetus, a thorough examination is necessary to uncover the cause regardless the amount of blood discharged.
Reasons of antenatal bleeding
1. Abnormal placenta and uterus
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placenta previa
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low-lying placenta: most patients suffer from mild conditions, and rarely are there severe conditions.
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marginal blood vessel rupture
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early placenta separation
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Vasa previa: bleeding often occurs during delivering babies; the condition is often accompanied by low-lying placenta.
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Uterine rupture
2. Cervix and vagina disease:
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cervix: including symptoms like erosion, polyp, and cancer
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vagina: including symptoms like trauma, varicosis, and foreign object
3. Urogenital infection
4. Hematology's disease
Bleeding signs
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Abortion: vagina bleeding with lower abdomen pain
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Ectopic pregnancy: Symptoms include sudden lower abdomen pain, menstrual period overdue, vagina bleeding, pale face, and fast pulse. Once there is fallopian tube rupture, patients could suffer from acute internal bleeding.
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Molar pregnancy: during early trimesters, it is almost impossible to distinguish it from the normal pregnancy; by 7-8 weeks of the trimester, patients start to have vagina bleeding, anemia, and over distended uterus. There is no sign of fetal heartbeat but all kinds of symptoms of pregnancy.
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Placenta previa: 7 months after the pregnancy, patients could suffer from sudden painless vaginal bleeding.
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Early placenta separation: symptoms include vagina bleeding, acute abdomen pain, drop of blood pressure, and increase of pulse rate.
Clinical treatments
1. Abortion:
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• Sign of abortion: attend to bed-rest; intake oral or intramuscular progesterone.
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• Incomplete abortion: use uterine contraction agents or uterus curettage.
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• Complete abortion: observation and follow-up check
2. Ectopic pregnancy: Physicians often undergo conservative observation base on patients’ condition and willingness. The method of the surgery is either laparoscopy or open-method, surgeons undergo laparoscopic salpingostomy or salpingectomy base on patients’ condition.
3. Molar pregnancy: Molar pregnancy can be treated with uterine curettage. 20% molar pregnancy will develop into malignant tumor; therefore, long-term follow-up checks are required and pregnancy should be avoided for one year.
4. Placenta previa: It can be treated base on the degree of severity, gestational weeks, and mother and fetal condition.
5. Early placenta separation: For mild or uncertain cases, doctors often ask patients to attend to plenty of bed-rest, to stay calm, and to be supervised under careful observation. Immediate delivery is recommended when patients are diagnosed of early placenta separation.
中國醫藥大學附設醫院
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