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Perinatology (Risky Pregnancies):



BREAST BLEEDINGS

Bleeding after the 20th week is seen between 2% and 5% of all pregnancies, except for bleeding in the first 20 weeks due to the risk of miscarriage.

Reasons

Placenta previa (baby's partner is ahead)

It is seen in approximately 30% of prenatal hemorrhages. In most cases seen before 24 weeks of gestation, this will resolve after 24 weeks.

Therefore, the diagnosis is made after the 24th week.

In this case, which is among the most important causes of prenatal bleeding, delivery is usually performed by cesarean section (sometimes normal delivery can be made considering the distance of the baby's partner to the cervix and the conditions of both the baby and the mother).

The risks created by this situation include premature birth, developmental delay in the baby, sudden infant death, and the baby not coming with the head.

The predominance of the baby's spouse often presents itself with painless vaginal bleeding. The diagnosis is made by ultrasonography.

The expectant mother with this diagnosis should be alert in terms of bleeding, if she is not hospitalized in terms of emergencies near the birth, she should not be admitted to the hospital where the birth is planned at the latest.

They should live within 15-20 minutes, know their blood type, and their relatives who can give blood in an emergency should be prepared for this situation.

Placental abruption (departure of the baby's partner before birth)

It occurs in approximately 20% of prenatal hemorrhages. It can be seen before birth as well as during birth.

The amount of bleeding can vary from an occult bleeding to overt bleeding. Intense uterine contractions (unability to relax the uterus) and pain accompanying bleeding are stimulating. Ultrasonography can help in the diagnosis although it does not provide 100% information.

Risk factors include high blood pressure, multiple births, smoking, hypertension, and excess water in the baby.

The way of delivery is decided according to the well-being of the mother and the baby. Cesarean section is preferred in cases where the lives of mother and baby are threatened.

Except for these frequent cases; Engagement, infections of the cervix and vagina, trauma, genital varicose veins, genital masses, vasa previa (passing of the veins from the partner to the baby over the cervix) can be counted among the other causes of prenatal bleeding.

As a result, regardless of the cause and amount, prenatal bleeding should be investigated. In such a case, the expectant mother should immediately apply to the hospital.

Vaginal expulsion of pregnancy tissue and painful bleeding

Painful bleeding with signs of blood loss

Disappearance of pregnancy signs without bleeding

About 20% of pregnancies have vaginal bleeding. This situation causes great uneasiness for the pregnant woman and her husband.

Heavy bleeding in early pregnancy should never be ignored and should be investigated urgently.

The amount of bleeding varies from mild to very intense.

Painless bleeding is generally considered a threat of miscarriage. Patients seen in clinics mostly have painless bleeding.

In most of these patients, bleeding is due to normal changes in the cervix. Pain occurs when tissue or blood clot causes the cervix to open or stretch.

Pregnancy may continue normally after the patient has bleeding or pain, there may be a clinical pregnancy loss or this loss may be silent but can be detected on routine ultrasonography screening.

It has been shown that 12% of pregnancies with bleeding end in miscarriage. In contrast, many pregnancies are lost before they are recognized.

Risk factors

The most important risk factor is chromosomal abnormalities in the fetus, other risk factors are advanced maternal age, previous miscarriage, maternal infections, medications and environmental factors, chronic diseases, immune system disorders, and structural abnormalities of the uterus and cervix.

Spontaneous abortions are defined in five groups;

Threat of Miscarriage (Abortus Imminens)

By definition, it is bleeding without a cervix opening.

It can be understood by pregnancy hormone (B-hCG) and ultrasound follow-ups that the pregnancy is located in the uterus and maintains healthy growth and development.

Threatened miscarriage cases are approached as follow-up. At the threat of miscarriage, it is recommended to restrict their physical activities, bed rest, prohibition of sexual intercourse.

In addition, drugs containing progesterone hormone can be used in cases where hormonal failure is considered as the cause of the threat of miscarriage.

Despite all precautions, the threat of miscarriage may result in miscarriage, and the most common reason for this termination is that the fetus has a chromosomal anomaly.

Anti-D immunoglobin should be administered to women with blood incompatibility who are at risk of miscarriage.

If the bleeding is light and there is no pain, it should be considered that the pregnancy will continue.

More than 50% of pregnancies with bleeding continue.

Inevitable Miscarriage (Abortus Incipiens)

The amount of bleeding is excessive, opening of the cervix and abdominal / groin pain may occur. Sometimes fetal parts can be seen in the cervix. If the fetal heart has stopped or the cervix has been opened, the treatment is abortion. blood incompatible

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