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Antepartum bleeding, also known as antepartum haemorrhage (APH) or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery. [ 1 ] [ 2 ] It can be associated with reduced fetal birth weight. [ 3 ]
Risks of retained placenta include hemorrhage and infection. After the placenta is delivered, the uterus should contract down to close off all the blood vessels inside the uterus. If the placenta only partially separates, the uterus cannot contract properly, so the blood vessels inside will continue to bleed.
Chorionic hematoma is the pooling of blood between the chorion, a membrane surrounding the embryo, and the uterine wall. [2] It occurs in about 3.1% of all pregnancies , [ 2 ] it is the most common sonographic abnormality and the most common cause of first trimester bleeding .
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Couvelaire uterus is a phenomenon where the retroplacental blood may penetrate through the thickness of the wall of the uterus into the peritoneal cavity. This may occur after abruptio placentae. The hemorrhage that gets into the decidua basalis ultimately splits the decidua, and the haematoma may remain within the decidua or may extravasate ...
Women with placenta previa often present with painless, bright red vaginal bleeding. This commonly occurs around 32 weeks of gestation , but can be as early as late mid-trimester. [ 8 ] More than half of women affected by placenta praevia (51.6%) have bleeding before delivery . [ 9 ]
[1] [2] Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.
Women who have high blood pressure or who have had a previous placental abruption and want to conceive must be closely supervised by a doctor. [ 17 ] The risk of placental abruption can be reduced by maintaining a good diet including taking folate , regular sleep patterns and correction of pregnancy-induced hypertension .
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