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Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. [4] Bleeding may be vaginal or less commonly into the abdominal cavity. Bleeding which occurs before 24 weeks is known as early pregnancy bleeding. Causes of bleeding before and during childbirth include cervicitis, placenta previa, placental abruption and uterine rupture.
Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy.It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, [1] and is one of the signs that labor may be imminent. [2]
Early pregnancy bleeding (also called first trimester bleeding) is vaginal bleeding before 14 weeks of gestational age. [ 1 ] [ 2 ] If the bleeding is significant, hemorrhagic shock may occur. [ 1 ] Concern for shock is increased in those who have loss of consciousness , chest pain, shortness of breath , or shoulder pain.
Other causes include miscarriage, ectopic pregnancy, molar pregnancy, incompetent cervix, uterine rupture, and preterm labor. [31] Bleeding in early pregnancy may be a sign of a threatened or incomplete miscarriage. In the second or third trimester a placenta previa (a placenta partially or completely overlying the cervix) may bleed quite severely.
[8] [9] However, the case of intrauterine hematoma observed before 9 weeks of gestational age has been associated with an increased risk of miscarriage. [10] In one study women who complied with instructions for bed rest for the duration of bleeding had a lower rate of miscarriage and a higher rate of term pregnancy than non-compliant women.
[5] Vanishing twin syndrome has been characterized as the loss of a twin before 12 weeks of gestation, or early during the first trimester where it is uncommon for twin pregnancy to have been identified. [6] According to Boklage, most twin pregnancies are ultimately born as singles, and vanished twins are a possible source of abnormal cells. [7]
A cervical pregnancy is an ectopic pregnancy that has implanted in the uterine endocervix. [2] Such a pregnancy typically aborts within the first trimester , however, if it is implanted closer to the uterine cavity – a so-called cervico-isthmic pregnancy – it may continue longer. [ 3 ]
Use of aspirin before 16 weeks of pregnancy to prevent pre-eclampsia also appears effective at preventing antepartum bleeding. [4] In regard to treatment, it should be considered a medical emergency (regardless of whether there is pain), as if it is left untreated it can lead to death of the mother or baby.