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It is estimated that less than 1ml of fetal blood is lost to the maternal circulation during normal labour in around 96% of normal deliveries. [1] [2] The loss of this small amount of blood may however be a sensitising event and stimulate antibody production to the foetal red blood cells, an example of which is Rhesus disease of the newborn.
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]
Hemorrhoids are common in pregnancy as a result of constipation and increased intra-abdominal pressure. Hemorrhoids can cause bleeding, pain, and itching. [31] Treatment is symptomatic, including improving underlying constipation. Symptoms may resolve spontaneously after pregnancy, although hemorrhoids may remain in the days after childbirth. [32]
A pregnancy test detects the presence of the pregnancy hormone human chorionic gonadotropin in a person’s body. The body doesn’t produce that hormone until several days after conception.
A hemodynamically unstable individual would necessitate an immediate transfer to the emergency department. It is important to recognize that women may suffer significant blood loss before any signs of hemodynamic instability are evident. [18] The initial evaluation of early pregnancy bleeding involves a history and physical examination. [19]
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. [3]
Vessel rupture is very likely in the event of a membranous rupture as foetal blood vessels aren't protected by the umbilical cord of the placenta. In the event of foetal vessel rupture, antepartum haemorrhaging occurs however blood is lost from the foetal blood supply. If the foetus is developed enough caesarean sections are often recommended. [17]
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