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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.
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.
In 2021, the items of the Revised Geneva Score were re-evaluated on pregnant women. [4] Some items were removed, and the threshold values for the remaining items were modified to better discriminate patients even with the altered physiologic baseline of pregnancy (e.g. higher cut-off value for heart rate, lower cut-off value for age).
[35] [36] [37] Bleeding can be a symptom of miscarriage, but many women also have bleeding in early pregnancy and do not miscarry. [38] Bleeding during the first half of pregnancy may be referred to as a threatened miscarriage. [39] Of those who seek treatment for bleeding during pregnancy, about half will miscarry. [40]
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 ]
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. Placental abruption is often associated with uterine bleeding as well as uterine pain. [32]
The main issue with anticoagulation in pregnancy is that warfarin, the most commonly used anticoagulant in chronic administration, is known to have teratogenic effects on the fetus if administered in early pregnancy. [11] [12] Still, there seems to be no teratogenic effect of warfarin before six weeks of gestation. [13]
Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. [2] Some have added the requirement that there also be signs or symptoms of low blood volume for the condition to exist. [ 6 ]
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