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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.
Although described as "morning sickness," pregnant women can experience this nausea any time of day or night. The exact cause of morning sickness remains unknown. Nausea and vomiting in pregnancy is typically mild and self-limited, resolving on its own by the 14th week of pregnancy. Other causes should also be ruled out when considering treatment.
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.
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]
[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 ]
A threatened miscarriage is signs or symptoms of miscarriage, most often including bleeding that occurs in the first 20-weeks of a pregnancy. [28] Research has shown that supplementation of progesterone can lower the rate of miscarriage, however, it did not have an effect on lowering the rate of pre-term births and live births . [ 29 ]
Hypercoagulability in pregnancy likely evolved to protect women from hemorrhage at the time of miscarriage or childbirth. In developing countries, the leading cause of maternal death is still hemorrhage. [25] In the United States 2011-2013, hemorrhage made up of 11.4% and pulmonary embolisms made up of 9.2% of all pregnancy-related deaths. [26]
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