VAGINAL BLEEDING DURING PREGNANCY IN ENGLISH

                                                   

                       VAGINAL BLEEDING DURING PREGNANCY IN ENGLISH

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VAGINAL BLEEDING IN EARLY PREGNANCY

Any vaginal bleeding in early pregnancy (before 24 weeks ) is abnormal and of concern to the woman and a midwife, especially if there is a history of previous pregnancy loss

CAUSES

There are many causes of vaginal bleeding in early pregnancy (before 24 weeks ), some of which can occasionally lead to life threatening situations and others of less consequence for the continuance of pregnancy. Such as-

Implantation bleeding

Cervical ectropion

Cervical polyps

Carcinoma of the cervix

Spontaneous abortion

Ectopic pregnancy

 

Implantation bleeding-

A small vaginal bleed can occur when the blastocyst

embeds in the endometrium. This usually occurs 5–7 days after fertilization. This type of bleeding is harmless.

But sometimes if the date of bleeding  is same as expected menstruation, than it may cause confusion over the dating of the pregnancy (EDD) if the menstrual cycle is used to estimate the date of birth.

 

Cervical ectropion-

Cervical ectopion or sometimes referred as cervical erosion is a condition where bleeding may be seen at cervix level.

 The number of columnar epithelial cells in the cervical canal increase significantly under the influence of estrogen during pregnancy. These cells extend beyond to the vaginal surface of the cervical os, giving it a dark red appearance.

As this area is vascular, and the cells form only a single layer, bleeding may occur either spontaneously or following sexual intercourse. This condition is also harmless and Normally, no treatment is required, and the ectropion reverts back to normal cervical cells during the puerperium.

 

Cervical polyps

These are small, vascular, pedunculated growths on the cervix, which consist of squamous or columnar epithelial cells over a core of connective tissue rich with blood vessels.

During pregnancy, the polyps may be a cause of vaginal bleeding. Cervical polyps require no treatment unless the bleeding is

severe . These polyps can be removed in OPD and a biopsy is sometimes done to confirm they are benign, as in rare cases they can harbor pre-cancerous cells.

 

Carcinoma of the cervix

Carcinoma of the cervix is the most common gynaecological malignant disease occurring in pregnancy. The condition presents with vaginal bleeding and increased vaginal discharge. On speculum examination the appearance of the cervix may lead to a suspicion of carcinoma.

Carcinoma of the cervix is diagnosed following colposcopy or a cervical biopsy. The Pap smear is not routinely carried out during pregnancy. Treatment for cervical carcinoma in pregnancy will depend on the gestation of the pregnancy and the stage of the disease.

For carcinoma in the early stages, treatment may be delayed until the end of the pregnancy. Where the disease is more advanced, and the diagnosis made in early pregnancy, the woman may be offered a termination of pregnancy in order to receive proper cancer treatment.

 

Spontaneous abortion

The term miscarriage (abortion) is used to describe a spontaneous pregnancy loss. A miscarriage is seen as the loss of the products of conception prior to the completion of 24 weeks of gestation and early pregnancy loss being one that occurs before the 12th completed week of pregnancy. Spontaneous abortion is also a leading cause of vaginal bleeding in pregnancy

A threatened miscarriage occurs where there is vaginal bleeding in early pregnancy, which may or may not be accompanied by abdominal pain. The cervical OS remains closed, and in about 80% of women presenting with these symptoms a viable pregnancy will continue.

If the products be retained, this is termed an incomplete miscarriage. Infection is a risk with incomplete miscarriage and therapeutic termination of pregnancy. The signs and symptoms of miscarriage are present, accompanied by uterine tenderness, offensive vaginal discharge and pyrexia.

 

Ectopic pregnancy

An ectopic pregnancy is a condition where a fertilized ovum implants outside the uterine cavity, often within the fallopian tube. However, implantation can also occur within the abdominal cavity, the ovary or in the cervical canal. The incidence of ectopic pregnancy is 11.1 per 1000 pregnancies

Ectopic (tubal) pregnancies present with vaginal bleeding and a sudden onset of lower abdominal pain, which is initially one sided, but spreads as blood enters the peritoneal cavity. There is referred shoulder tip pain caused by the blood irritating the diaphragm.

 

Management of vaginal bleeding in early pregnancy-

Management of vaginal bleeding in early pregnancy depends upon cause of the bleeding. As we have discussed the causes in this lecture accordingly diagnostic investigations are done and treatment is provided. This detail we will discuss during lectures of that particular problem

 

Nursing Management

Nursing care includes:

•        Maintaining airway, breathing, and circulation.

•        Assessment and recording of vital signs frequently.

•        Estimate and document the amount of vaginal bleeding.

•        Keep the woman on bed rest and provide a calm environment.

      •        Establish IV line for fluid replacement and possible blood transfusion.

•        Prepare for emergency procedures (D&C, laparotomy in case of ectopic rupture).

•        Administer medications as prescribed:

•        Analgesics for pain

•        Antibiotics to prevent infection

•        Anti-D immunoglobulin if mother is Rh-negative

       •        Monitor emotional response and provide psychological support.

•        Educate the woman and family regarding:

•        The importance of follow-up

•        Possible outcomes (continuation, miscarriage, ectopic) and

•        Warning signs: increased bleeding, severe pain, fainting, fever