Antepartum hemorrhage refers to vaginal bleeding that occurs after 28 weeks of pregnancy. Pregnant women are prone to antepartum hemorrhage due to trauma, excessive induction of labor, dystocia, previous uterine surgery, multiple pregnancies, polyhydramnios, malpresentation, and so on. In addition, the following conditions in pregnant women themselves are also likely to lead to antepartum hemorrhage: vaginal diseases, such as vaginal trauma, varicose vein rupture; abnormal conditions of the placenta and uterus, such as uterine rupture, cervical erosion or tumor; blood diseases, and so on. The most common cause is placental abruption and placenta previa. A normal placenta should be attached to the upper body of the uterus. If it is attached to the lower segment of the uterus or directly covers the internal os of the cervix, it is called placenta previa. When the uterus contracts irregularly in the late stage of pregnancy or the lower segment of the uterus dilates during labor, the placenta covering the internal os of the cervix can separate from the uterus, causing bleeding. Placenta previa is common in women with multiple abortions, endometritis, or atrophic lesions, and the bleeding is painless. Pregnant women often have no symptoms or only mild lumbar pain or a feeling of descent. Vaginal bleeding can be recurrent, multiple, and in small amounts, causing severe anemia in pregnant women, or it can be a massive hemorrhage, causing the pregnant woman to go into shock. If not treated in time, it can lead to maternal and fetal death.
For antepartum hemorrhage caused by these two diseases, regardless of the amount of bleeding, it is necessary to seek medical attention promptly. Otherwise, it can lead to intrauterine fetal distress and even intrauterine fetal death, and can also cause coagulation dysfunction leading to difficultly controlled postpartum hemorrhage, and induce acute renal failure and other pathological changes.
Vaginal bleeding in the late pregnancy, whether accompanied by abdominal pain or not, regardless of the cause, is an adverse phenomenon. If not treated promptly and allowed to continue to develop, the consequences will be very serious. Therefore, when vaginal bleeding in the late pregnancy is found, it should be given high attention and should not be taken lightly, otherwise, it may be too late to regret.
Placenta previa (placenta prevail) is one of the main causes of antepartum hemorrhage in the late pregnancy. It refers to the placenta attaching to the lower segment of the uterus or covering the internal os of the cervix, and its position is lower than that of the fetus. In recent years, with the development of ultrasound technology, it has been found that the majority of placenta that is located lower in the middle of pregnancy rises to a normal position in the late pregnancy. Therefore, most scholars believe that after 28 weeks of pregnancy, only those with abnormal placental implantation confirmed by ultrasound, vaginal examination, cesarean section, or vaginal delivery can be diagnosed as placenta previa. Patients with hemorrhage in the middle of pregnancy, although ultrasound has found abnormal placental position, are still diagnosed as late abortion, and its etiology may be related to abnormal placental position. Modern ultrasound finds more abnormal placental positions in the middle of pregnancy than in the late pregnancy, so attention should be paid to the existence of placenta previa when induced labor is performed. The incidence of placenta previa is 1 in 200 pregnancies, with an incidence rate of 0.26% to 0.9% in foreign countries and 0.24% to 1.57% in China.
Antepartum hemorrhage is an obstetric emergency. If not treated or treated promptly, the consequences can be serious, often threatening the lives of both mother and child. There are many causes of antepartum hemorrhage, and the most common ones that affect mother and child the most are placenta previa and placental abruption.
1. What are the causes of antepartum hemorrhage
The most common cause is placental abruption and placenta previa. The etiology of placenta previa is not yet clear and may be related to the following factors:
1, Endometrial lesions and maldevelopment: According to statistics, 85-95% are multiparous women, such as induced abortion, cesarean section, multiple pregnancy, or endometrial infection, etc., which lead to incomplete development of the decidua vessels in the uterus;
2, Delayed development of the fertilized egg;
3, Abnormal placental development: such as multiple pregnancy, local or systemic malnutrition, accessory placenta, or membranous placenta, etc.;
4, Abnormal uterine cavity morphology;
5, Other: Some believe that smoking and drug abuse can cause placental blood flow reduction and hypoxia, leading to compensatory enlargement.
4. How to prevent antepartum hemorrhage?
In recent years, active expectant management and timely cesarean section have significantly reduced the mortality rates of pregnant and postpartum women and perinatal infants.
1. Active expectant management:When it does not affect the safety of the pregnant woman's life, try to make the fetus reach maturity. During the waiting period, various effective treatments for the mother and close monitoring of the fetus are required.
(1) Bed rest and left lateral position: Placenta previa has the potential for bleeding at any time, so hospital observation is required. During the bleeding period, absolute bed rest is necessary; after hemostasis, only slight activity is allowed. The left lateral position can reduce the pressure of the enlarged uterus on the inferior vena cava, improving the uteroplacental blood circulation. Pregnant women should maintain mental calmness and may be given appropriate sedatives.
(2) Avoid local irritation: Those suspected of having placenta previa should be prohibited from sexual activity and vaginal examination. B-ultrasound examination should be performed first, and vaginal examination may be considered if necessary. During the examination, a speculum is generally used. Exposure and observation are carried out to exclude cervical and vaginal wall diseases. If it is necessary to perform an internal os examination, fluid replacement, blood matching, and preparedness for cesarean section are required, and it should be performed by an experienced physician.
(3) Oxygen therapy, correction of anemia: Pregnant women with placenta previa have varying degrees of anemia. The placenta is attached to the lower segment of the uterus or the placenta is thin with a large implantation area, resulting in poor blood circulation. Intermittent oxygen therapy can increase the blood oxygen concentration of both the mother and the fetus. In addition to a diet rich in nutrition for pregnant women with mild anemia,补血 drugs should be administered. Pregnant women with moderate to severe anemia require multiple blood transfusions.
(4) Oxytocin inhibitors: Bleeding from placenta previa is due to the stretching of the lower uterine segment and misalignment with the attached placenta, which becomes more apparent during uterine contractions. Therefore, during the bleeding period, the use of oxytocin inhibitors can effectively reduce bleeding and extend the gestational period.
2. Timing for termination of pregnancy:The following situations should consider terminating the pregnancy.
(1) Those who have the condition to perform fetal lung maturity testing can consider terminating the pregnancy once the fetal lungs are mature;
(2) Those who cannot undergo fetal lung maturity testing, as the fetus is basically mature after 35 weeks of pregnancy, can also terminate the pregnancy;
(3) Repeated bleeding leading to anemia and shock in pregnant women.
6. Dietary taboos for prepartum hemorrhage patients
1. Excessive bleeding in prepartum hemorrhage patients can lead to anemia, so attention should be paid to supplement protein and iron-rich foods, such as animal proteins such as milk, eggs, lean meat, pork liver, kidneys, heart, gastrointestinal tract, and seaweed, purple kelp, soybeans, spinach, celery, rapeseed, tomatoes, apricots, jujubes, and oranges, which are rich in iron. These foods not only contain the essential amino acids needed by the human body, but also contain abundant vitamin A, B1, B2, B12, and other vitamins.
2. Avoid overeating and avoid cold and spicy foods and seasonings, such as chili, pepper, scallion, garlic, ginger, and alcohol.
3. Foods to avoid include cold foods such as pear, banana, water chestnut, stone ear, stone flower, and earth ear; spicy and刺激性 foods such as cinnamon, Sichuan pepper, clove, pepper, and chili.
4. It is advisable to have a light diet, and eat more fresh fruits and vegetables rich in vitamin C, such as spinach, rapeseed, kale, tomatoes, carrots, apples, pears, bananas, oranges, hawthorn, fresh jujube, etc. These foods are not only rich in iron and copper, but also contain folic acid, vitamin C, and carotene, which have a good effect on treating anemia and assisting in hemostasis.
7. Routine methods for treating prepartum hemorrhage in Western medicine
Treatments in traditional Chinese medicine can be divided into the following five types:
1 Deficiency of Qi and Blood
Pale complexion, insufficient lactation or absence of lactation, amenorrhea, fatigue and weakness, dizziness and tinnitus, dry skin, Shengyu decoction can be used.
2 Spleen and Stomach Cold Deficiency
Yellow complexion, emaciation, lack of strength, chest tightness and abdominal distension, hidden pain in the umbilical and abdominal area, poor appetite, fear of cold, loose stools, can be used with modification of Sijunzi decoction.
3 Kidney Qi Deficiency
Insufficient lactation or complete absence after childbirth, amenorrhea, dark complexion, dull consciousness, soreness and weakness of the waist and knees, dizziness and tinnitus, Kidney Qi pill can be used.
4 Kidney Yin Deficiency
Insufficient lactation or absence of lactation after childbirth, amenorrhea, dark complexion, afternoon feverishness and red cheeks, restlessness of the five centers, night sweat, soreness and weakness of the waist and knees, or burning and dryness in the vaginal area or red urine, Six Pillars of Earth formula with modification can be used.
5 Yin Exhaustion and Yang Deficiency
If the illness persists for a long time, the condition worsens day by day, leading to dizziness and fatigue, unable to sit up, low voice, even loss of appetite, nausea and vomiting, palpitations, sweating or diarrhea, and eventually leading to coma, cold limbs, damp and cold skin, or alternating chills and fever, Shenfu decoction combined with Shengmai powder can be used.
