The problem of obstetric hemorrhage can be attributed to a kind of eternal problem that is defined by a high rate of maternal morbidity and reproductive losses, which can be a cause of bleeding during pregnancy. If the medical facility on assistance for bleeding resolved, it says about the level of training and the level of provision of skilled care in maternity homes.

If pregnancy in women uncomplicated, from the genital tract secretions should not be pathological. Bleeding during pregnancy is a threatening condition, as it can lead not only to abortion, as well as cause of maternal mortality in the profuse blood loss. Timely provision of specialized care is the key to successful development of pregnancy.

The consequences of improper placental

In the uterus the placenta may be attached to the uterine wall is wrong, that is located in the lower uterine segment and covers the internal os. This pathological condition was called placenta previa. Bleeding develops almost every third case, if the placenta is attached atypical location. If we evaluate the percentage of clinical cases of calculating the total number of births, the presentation occurs at 0, 8%. Despite the relatively low frequency, a high percentage of maternal morbidity.

You can not point to any clear evidence about the cause of previa. There is the effect of a large number of factors that can be divided into the causes of maternal and fruit. On the part of the mother's body causes are:

• transferred inflammation with damage to several layers of the uterine wall (endomyometritis). In a separate group include inflammation in the early period after delivery (septic complications)
• surgery (diagnostic and therapeutic procedures, separate scraping, husking myoma node, caesarean section, etc.)
• malformations of the uterus
• various kidney diseases, metabolic, cardiovascular system, which lead to angiopathies. Fact vascular disorders has an important place among the possible causes of

If we evaluate the features of the ovum, the abnormal attachment of the placenta to cause changes in the enzymatic properties of the trophoblast when it appears later proteolytic activity. For this reason, nidation of the ovum occurs in the lower parts of the uterus, which receives its development chorionic villi. When sprouting chorionic it overlaps the internal os.

As a screening method is used ultrasound scanning to be conducted in a timely pregnancy. Clarification chorion and placenta localization allows for the prevention of bleeding if diagnosed placenta previa. Screening should be carried out in the ninth week in a period of 16-24 and 32-36 weeks of pregnancy. In the future, everything is determined by the current clinical situation, so the doctor prescribes for every pregnant woman ultrasound indicated.

The main clinical symptom previa is vaginal bleeding, which has a number of characteristics. The most intense structural changes occur in the uterine segment pregnancy 28-30 weeks, so during this period often develops bleeding. The intensity of bleeding is determined by the extent to which the placenta covers the internal os.

In the case of a complete previa bleeding episodes observed since the second trimester, gradually acquiring more intense. Until now, there is a misconception among pregnant that spotting is normal during pregnancy, so they do not turn in a timely manner to the gynecologist. Late treatment of women going to the doctor progression of pathological changes, repeated episodes of bleeding while pregnant increases anemizatsiya and her condition worsens. Even when a scant vaginal discharge should immediately seek specialized help.

The most dangerous symptom is the lack of pain during bleeding. Bleeding occurs on the background of the general welfare and well-being. Outside the study of the body of the uterus and is painless, the uterus is in a normal tone. The presence of such a "painless bleeding" should alert the clinician to plan the possible presence of a pregnant placenta previa, to be able to promptly take the necessary measures to provide immediate assistance. Pregnant, which reveals presentation, should be informed that she is at risk for the development of bleeding.

Structure of bleeding in early pregnancy

One of the most common causes of bleeding during pregnancy is a spontaneous miscarriage. Termination of pregnancy may depend on the presence of disturbances in women at different levels - heart disease, acute and chronic infections, infantilism, hormonal disorders Hormonal disorders: causes and the most frequent disease   and other reasons, including the pathology of the ovum. There is a complex or group of factors that can be divided into predisposing and resolutions. Factors predisposing the group contribute to abortion, causing changes or death of the embryo, and permitting - lead to a reflex contraction of the uterus, with the death of the embryo occurs in the result of the chorionic detachment.

There is implanted ovum atypical location in the uterus, and in the cervical canal. Since by the anatomical and functional characteristics of the neck can not perform the function plodovmestilischa, such pregnancy is interrupted in the early stages (after six weeks). A characteristic feature of bleeding in this disease is that it is sufficiently intense, scarlet, blood flows from the genital tract trickle. Such heavy bleeding can be stopped only by surgery, so as a method of treatment should be chosen operational method, ie, the operation in the amount of hysterectomy. With the purpose of use of hemostatic tamponade neck, but it is allowed only at the stage of preoperative preparation.

The source of bleeding in early pregnancy may be molar pregnancy. There is a structural degeneration of chorionic villi, and they turn into grozdevidnye education, consisting of fluid-filled bubbles. In this case, the death of the embryo occurs. Clinically it is manifested by bleeding from the genital tract, which often develops in pregnancy 8-12 weeks. The bleeding is not abundant, it is moderate and repeated at any time, while it is not accompanied by pain. In some cases, together with the blood of a pregnant depart bubbles, which largely facilitates the diagnosis.

The prognosis of this disease is unfavorable. The longer the bank will remain in the uterine cavity, the worse the prognosis. The only correct tactics is the removal of hydatidiform mole, that is emptying the uterus instrumental methods. In the future, the woman should be under medical observation and be screened. Be sure to monitor the level of human chorionic gonadotropin (assessment of the dynamics of reverse development process) and to investigate the state of the abdominal cavity with the help of radiography for timely detection of complications. The most adverse and severe complication of hydatidiform mole is horionepitelioma, which is an indication for chemotherapy.

Factors that predispose to the occurrence of obstetric hemorrhage in late pregnancy

If a woman's pregnancy proceeds without complications, then there is the preservation of a close connection of the placenta and the uterine wall. This is ensured by a number of defense mechanisms that prevent the occurrence of bleeding during pregnancy. In some cases, it may occur premature detachment of the placenta, which requires the adoption of emergency measures to provide medical assistance. This pathology is relatively rare, but its importance is determined by the character of massive bleeding, which can lead to the death of the pregnant woman.

Abruptio occurs most frequently in the case of the presence in the uterus and placenta of various inflammatory and degenerative processes, resulting in a communication failure between the wall of the uterus and placenta. This relationship can be easily broken under certain circumstances. This is facilitated by chronic endometritis, uterine fibroids with submucosal location nodes. Also predispose to placental abruption following obstetric complications:

• polyhydramnios
• twins
• large fruit
• preeclampsia

Excessive stretching of the uterus, which occurs in the case of the development of polyhydramnios, multiple pregnancy or when large amounts of the fetus, leading to a thinning of its walls, increasing the surface of the placental site, thinning of the placenta, so this is a factor predisposing to its premature detachment. The greatest attention should be paid in the event that develops such complications as preeclampsia. There are changes on the part of the vascular system, especially relates to a complex of uteroplacental vessels. The changes affect blood vessels, which become fragile, brittle and lead to the development of hemorrhage and placental abruption Placental abruption - why is it so dangerous to a woman's life? . The most probable risk are pregnant women with long-standing preeclampsia, fetal malnutrition or accompanied by a rapid increase in the severity of preeclampsia. These changes occur in a woman's body as diabetes mellitus Diabetes , Chronic infections, diseases from the blood vessels. It is believed that the bleeding with placental abruption in young, healthy and primigravidae can be explained by an immunological crisis - immune conflict between parent and fruit tissues, resulting in the development of rejection.

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