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Pregnancy and Childbirth: The answers

Bleeding in late pregnancy

 

Obstetric hemorrhage continues to wreak havoc in many parts of the world. It is estimated to be responsible for 25% of all mothers who die in childbirth. The absolute numbers are shocking with hundreds of thousands dying every year in developing countries where prenatal care is threadbare or non-existent.

 

In countries such as Afghanistan and Sierra Leone, approximately 1 woman dies per 50 live-births. This is compared to 1 per 10,000 in countries like Iceland or Austria where it is 1 per 25,000.

 

If we refer to pregnancy beyond 24 weeks of gestation as late pregnancy, then bleeding after this stage is much less common but still a significant problem.

 

We know that in the first trimester (the first 13 weeks); up to 1 in 5 of pregnant women will experience vaginal bleeding. After 24 weeks, the figure is less than 1 in 20.

 

Causes of vaginal bleeding in late pregnancy

The causes are many and varied. One important piece of statistics is that, in up to 50% of cases, the cause of the bleeding is never established.

 

Among those that are identifiable, the important causes are placenta previa, placental abruption and cervical pathology.

 

Placenta previa

 

Placenta previa simply means that the placenta is low-lying.

Normally, the placenta (afterbirth) is implanted well away from the neck of the womb. In some cases, however, the placenta is very close to and even overlying the opening of the neck of the womb (cervix). This makes it prone to bleed in the course of the pregnancy.

 

Significance of placenta previa

The degree of significance largely depends on how close it is to the cervical opening. When it is actually covering the cervical opening, it is very serious indeed and many obstetricians will admit such a patient to hospital at a certain stage of the pregnancy, to stay in for the remainder of the pregnancy. This could be done even in the absence of any bleeding.

 

The main reason for such an interventionist approach is because bleeding in major placenta previa can be quite abrupt and heavy as to endanger the lives of both mother and fetus within minutes.

Continues next page

 

 

Placenta previa

Cervix

Umbilical Cord

Placenta

Endometrium

Fetus