Vaginal bleeding in middle to late pregnancy

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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Chapter 40 VAGINAL BLEEDING IN MIDDLE TO LATE PREGNANCY

The three main causes of vaginal bleeding in the second half of pregnancy are placenta previa, placental abruption, and preterm labor. Placenta previa is painless, whereas placental abruption and preterm labor are characterized by abdominal pain and uterine contractions.

Placenta previa occurs when the placenta is located close to or over the internal cervical os. Risk factors for placenta previa include advanced maternal age, increased parity, and prior cesarean section. The first episode of bleeding with placenta previa usually occurs at around 30 weeks of pregnancy and is usually painless.

Placental abruption is the premature separation of the placenta. Risk factors for placental abruption include prior abruption, abdominal trauma, smoking, cocaine use, multiple-fetus gestation, hypertension, preeclampsia, and thrombophilia. Placental abruption is accompanied by bleeding and pain. It occurs in about 1% of pregnancies and is associated with significant morbidity.

Preterm labor is defined by the onset of regular uterine contractions, which affect cervical change and occur before the end of the 36th week of gestation. Bloody show also is associated with labor at term.

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