Preface

Vaginal bleeding during pregnancy is an indication of abnormal pregnancy. To avoid endangering mother and fetus, a thorough examination is necessary to uncover the cause regardless the amount of blood discharged.

Reasons of antenatal bleeding

1. Abnormal placenta and uterus

• placenta previa
• low-lying placenta: most patients suffer from mild conditions, and rarely are there severe conditions.
• marginal blood vessel rupture
• early placenta separation
• Vasa previa : bleeding often occurs during delivering babies; the condition is often accompanied by low-lying placenta. 
• Uterine rupture

2. Cervix and vagina disease:

• cervix : including symptoms like erosion, polyp, and cancer
• vagina : including symptoms like trauma, varicosis, and foreign object

3. Urogenital infection
4. Hematology's disease

Bleeding signs

1. Abortion : vagina bleeding with lower abdomen pain
2. Ectopic pregnancy : Symptoms include sudden lower abdomen pain, menstrual period overdue, vagina bleeding, pale face, and fast pulse. Once there is fallopian tube rupture, patients could suffer from acute internal bleeding.
3. Molar pregnancy: during early trimesters, it is almost impossible to distinguish it from the normal pregnancy; by 7-8 weeks of the trimester, patients start to have vagina bleeding, anemia, and over distended uterus. There is no sign of fetal heartbeat but all kinds of symptoms of pregnancy.
4. Placenta previa : 7 months after the pregnancy, patients could suffer from sudden painless vaginal bleeding.
5. Early placenta separation : symptoms include vagina bleeding, acute abdomen pain, drop of blood pressure, and increase of pulse rate.

Clinical treatments

1. Abortion:

• Sign of abortion : attend to bed-rest; intake oral or intramuscular progesterone.
• Incomplete abortion : use uterine contraction agents or uterus curettage.
• Complete abortion : observation and follow-up check

2. Ectopic pregnancy : Physicians often undergo conservative observation base on patients’ condition and willingness. The method of the surgery is either laparoscopy or open-method, surgeons undergo laparoscopic salpingostomy or salpingectomy base on patients’ condition.
3. Molar pregnancy : Molar pregnancy can be treated with uterine curettage. 20% molar pregnancy will develop into malignant tumor; therefore, long-term follow-up checks are required and pregnancy should be avoided for one year.
4. Placenta previa : It can be treated base on the degree of severity, gestational weeks, and mother and fetal condition.
5. Early placenta separation: For mild or uncertain cases, doctors often ask patients to attend to plenty of bed-rest, to stay calm, and to be supervised under careful observation. Immediate delivery is recommended when patients are diagnosed of early placenta separation.