The Ultimate Guide to Accidental Hemorrhage: Symptoms, Causes, Diagnosis, Treatment
What is Accidental Hemorrhage?
Hemorrhage is bleeding from the site where the placenta is situated in the normal position, between or after 28 weeks of gestation and may interfere with the baby’s supply of oxygen and nutrients simply considered as an abortion. Accidental hemorrhage is divided into three varieties.
Signs & Symptoms of Accidental Hemorrhage
Bleeding may occur at various times in pregnancy. Although bleeding is seen, it may or may not be a serious problem. It is quite common to bleed in the first trimester of pregnancy. At the time of bleeding in the pregnancy, the amount of pain may vary depending on the cause. It may be due to the following reasons:
- Severe Pain in the abdomen (in the uterus) which may be localized or diffuse due to the collection of blood between placenta and uterus
- Heavy Bleeding per vagina without evident cause
- Uterus is tender, enlarged
- Height of uterus slightly increased
- Pallor is present because of internal bleeding
- Fall in BP and thready pulse
- There is no tenderness on the abdomen
- Dark vaginal bleeding results from the escape of blood from the retroplacental haematoma.
- hypovolemic shock
- Cessation of foetal movement is common.
Causes of Accidental Hemorrhage
There is no one cause of Accidental Hemorrhage, there are many factors that are responsible for the occurrence of Accidental Hemorrhage. This include
- Hypertension
- Toxemia
- Pre eclampsia
- cervical ectropion
- Retained placenta
- Placenta accreta/increta/percreta
- Uterine bleeding
- Coagulopathies
- Uterine atony
- Laceration/uterine rupture
- Placental abruption
- hypovolaemia,
- due to sudden distension of the uterus, reflex spasm of the renal vessels will occur
Risk factors of Accidental Hemorrhage
Risk factors for Accidental Hemorrhage should be identified as soon as possible to protect the health and safety of the mother and child. This includes
- Twins
- Toxemia
- Bleeding disorders
- maternal high blood pressure
- Clotting factors deficient
- uterine damage,
- uterine atony,
- coagulation failure (DIC),
- anaemia
- Complications
Complications of Accidental Hemorrhage:
Complications for the mother and baby are very high in Accidental Hemorrhage. But the cause of placental abruption is not entirely clear. The following are some of the Complications of Accidental Hemorrhage:
- Decreased oxygen to the baby, which could lead to brain damage
- fetal distress
- low birth weight of the baby
- preterm delivery
- Stillbirth
- Maternal blood loss leading to shock
- Emergency hysterectomy (surgical removal of the uterus) if the bleeding cannot be controlled
- Maternal death from severe blood loss.
Types of Accidental hemorrhage
Revealed Accidental Hemorrhage: In this, the bleeding is completely external. In Revealed hemorrhage, the patients often experience bleeding from the vagina without any noticeable signs and symptoms or just slight abdominal discomfort and tenderness over the placental site.
In revealed haemorrhage, the management is more or less straightforward. Immediate bed rest in the hospital is necessary. Sedation may be needed to allay anxiety. If the patient is already in hospital e.g. a haemorrhage in a preeclamptic confined to the hospital, oxygen may be administered during the bleeding if it happens to be a bit profuse.
Concealed Accidental Hemorrhage: In this, there is no sign of blood externally. In the Concealed hemorrhage, the patient often complains of a sudden attack of abdominal pain and at the same time feels faint and suffers from nausea.
Mixed or Combined Accidental Hemorrhage: It which shows features of both concealed and revealed. The most important among these is the concealed variety and there are four ways in which a hemorrhage may remain concealed.
- A retro placental hemorrhage occurs in the central area of the placenta, but the margins of the placenta remain adherent to the uterine wall.
- If the placenta becomes completely separated then the membranes remain attached to the uterine wall.
- The blood may come through the membranes into the amniotic sac mix with the liquor, and immersing the foetus in a blood bath.
- The blood cannot make its way past it into the vagina when the foetal head is accurately applied to the lower uterine segment.
It is much more common for blood to escape externally in spite of these mechanisms. Thus a concealed accidental haemorrhage becomes a mixed accidental haemorrhage.
Accidental Hemorrhage is a serious or potentially serious condition. There are three cases in Accidental Hemorrhage and the signs and symptoms vary in each case from the mild barely noticeable ones.
Mild case: Mild cases are those with symptoms like slight bleeding but are otherwise well. Generally, it requires no special treatment than rest. There are many cases on record of Mild Accidental Hemorrhage with temporary recovery and discharge of hospital but sometimes it will become even serious Hemorrhage at later date. If an associated toxaemia is present in this mild case if it doesn’t clear at once, the pregnancy should be terminated because of the danger of recurring Hemorrhage and worsening toxaemia.
There are no dangers in mild case other than those of actual blood loss which can be seen and restored if necessary. The possibility that the case if not treated properly may pass into the next group that is moderate. The only way to reduce foetal morality in Accidental Hemorrhage is by energetic treatment of all mild cases and should not underestimate their consequence.
Moderate cases: Moderate cases are those showing some shock or moderate external loss or internal bleeding as indicated by hyper tonicity of the uterus and abdominal tenderness. As we have already known that the abdominal tenderness indicates some degree of clotting defect.
In such a case, the patient must be admitted to hospital with all possible speed and should be treated by immediate puncture of membranes and drain of the liquor combined with blood transfusion of two or more pints.
Severe cases: Severe cases are those exhibiting Shock and a tender distended uterus of board-like consistency together with the absence of foetal heart sounds. It could be dangerous in this case and the marital deaths can occur.
Hemorrhage in the moderate and severe cases is of a particular type and requires special treatment. It is due to a clotting defect associated with a fall in blood fibrinogen. The patient may die undelivered, or after the section or more likely after section-hysterectomy. The ordinary methods of treatment are not effective and may even be harmful by causing trauma.
Medical advice for Accidental Hemorrhage
It is important to consult the doctor when there is increase bleeding when there is the pain in the abdomen when you are not feeling foetal movements. Without proper medical treatment, a severe case of Accidental Hemorrhage can have terrible consequences for the mother and her unborn child, including death. So it is very important to consult the doctor as soon as possible.
Treatment for Accidental Hemorrhage
Treatment depends on the amount of blood loss, the status of the fetus and the severity of the condition. If the fetus is less than 36 weeks and neither mother or fetus is in any distress, then they may simply be monitored in the hospital that should include regular checks of the vital signs of both mother and baby until a change in condition or fetal maturity whichever comes first. So the Patient should be referred to hospital immediately before termination of pregnancy.
In Mild cases, earlier in pregnancy, if the baby isn’t distressed and if the vaginal bleeding stops, you may be allowed to go home and rest. But regular check-ups are mandatory until your condition changes.
In Moderate cases, earlier in pregnancy – you may need to stay in the hospital until the baby is old enough for the doctor to safely induce labor. The doctor may recommend medicines to help the baby’s lungs grown-up more quickly prior to birth.
In Between Mild to moderate cases, later in pregnancy at 36 weeks’ gestation or more, the doctor may recommend delivery. A vaginal birth may be possible. But, if the placenta separates further from the wall of the uterus during labor, the doctor may immediately switch to delivery via caesarean section.
In Severe cases – immediate delivery is the safest treatment. The mother may require supportive care. Heavy maternal bleeding may be treated with a blood transfusion or emergency hysterectomy or sometimes both.
Dos and Don’ts of Accidental Hemorrhage
An Accidental Hemorrhage is a serious situation to be in irrespective of it is mild or severe. So it is important to prevent Accidental Hemorrhage because the risk can be reduced by having the basic knowledge of what exactly is to be done and what is to be avoided when experiencing Accidental Hemorrhage. The Suggestions include:
- Avoid the substances during pregnancy including cigarettes, alcohol, drugs, and medicines unless prescribed by your doctor.
- Consult with your doctor for advice and treatment to Control the high blood pressure.
- Avoid the possibility of falls by Wearing a seatbelt while traveling and.
- It is important to talk to your doctor if you have had placental abruption in a previous pregnancy.
Self-care for Accidental Hemorrhage
Any woman who gives birth can have Accidental hemorrhage which may threaten her life and the child’s life. So it’s very important to take some self-care to avoid the risk of death. This include
- Hemoglobin level should be maintained, iron supplementation, folic acid should be taken.
- Healthy diet like fruits should be taken.
- Fat-containing food should be avoided
Investigations for Accidental Hemorrhage
- Complete Blood Count
- Blood grouping and Rh typing
- Bleeding time and clotting time
- Ultrosonograph
- Ultrasound Scanning: detects normally sited placenta with a retro placental haematoma that may dissect the placental margin.
Accidental Hemorrhage FAQs
Is an Accidental Hemorrhage a serious issue?
Worldwide, Accidental Hemorrhage occurs in about one pregnancy in every 100. In about half of cases, Accidental Hemorrhage is mild and can be managed by continuous monitoring of the mother and baby. Another half percent of cases are moderate, and sometimes threaten the life of both baby and mother.
What might be the cause of Accidental Hemorrhage?
In most of the cases, doctors don’t know the exact cause of Accidental Hemorrhage. It is considered that an abnormal blood supply in the uterus or placenta may be the reason, but the actual cause of the suspected abnormality isn’t clear.
Where to get help?
If you observe any of the symptoms immediately consult to the Emergency department of your nearest hospital without delay.
Is it possible to prevent the Accidental Hemorrhage?
While it is impossible to prevent Accidental Hemorrhage, but the risk can be reduced by taking necessary self-care measures.
Can bleeding during pregnancy affect the baby?
Yes, bleeding during pregnancy may cause injury to the baby. The baby might not grow as quickly as expected, and you might have low amniotic fluid (oligohydramnios) or other complications.
Is spotting a normal issue during pregnancy?
During pregnancy, it is common to see light bleeding, or spotting, especially during the first trimester. Usually, this can cause no harm.
When does Accidental Hemorrhage occur?
Accidental Hemorrhage occurs when the placenta partially or completely separates from the inner wall of the uterus before delivery. This can cause heavy bleeding in the mother and may decrease or block the baby’s supply of oxygen and nutrients.
How the problem of heavy maternal bleeding is treated?
Heavy maternal bleeding may be treated through a blood transfusion or emergency hysterectomy or both.
How is Accidental Hemorrhage diagnosed?
The diagnosis of Accidental Hemorrhage is usually made by the symptoms and the amount of bleeding and pain. Ultrasound can also be used to show the location of the bleeding and to check the fetus.
What is abdominal trauma? How it occurs?
Abdominal trauma is an injury to the pregnant woman’s abdomen may tear the placenta from the wall of the uterus. Events that may cause this type of injury would include assault or fall, a car accident, etc.
What is uterine decompression? How it occurs?
Uterine decompression is a sudden loss of amniotic fluid from the uterus, which can suck the placenta from the uterus wall. Possible causes of uterine decompression include rupture of amniotic membranes when there is excessive amniotic fluid or the birth of the first twin (or multiple).
Does Hypertension increase the risk of bleeding during pregnancy?
Hypertension or high blood pressure increases the risk of abnormal bleeding between the placenta and the wall of the uterus. The most common causes of hypertension during pregnancy are a condition known as pre-eclampsia.