author:
Yang Min (Affiliated Hospital of Guilin Medical College, Guangxi)
Zhan Yaei (Guangxi Guilin City Women’s Children’s Hospital)
Liu Xiangyuan (the Third Hospital of Peking University)
Zhu Fengli (Maternal and Child Health Hospital, Mudan District, Heze City, Shandong Province)
Basic chapter
1. What is vaginal bleeding?
Answer: It is the most common symptom of female genital diseases. It refers to bleeding from any part of the genitals such as vagina, cervix, endometrium, etc. Most bleeding comes from the uterus.Except for normal menstruation, it is called vaginal bleeding.
2. What are the common causes of vaginal bleeding?
Answer: It can be divided into 7 categories:
(1) Volidation of ovarian endocrine dysfunction: Including ovulation -free and ovulation dysfunction, uterine bleeding, and follicular rupture during menstrual period causes sex hormone disorders and fluctuations, causing bleeding.① No ovulation and blood: adolescent girls and menopause women, manifestations of cyclical disorders, extended menstrual periods, and uncertain menstruation.② Ovulation and blood: Women in childbearing age, bleeding during ovulation occur in the middle of the two menstrual period, less than menstruation, and occasionally accompanied by lower abdominal pain and discomfort.
(2) Pathological pregnancy: abortion and ectopic pregnancy in early pregnancy; premature peeling and miscarriage of placenta in the middle of pregnancy; premature peeling, premature placenta, premature birth, and blood vessels and pregnancy -related disease -related diseases nourishing in the third trimesterCell tumor et al.
(3) Internal genital inflammation: vaginitis, cervicitis, endometritis, etc.;
(4) Internal genital tumors: functional tumors such as ovarian granular cell tumors, follicular membrane cell tumors; benign tumors such as uterine fibroids; malignant tumors such as vaginal cancer, cervical cancer, uterine sarcoma, endometrial cancer, etc.;
(5) Trauma and foreign objects: genital trauma, in -palace internal breds, etc.;
(6) Exogenous hormones: improper application of sex hormones;
(7) Systemic diseases: regenerative disorder anemia, leukemia, platelet reduction purpura, and severe liver function damage.
3. When vaginal hemorrhage is brown blood, sometimes blood, what is the difference?What are each prompt?
Answer: The vaginal brown, brown, coffee, soy sauce, and red excretion liquid all means bleeding.Brown indicates that the amount of bleeding is relatively small and the vaginal secretion is mixed, or old bleeding.The vaginal blood indicates that the bleeding at the time was a lot.The vagina is a long genital cavity, and a small amount of bleeding may remain. In the following days, there may be a small amount of blood.
4. What is the most important treatment after vaginal bleeding?
Answer: Find the site and cause of the bleeding and deal with it accordingly.Determine bleeding from vagina, cervix or uterine cavity?Is it aniated pregnancy, hydatidal, aura or blood disease?Gynecological examinations, ultrasound examination, blood -related endocrine, HCG and blood disease -related examinations, etc., and then take corresponding measures.
5. How to calculate vaginal bleeding?What is the case?
Answer: (1) Visual inspection method: Visual detection of blood loss is often half of the actual bleeding amount.
(2) Weight method: The total weight of gauze and sanitary napkins after use is divided by 1.05 = bleeding milliliters.
(3) Volume method: Collect vaginal hemorrhage for commonly used vessels with scale.
(4) area method: blood wet area, 10*10cm is 10ml, 1cm² is 1ml.Vaginal hemorrhage exceeds twice the amount of menstrual flow. It should be paid attention to, and more than 500 ml is major bleeding.
6. What kind of anticoagulant drugs are not prone to vaginal bleeding?
Answer: Sodium Sodium Soda.Because: (1) The molecular weight is lower than that of ordinary low molecular heparin. The lower the molecular weight, the stronger the anticoagulant factor XA activity, and the stronger the anticoagulant effect, resulting in bleeding risk less than ordinary low molecular heparin.(2) When the anticorbase III is fully utilized, increasing the concentration of sodium sodium sodium be sulfa will not increase the anticoagulation effect and it is not easy to increase the risk of bleeding.
Pregnancy
7. If vaginal bleeding during pregnancy, is it life -threatening?
Answer: Yes, you need to go to the doctor in time.
8. Will vaginal bleeding during pregnancy occur repeatedly?
Answer: Some vaginal bleeding will occur repeatedly, such as abnormal placenta positions, inflammation (including immune sterile inflammation), cervical uterine tumors, uterine are susceptible to irritability and hematological diseases.
9. Does continuous vaginal bleeding affect fetal development?
Answer: As long as the fetus is still in the palace, there is no abnormality in development. Even if the pregnant mother continues to have a small amount of medium bleeding, it will not affect the fetal development.However, a large amount of continuous bleeding may affect the growth and development of the fetus after the anemia causes anemia.
10. Can vaginal bleeding during pregnancy cause infection?Do I need to use antibiotics?
Answer: (1) If the vaginal bleeding time is too long, there is a possibility of infection. It is recommended to check the leucorrhea. According to the specific situation, use antibiotics as appropriate.
(2) Bleeding caused by vaginal mucosa injury can be cleaned with potassium permanganate, disinfected in iodophor, and take potassium oxide tablets at the same time. Pay attention to the hygiene of the perineum during treatment, wear loose cotton underwear, and change diligentlyUnderwear, boiling water, dry the sun.Do not live sex, usually eat less spicy, greasy and cold food, do not put your hands in the vagina to avoid causing gynecological inflammation.
11. What are the causes of vaginal hemorrhage in patients with recurrent abortion?
Answer: The main reason includes:
(1) A little bleeding in pregnancy is generally more likely to have physiological bleeding during the bed, followed by biochemical pregnancy, and you need to dynamically monitor HCG to judge.
(2) Insufficient progesterone levels caused by incompetence of luteal function, can not stabilize the uterus and cause bleeding.
(3) Patients with adenomy patients are high (often can make spring dreams), while the progesterone androgen antagonism is insufficient, and the uterine excitement causes the pregnancy sac to peel off and misplaced bleeding.
(4) Large uterine fibroids and submucosal uterine fibroids affect the coordination of uterine contraction, causing the gestational sac to peel off and bleed.
(5) Emotional stress causes a large number of inflammatory factors to release the release of immunity, inflammation, and coagulation network factors and bleed.
(6) The immune tolerance of the mother tire interface causes bleeding caused by immune exclusion attacks.
(7) Endometritis affects the bed and nourish the cells of the pregnant eggs and nourishes cells.
(8) Insufficient anticoagulation and excessive anticoagulant lead to bleeding;
(9) Inappropriate use of glucocorticoids lead to bleeding.
(10) vaginitis, cervicitis, cervical polyps, cervical cancer, etc. also cause vaginal bleeding.
(11) Uterine malformations, especially the most prone to vaginal bleeding during the early pregnancy of uterine inconvenience.
12. What are the most common causes of vaginal bleeding in the early stages of pregnancy?
Answer: (1) Early pregnancy vaginal bleeding: It is mainly due to insufficient progesterone levels caused by incompetence of luteal dysfunction, which cannot stabilize the uterus and cause bleeding.Essence(2) Mid -stage and late vaginal bleeding: caused by contraction, cervical lesions, front placenta, vascular front, premature placental peeling, sexual life, etc.
13. What is a physiological vaginal bleeding during pregnancy?
Answer: (1) Physiological vaginal bleeding refers to the early pregnancy stage. After the fertilized egg landed on the endometrium, it is necessary to bury into the fertile soil (endometrium). The embryo is in the uterine development process, eroding the uterine blood vessels, and the mother bodyBleeding caused by blood circulation, about 30%to 50%of all pregnant women;
(2) Most of them are brown blood, sometimes blood, most of which can continue pregnancy, a small amount of bleeding may remain, and there may be a small amount of blood stains in the following days;
(3) No need to panic, it is important to eliminate psychological panic during pregnancy.If there is no abdominal pain, the amount of bleeding is not large, the HCG increases well, and ectopic pregnancy can be excluded, you can continue to observe.
14. How to identify whether vaginal bleeding in early pregnancy is physiological bleeding, ectopic pregnancy or threatened abortion?
Answer: (1) The difficulty of identification needs to be comprehensive judgment. According to clinical manifestations, ultrasound examination, gynecological examination, blood HCG, and coagulation, etc.
(2) Brown bleeding with mild spasm and sore abdomen 6 to 12 days after pregnancy, and the three pregnancies have grown well, generally bleeding in bed (30%~ 50%of pregnant women);
(3) Extraordinary pregnancy is often manifested as a hidden pain or soreness on the lower abdomen on one side. When the tubal pregnancy abortion or rupture occurs, the lower abdomen is torn -like pain on the lower abdomen, which is often accompanied by nausea, vomiting or anal swelling.After the death of the embryo, there are often irregular vaginal bleeding, dark red or dark brown, and the amount is small. Generally, it does not exceed menstrual flow. A few patients have more vaginal bleeding, similar to menstruation.Three pregnancy growth is poor, and the blood HCG2000 or more is reminded that no pregnancy sac is seen in the palace. It is reminded that the bleeding induced by external pregnancy. Those with severe symptoms need to be hospitalized urgently. Pay attention to abdominal pain and do not use painkillers to avoid misdiagnosis delays.
(4) No tire preservation measures or inadequate fetal preservation measures are incorrect, and the three pregnancy growth is poor. Ultrasound is displayed as intrauterine pregnancy, indicating that the possibility of aura abortion.
15. Insufficient anticoagulant drugs cause vaginal bleeding caused by high gels. Why?
Answer: The pregnancy in the high -coordinated state is easy to form micro -thrombosis in the mother’s uterus, the body’s immune disorders, the lack of blood supply to the embryo, can have a miscarriage and dead tires, leading to vaginal bleeding.
16. How to identify whether the vaginal hemorrhage in the early pregnancy is caused by excessive anticoagulant drugs or insufficient anticoagulant drugs?
Answer: (1) Bleeding caused by insufficient anticoagulant drugs: often no bleeding phenomenon in other parts, small anticoagulant or small dosage, testing indicators such as D-di and thrombosis, and other indicators to indicate high condensation.
(2) If you use a larger dose of anticoagulant drugs, you can usually bleed your mouth and brush your teeth. Smoil occurs in the subcutaneous skin. Injecting needle eyes are not easy to stop bleeding, and indicators such as D-di and thrombosis are tested.Excessive anticoagulant.
17. Why should vaginal bleeding in early pregnancy be alert to ectopic pregnancy?
Answer: The incidence of ectopic pregnancy is about 1%, of which 95%occur in the fallopian tube.Because the tube wall of the fallopian tube is very thin, the blood circulation and nutrition of sufficient embryo cannot be provided, so abnormal vaginal bleeding will occur at 7 to 8 weeks of pregnancy, and even severe abdominal pain or shock due to abdominal bleeding.In the early stages of determining pregnancy, if there is no embryo in the uterus in the uterine test, it is necessary to combine the possibility of the possibility of uterine pregnancy in the blood in the blood as soon as possible, and appropriate treatment in time.
18. Can hydatidal bleeding in early pregnancy?
Answer: Portuguese tires are a benign chorionic disease, and the incidence rate is about one -thousandth.Because the placental velvet nourishing cells are abnormal hyperplasia, the end velvet is transformed into blisters, and the blisters are connected into a string.In the early stages of pregnancy, there will be symptoms such as abnormal vaginal bleeding, severe pregnancy, and even palpitations.It can often be diagnosed with ultrasound plus detection of HCG; the treatment method is to remove the hydatiditic fetus with endometrial vacuum attractiveness. The subsequent tracking of the velvetoosteroid hormone index is normal until 3 weeks in a row.Normally for half a year in a row, if the index is not ideal, it is necessary to consider using chemical drugs.During the tracking period, you must be strictly contraception, and you plan to get pregnant after 1 year.Older father and mother are less than 20 years old and more than 40 years old, and have a history of abortion, smoking, lack of carotene (carotene) and animal fat in food. There is a history of hydatidal diseases that are prone to high -risk factors.
19. Can cervical lesions also cause early pregnancy vaginal bleeding?
Answer: For early pregnancy bleeding, many people often ignore the problem of cervix.The cervix serious inflammation caused erosion, or that the cervical polyps already already had cervical polyps, which is easy to cause surface microvascular rupture due to changes in pregnancy hormones.In recent years, the most common age of cervical cancer has quietly dropped to 30 to 40 years old; so pregnancy does not mean that the cervix must be fine, and the cervical scratching should be performed regularly before and after pregnancy;It should also check whether there is a problem with the cervix.
20. How to identify vaginal bleeding in the middle and late pregnancy is caused by premature birth?
Answer: Since 4 months of pregnancy, the uterus will shrink from time to time every day for a few seconds. Medicine is called "painless contraction".However, if the frequency of uterine contraction increases, the lower abdomen has a strong sense of falling, and it has a painful feeling, vaginal bleeding, even lumbaric acid, labia pumping, etc. These are symptoms of premature birth.As long as it takes full rest and cooperates with drug treatment, in severe cases, they need to be hospitalized. Generally speaking, they can be produced smoothly until the month.Those who are too busy with work, the history of premature birth, polyphys, uterine fibroids, bipolar uterus, smoking, incorrect medication, etc. are all risk factors that cause premature birth.
21. What are the differences between vaginal bleeding during pregnancy or menstrual sensation with abdominal pain and menstrual sense?What is the difference in processing?
Answer: The possible cause of vaginal bleeding in early pregnancy with abdominal pain and menstrual sense is the endometriosis before pregnancy?Pelvic inflammatory disease?Uterine fibroids?Do not rule out ectopic pregnancy, symptomatic treatment after related examinations, strengthen luteal therapy, and anti -spasm treatment if necessary.The possible causes of machining in the early stages of vaginal bleeding in early pregnancy without abdominal pain and menstrual sense are insufficient luteal function?Portuguese tires?Vaginal inflammation?Cervical factor?Immune abnormalities?Blood disease?Captive treatment and symptomatic drugs.
22. How to identify vaginal bleeding in the middle and late pregnancy is caused by the front placenta?
Answer: Ultrasound.During normal pregnancy, the placenta is attached to the front, rear wall or top of the uterine wall. If the placenta attached to the uterus is too low, cover the inner mouth of the cervix and block the fetal first exposure, which is called the front placenta.The incidence of the front placenta is about two %. Clinically, it covers the degree of the inner area of the cervix according to the placenta, and is divided into 4 types: complete, partiality, marginity and low level.As the uterus will increase as the number of pregnancy weeks increases, the placenta position will also increase upward.Therefore, if there is still complete or partial pre -placenta after 8 months of pregnancy, the chance of vaginal bleeding is greatly increased.Because the placenta itself is very rich in blood vessels, once bleeding due to the front placenta, as if the amount of menstruation or more, most of the front placenta stops bleeding after bed rest, but some pregnant women have a large amount of bleeding as much as possible to the image.Blood collapse may even further cause uterine contraction to induce pain; this kind of bleeding may not only cause severe ischemia and hypoxia in the abdominal fetus, but the pregnant woman itself is extremely dangerous, and may even cause shock death.The mother’s uterus had old scars before, such as abortion surgery, uterine fibroids or uterine malformations, ancestral cesarean section or had undergone uterine surgery, the history of the front fetuses, and smoking, which led to the high -risk factors of the front placenta.
23. How to identify vaginal hemorrhage in the middle and late pregnancy is caused by the early placental peeling?
Answer: Under normal circumstances, the placenta is separated after the fetus is produced. Before the fetus is delivered, part of the placenta is separated from the uterine wall of the bed part, which is called early placenta stripping.Early placental stripping is a serious complication in the late pregnancy. It progress is quite fast. If the treatment is not timely, it may endanger the life of the mother and the fetus.Clinically divided into two types: hidden and outflow.The main symptoms of the early peeling of the outflow placenta are vaginal bleeding, the amount of bleeding is generally more, and the color is dark red. It will be accompanied by mild abdominal pain or abdominal pain.The hidden placenta is severe in the early stage, and most of them occur in pregnant women with severe pregnancy hypertension.Symptoms are sudden persistent abdominal pain or backache. The vagina may only have a small amount of bleeding or no bleeding at all.Once the placenta is stripped early, the fetus is at a very dangerous situation. It is necessary to stop pregnancy and quickly perform cesarean section surgery to save the life of pregnant women and fetuses.Elderly maternal, gestational diabetes, premature eclamps, external force impacts, polyphys, umbilical cords are too short, and the history of early stripping patients is the high risk factors that cause early stripping of the placenta.
24. How to distinguish vaginal bleeding and hemorrhoid bleeding during pregnancy?Answer: Hemorrhoids during pregnancy are difficult to distinguish blood from anus or uterus.Hemorrhoid bleeding often has a medical history. It usually has sedentary or constipation. It is feasible to determine the anal diagnosis. Patients should usually eat more vegetables and fruits to keep their stools smooth.
25. Will the early pregnancy maternal Games cause vaginal bleeding?
Answer: Strong exercise is possible.Before the placenta is not completely stable, a quiet life can effectively prevent the occurrence of abortion.In the early pregnancy, you can exercise under the guidance of a doctor to take good walks.
26. Will the checkup cause vaginal bleeding?
Answer: Sometimes there is bleeding after diagnosis.If it is only a small amount of bleeding and only lasts for 2 to 3 days, you don’t need to worry.Pay attention to the internal diagnosis, the doctor moves softly, and the patient takes breathing deeply to relax the whole body, which will reduce the occurrence of bleeding.
27. Does the mental stress cause a threatened abortion and vaginal bleeding?Answer: Schizophrenia rarely causes threatened abortion, because it does not hinder the fetus from obtaining nutrition from the mother.Of course, the pressure of pregnant mothers is too large, which can cause abnormal secretion of sex hormone and is not conducive to the healthy growth of the baby.
28. Is the vaginal bleeding in early pregnancy after the birth of reproduction more common than normal pregnancy?
Answer: Yes, some people have statistics that the probability of bleeding in early pregnancy (about 36%) is significantly higher than normal pregnancy (about 25%).The increase in probability of early pregnancy bleeding after artificial pregnancy may be related to the super -promoting ovulation, ovulation, luteal support, and basic factors of maternal infertility.There are many causes of bleeding. Among them, threatened abortion is the most common cause. Other causes include cervical diseases, ectopic pregnancy, infection, etc.Whether bleeding in early pregnancy prompts the risk of bad pregnancy ending risks.
29.B over test is of great significance to the diagnosis of early pregnancy bleeding?
Answer: (1) In addition to Blood β-HCG, P, E2, B-ultrasound has become a necessary auxiliary tool for bleeding and predicting pregnancy ending in early pregnancy.
(2) Early pregnancy B -ultrasound can be observed as the yolk cysts earlier, which is earlier than the germ and heart tube. It is the first place for the exchange of embryo and the maternal matter.Normal yolk is a round transparent thin wall cyst structure with a diameter of about 3 ~ 7mm.B -ultrasound found that the formal abnormalities of the yolk (lack of yolk, small, large, large, movement, floating, shrinking, calcifying, etc.) often means that the embryo is changing, and it is the earliest ultrasound manifestation of the end of bad pregnancy ending.But it is not absolute.
30. What preparations should be made in advance to prevent the vaginal bleeding during pregnancy?
Answer: (1) Generally comprehensive examination of pre -pregnancy, including body test, gynecological examination, and blood examination, etc., as much as possible to treat the primary disease as much as possible;
(2) Before pregnancy, do a good job of blood type, anti -A, anti -B, AB antibody (pregnant women are type O blood, husbands A, B or AB blood), irregular antibody (anti -red blood cell antibody) test: if there are irregular antibodiesIt may cause blood transfusion reactions, severe cases of hemolytic blood transfusion, and endangering patient life.The increase in anti -A, anti -B and anti -AB antibodies may cause newborns to develop hemolytic disease, affecting the development of newborns’ organs and intellectual development. In severe cases, it will endanger the safety of newborn life.
(3) Ultrasonic understanding of pregnancy after pregnancy, regular specialty examination;
(4) Avoid mental stimulation, excessive volatility, fatigue, sexual intercourse, trauma and bumps.
31. What are the commonly used hemostatic drugs for the treatment of vaginal bleeding during pregnancy?Do you need to prepare more regularly during pregnancy?
Answer: Generally not needed.The commonly used hemostatic drugs for the treatment of vaginal hemorrhage during pregnancy include: hemostatic, aminic acid, and aminopine.These drug hospitals will be available. As long as you check regularly, you can go to the hospital in time as soon as there are abnormal conditions.Don’t worry too much.Pregnant mothers with a history of adverse pregnancy can usually use some drugs that have hemostasis, such as vitamin C and Anluo blood. If they are too late to go to the hospital, they can be taken temporarily.
32. If vaginal bleeding during pregnancy, can it be blocked by blocking vagina?
Answer: No.It is recommended to see the doctor urgently, find out the cause, treat the cause, and treat them with symptomatic treatment.
33. If it is an anticoagulant aspirin and low -molecular heparin bleeding, is it first reduced or discontinued aspirin or low molecular heparin?
Answer: Aspirin has the function of aggregation of antiplatelets. Low molecular heparin has the effect of anticoagulantase. Both prevent thrombosis. If anticoagulant is excessive, aspirin should be discontinued first, and then according to the results of the hematic test, discontinued or reduced volume reductionSpecific drugs such as heparin.How long to stop can be used, which is also analyzed based on the changes in the condition and the history of adverse medical history and various test results.
34. Do patients with immune adequate pregnancy patients permanently discontinued anticoagulant drugs once they have vaginal bleeding during pregnancy?
Answer: No.
(1) If the amount of bleeding is not large, reduce the dose or extend the interval between anticoagulant drugs;
(2) If the amount of bleeding is large, it can be suspended for 1 day to several days. After the bleeding is not added, the dose can be appropriately reduced. At the same time, vitamin C orally.
(3) If the patient exists, the disease of anticoagulant such as anticoagulant, such as anti -phospholipid syndrome, can cause tire stop and abortion once permanently.
35. What should I do if vaginal bleeding in the early pregnancy?Answer: (1) Early pregnancy mothers find vaginal bleeding, which is easy to panic and anxiety. Worried about "will it be abortion?", First, do not panic and cope with pregnant women and family members.
(2) There are many causes of bleeding. It is difficult to judge the cause and severity according to the color and amount of bleeding.You should go to the hospital for diagnosis in time; if the vaginal bleeding of pregnant women is very serious, or with drama pain, you cannot go to the emergency medical treatment immediately, and you can call the 120 emergency call.
(3) Compared with unatient pregnancy, the intrauterine cavity of pregnancy is in a congested state, which will cause bleeding due to internal diagnosis and intercourse. It often stops within 1 to 2 days without worry.
(4) Vaginitis caused by microorganisms can also mix blood in excrement. In order to infect the fetus during childbirth, it should be treated in time.
(5) Usually, some drugs that can stop bleeding such as vitamin C and Anluo blood can usually be used. If it is not time to go to the hospital, you can take it temporarily.
36. Premature abortion during pregnancy, why is it best to choose to recuperate?Answer: (1) No matter which type of vaginal bleeding is selected, it is the most basic at home or hospitalization, and it takes 4 to 5 days.Especially if vaginal bleeding is continuous, you can’t do housework at all.If the bleeding is eased, the minimum housework allows it.
(2) If there are too many patients, the blood pressure may increase, the local cycle volume is large, it is difficult to form blood scabs, or the newly formed blood scab may fall off, resulting in continuous bleeding.
37. What about vaginal bleeding during anticoagulation during anticoagulation during recurrent abortion?
Answer: (1) Not nervous (prevent blood pressure from increasing blood pressure, aggravate bleeding), if it is an embryonic bed or a small amount of bleeding when the endometrium falls off, it is brown blood, which may not be harmful.No treatment or oral vitamin C 0.2g, 3 times a day.
(2) If a large amount of bleeding after the bed, consider more harmful bleeding, two cases should be considered: (A) Excessive anticoagulant drugs: add 0.4g of vitamin C tables 3 times a day to reduce the dosage and low dose and low of aspirin per dayThe number of times of molecular heparin, if there is a lower abdomen or other discomfort, add 80 mg muscle injection, 2 times a day, or 200ml of 200mg+physiological saline, VD, if the bleeding is still more than the bleeding or the amount of bleeding is equivalent to the same as that of the bleeding amount is equivalent to the same as that of the bleeding amount is equivalent to the same as that of the hemorrhage.When menstrual flow, heparin and aspirin are suspended. At the same time, adding hematopoietic amino amino amino ammonia tolitic acid 0.3g+5%glucose 250ml or 0.9%sodium chloride 250ml+VC 3G, VD, once a day;The number of molecular heparin and may increase the dose of aspirin and increase the dose of aspirin.
38. Excessive injection of low molecular heparin causes a lot of vaginal bleeding. Can fishy protein neutralize?
Answer: (1) The bleeding caused by excessive heparin and hypomatte heparin can be neutralized with fishy protein, but it is rarely used clinically. It may be that their half -life is short.Can achieve the purpose of hemostasis.
(2) If the low -molecular heparin is injected for more than 12 hours last time, there is no need to inject fish essence protein.
(3) If general hemostatic measures are invalid, fish essence treatment is also a choice.If the last time is injected within 8 hours, the low molecular heparin 100IU needs to use 1 mg of fish essence. If the last time is injected more than 8 hours or the needle is needed to be injected again, the low molecular heparin 100IU requires 0.5 mg of fish essence protein.
39. How to deal with intrauterine blood accumulation (undercurry bleeding) during subcutaneous heparin?
Answer: (1) Analyze the causes of undercurricular hemorrhage: excessive anticoagulant drugs, immune abnormalities (TH1/TH2 cytokine imbalance, increased attackers in the mother tire interface, vasculitis), vascular reshaping, hypertrophic and ischemiaPour again;
(2) Determine the severity of bleeding, and the following situations are prompting more serious: the bleeding site is at the placenta attached part (near the umbilical cord) and the bottom of the palace, and the bleeding area exceeds 1/3 of the area of the gestational sac.Fighting.
(3) Adjust the dosage and intervals of low molecular heparin according to the cause and severity, and increase progesterone, vitamin C, intercopylphenol or atoro, glucocorticoids, cyclosporium, and immunoglobulin.
40. What should I do if I use aspirin and hypothermal heparin treatment during pregnancy. What should I do?
Answer: (1) If the vagina bleeds a small amount, anticoagulant drugs can be reduced, generally reduce aspirin first, and then reduce the dose of low molecular heparin;
(2) If the amount of bleeding is large, it can be temporarily stopped for 1 to 2 days of aspirin and low -molecular heparin, and then recover, but the recovery dose is less than the original;
(3) Can be used to use progesterone and vitamin C. If the curative effect is not good, it can be used with a phenylphenol 80 ~ 200 mg, muscle injection or venous.
41. How to deal with vaginal bleeding during pregnancy after auxiliary reproductive transplants?
Answer: (1) First of all, it is necessary to clarify the bleeding site and cause. The vaginal bleeding caused by cervical polyps can be temporarily observed, and the second trimester can be removed. Those with vaginal inflammation should be treated with anti -inflammatory treatment.If it is an intrauterine bleeding, the next step is determined by the combination of B-ultrasound combined with the blood β-HCG value.In the treatment, embryos are likely to survive, and the changes in the culminated structure should be considered or inevitably aborted by embryos, and it is not advisable to protect the fetus blindly.
(2) Improve relevant examinations, give individual chemotherapy for different causes, such as combined with infected infection; autoimmune disorders can use glucocorticoids, hydroxyl chlorine, cingling, biological agents, immunoglobulin, etc.Use aspirin, Boliwei, low molecular heparin, etc.; Patients with luteal dysfunction replenish progesterone.
(3) Symptoms such as antispasmids and (or) hemostasis, blood transfusion treatment if necessary.
42. How to reduce the adverse effects of vaginal bleeding in the late pregnancy?
Answer: In order to reduce the impact of prenatal bleeding on maternal and infants in the end of pregnancy, effective measures should be taken clinically for intervention, mainly including:
(1) To strengthen prenatal examinations before 24 weeks of pregnancy, do a good B -ultrasound imaging examination, and observe whether the danger of pre -placenta and premature placenta peeling.At the same time, the maternal maternal is urged to pay attention to maintaining relaxed, pleasant and good sleep during the examination, and can give the pregnant woman an appropriate amount of contraction drugs in accordance with the doctor’s advice.
(2) Guide pregnant women regularly during pregnancy and various prenatal examinations in order to make corresponding adjustments in time. When no clinical bleeding or other symptoms of abnormalities occur, the gestational week should be extended as much as possible to create good creation for the growth of the fetus to grow well.Conditions to avoid ending pregnancy in advance.
(3) If a large number of or continuous bleeding occurs during the pregnancy of pregnant women, regardless of whether the fetus is mature, medical staff should immediately terminate pregnancy.
(4) For premature pregnancy in placenta, medical staff must strengthen observation of maternal and fetal life signs and deal with it in time to improve the quality of survival of maternal and fetus.For maternal women who have the prefix of the umbilical blood vessels, the nursing staff should be vigilant and at the same time properly relax the indicator of cesarean section. Once vaginal bleeding and sharp fetal heart changes occur, they should immediately ask pediatricians with rich clinical experience to consult.Obstetricians performed cesarean section to ensure that the mother and fetus were safe.
43. What should I do if I use a variety of hemostatic drugs (hemostasis sensitivity, aminophytic acid, simple picanol, etc.).
Answer: (1) Find the reason further. Which links are there, the problem is there, and the coagulation system?Fiber -soluble system?Anticoagulant system?Vascular endothelial?Smart and nervous?blood pressure?
(2) Combined with multiple hemostatic drugs;
(3) Calcium glucose supplement, because calcium ions are also an important part of the coagulation system.
44. Why are some vaginal bleeding during pregnancy?
Answer: This is because these vaginal bleeding may be due to the high -coordinated state, micro thrombus and infarction stoves of the placenta and its accessories occur, which induce bleeding. When the low -molecular heparin is used, the blood flow is smooth, and the bleeding will end naturally.Similar to the blocked river, the water no longer overflows after cleaning the river.
45. If the vaginal bleeding during pregnancy, can it be transformed?
Answer: (1) According to the patient’s general situation, vital signs, blood routine, primary disease, etc., decide whether to transfish blood transfusion;
(2) Generally, if the hemoglobin is below 70g/L, it needs to be transfused; the hemoglobin is 70 ~ 90g/L, and the consumer supplement and oral or venous iron; the hemoglobin is above 90g/L or more, the general oral medicine can be.
(3) Of course, according to the patient’s severe hemorrhage and the symptoms of the severe occurrence of major bleeding. If you have severe bleeding in the short term, and have severe dizziness, fatigue, and palpitations, even if the hemoglobin is higher, blood transfusion is still needed.
(4) Checking blood type, hepatitis A, hepatitis B, syphilis, and AIDS before blood transfusion.
46. Systemic lupus erythematosus Pregnant women’s vaginal bleeding during pregnancy. Can blood transfusion?
Answer: Yes, but patients with systemic lupus erythematosus have a large number of antibodies in their body. In order to prevent immunohistic hemolysis, it is best to infuse and wash red blood cells.
47. How to deal with blood vaginal bleeding during pregnancy?
Answer: (1) Finding the cause: The pregnancy itself is caused by the drug factors or the autoimmune disease.
(2) Deal according to the cause, if it is caused by autoimmune diseases, glucocorticoids and immunoglobulin can be used;
(3) Symptoms: You can infuse platelets and fresh frozen plasma according to the condition.
48. What are the daily precautions for pregnant women with vaginal bleeding during pregnancy?
Answer: (1) Reduce anxiety, pay attention to rest, emotional stability, sufficient sleep, spiritual pleasure, prohibit housework, can not engage in heavy labor, do not do too much bending work, avoid hitting the abdomen, do not mention heavy objects.Wearing tight clothes, no chest, no high heels, keep the vulva clean, do not take a bath;
(2) Do a good job of pregnancy check, timely understand the fetal development, and deal with abnormal performance in a timely manner.
(3) Light diet, avoid stimulating foods such as pepper, fried, and thick coffee.
(4) Eat more iron -containing foods: pork liver, lean meat, poultry, pig blood, duck blood, egg yolk, red dates;
(5) Eat more foods containing vitamin C: The vitamin C content of leafy vegetables is more than the rhizomes, and the vitamin C content of acid -flavored fruits is more than the acid -free fruits.Vegetables containing more vitamin C include chili, tomatoes, rapeseed, cabbage, cauliflower and mustard.The cooking method of vegetables is fast and fry, and add some starch to thicken or add some vinegar to cook to reduce the loss of vitamin C.Fruits contain more vitamin C are cherry, pomegranate, citrus, lemon, grapefruit and strawberry.Some wild vegetables and wild fruits such as amaranth, pear, sea buckthorn and jujube are rich in content.Bioflavonoids in fruits such as jujube and pear can also protect the stability of vitamin C in food.
(6) Traditional Chinese Medicine Perspective: Anemia caused by blood plates and insufficient blood can be used.Water, stewed with a tiny fire until the trotters are rotten, seasoning and food therapy; Ejiao glutinous rice porridge can nourish yin and nourish the deficiency, stop bleeding and nourish blood, use Ejiao 20 ~ 30g, glutinous rice 100g, 15g of brown sugar, wash the glutinous rice, put it in the pot and add it to the potBoil the water. When the porridge is cooked, add the mashed Ejiao, stir well while cooking, and add brown sugar to eat.
49. What are the best ways to take vaginal bleeding during pregnancy?
Answer: For patients with dangerous lower limb thrombosis, they should take the left side position. Pay attention to avoid supine positions after the third trimester, and try to lie on the left side as much as possible.
50. Can vaginal bleeding during pregnancy be detected by vaginal ultrasound to predict the ending of pregnancy?
Answer: (1) Early pregnancy, vaginal bleeding is an important clinical manifestation of threatened abortion. Clinically hopes to understand whether the embryo survives and prognosis.Early ultrasound that the contents of the gestational sac can be observed in the early stages of the yolk sac, which is earlier than the germ and embryo blood vessels for 3 to 7 days.
(2) Extracting amplifier is often the ultrasonic expression of the earliest of embryos and the earliest ultrasonic performance of poor pregnancy ending.In the early pregnancy, due to the important role in the transportation of the mother fetus material, the abnormal changes in the yolk cysts can reflect the obstacles of the transportation process, which can affect the development of the embryo, leading to abortion and fetal malformations.
(3) The frequency of vaginal ultrasound probe is high, short wavelength, and strong resolution, and is close to target targets. It overcomes the influence of abdominal ultrasound due to abdominal wall fat, intestinal gas, and uterine position.The image is clear, which is observed earlier than the abdominal ultrasound early, and the measurement value is more reliable.
(4) Normal yolk sac is a good sign of pre -pregnancy. It can indicate the possibility of embryonic survival and normal development. Even if a small number of vaginal bleeding symptoms appear in a small amount of vaginal bleeding, the pregnancy ending is still good.Extremely abnormal yolk, especially when the yolk sac is lacking, should consider the possibility of bad pregnancy ending, and should not be blindly protected at this time.Vaginal ultrasound testing is a better means for those who predict the end of pregnancy in early pregnancy bleeding.
51. Is the in vitro fertilized embryo transplantation assisted in the early pregnancy and whether the uterine cavity accumulation occurs in the early pregnancy.
Answer: (1) Some studies have shown that in vitro fertilized embryo transplantation, compared with women with normal pregnancy, complications of pregnancy complications have significantly increased compared with women with normal pregnancy.The high level of antibody may be one of the causes of blood accumulation that causes complications during pregnancy.
(2) The accumulation of uterine cavity may be related to the abnormal implantation of the nourishing layer cells. It is an early imaging signs of the placental bed.The accumulation of uterine cavity causes complications during pregnancy by affecting the endometrium of nourishing layer cells.
(3) Placental accumulation of blood accumulation, post -uterine bloodstream blood, uterine angle or bottom chori membrane blood accumulation and continuous blood accumulation may increase the risk of complications during pregnancy.The volume of the accumulation of uterine cavity and the impact of pregnancy age when diagnosis of blood accumulation on pregnancy ending is still controversial.Different volume and reference standards used in different studies may be one of the reasons for controversy.
references:
1. Li Qing, Zhu Jin. Paimoline bloody pregnant women’s pregnancy ending analysis [J]. Chinese Medical Journal, 2016, 96 (17): 1383-1385.
2. Tang Wencheng, Li Weiping, Ruan Jianmin. Study on the correlation between the eloquent echins in the early pregnancy and the end of pregnancy [J]. Anhui Medicine, 2010,31 (10): 1220-1221.
3. Lu Jinwen, Yang Jing. In vitro fertilization-The cause of vaginal hemorrhage and clinical turn of vaginal hemorrhage after transplantation [J]. Journal of Wuhan University (Medical Version), 2009,30 (5): 660-662.
4. Zhang Yudi, Yu Song, Lu Dan. Effects of Early chori blood hematoma on pregnancy ending [J]. Clinical and pathological magazine, 2016, 36 (5): 601-605
5. Li Yiguo. Early pregnancy vaginal bleeding and duration of the impact on the ending of pregnancy [J]. Modern obstetrics and gynecology progress, 2014, 23 (2): 157-160
6. Wu Haiying, Shen Ying. In the early pregnancy, the clinical observation of the pregnancy end of the uterine hematoma pregnancy [J]. Hebei Medicine, 2016, 22 (3): 479-481.
Gratitude
After the Spring Festival in 2020, we successively launched a series of "Immune Advocated Pregnancy Answers" and "Discussion on Immunohistically Bad pregnancy".Doctors, experts, and professors (see the following list) who modify and supplement and supplement show deep gratitude!
As we all know, the diagnosis and treatment of poor recurrence of pregnancy involves a wide range of diagnosis and treatment. It is not completely covered by any medical profession. Each medical doctor’s view and opinions are not the same, even the opposite, and the majority of friends are even more very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very very likeConfusion, anxiety, pain, and even despair, at a loss.To this end, we have collected issues that do dozens of patients’ education meeting, and those who often mention or pay more attention to patients are often mentioned, and they organize doctors, high -age doctors, experts, and professors of the corresponding majors in the country to ask questions about keywords.Methods made detailed and objective answers, hoping to help the smooth pregnancy and childbirth of every pregnant mother with bad pregnancy!
It is worth noting that the special content of the series of "Immune Pasta pregnancy and doubt" is that every medical worker is summarized by reviewing the literature and materials at home and abroad, and combined with its own clinical practice. It is not necessarily suitable for all patients.Each patient should comprehensively analyze and judge based on their own situation, and these materials are for reference only!
Of course, in the process of writing, editing, modifying, and supplementation, there must still be a lot of omissions and errors. I hope that the majority of readers will criticize and correct that we will correct it when publishing books. Thank you!
Liu Xiangyuan and his team
2020-4-29
List of PhDs, doctors, experts and professors
(Published on the Internet, sorted according to the provincial and municipal and surname pinyin)
