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in: Algorithmic T reatment Methods in Obstetrics And Gynecology & Nutrition In Lactation, Muhammet Serhat Yıldız, Editor, Bayrak Yayınları, İstanbul, pp.83-91, 2022
Vaginal bleeding during pregnancy is often seen in all periods of pregnancy and usually has maternal / placental origin, but bleeding from the fetus is rare. Vaginal bleeding during pregnancy is frequently seen in the first trimester, and first trimester bleeding has been evaluated under a separate heading. The term antepartum bleeding refers to vaginal bleeding that typically occurs after the 20th gestational week. Although antepartum hemorrhages are less common compared to first trimester bleeding, serious bleeding that threatens fetal and maternal life can occur. In the approach to antepartum hemorrhages, the most important points are the patient’s hemodynamic state (whether it is stable or not), the gestational age and the character of the bleeding (mild or severe bleeding, pain-related or painless bleeding, intermittent or continuous bleeding). In pregnant women with severe bleeding, rapid intravascular volume loss may cause hemodynamic instability, decreased oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and death. The main causes of antepartum hemorrhages are ablatio placenta, placenta previa and uterine rupture. These bleedings are generally of placental / maternal origin. In vasa previa, which is less common, fetal bleeding may occur. Other causes of vaginal bleeding include cervical dilatation bleeding due to labor, cervical pathologies (e.g. cervical polyp, ectropion, infection, tumor), vaginal lacerations and trauma.