http___www.klokanica.hr_trudnoca_trudnica_implantacijsko-krvarenje-ili-znak-rizicne-trudnoce-1204_1.xml
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Normal pregnancy: A normal pregnancy occurs when a fertilized egg implants itself inside of the uterus. The fertilized egg continues to grow developing into a fetus. Ectopic pregnancy: An ectopic pregnancy happens when a fertilized egg implants itself outside of the uterus. An ectopic pregnancy can occur in the ovary, abdomen, cervix or fallopian tube, but more than 95% of the time it occurs in the tube. That’s why an ectopic pregnancy is often considered the same thing as a “tubal pregnancy”. Tubal pregnancy: A tubal pregnancy occurs after the fertilized egg implants itself in the fallopian tube and begins to develop. The egg however, cannot survive outside of the uterus because it will not get the nutrients it needs, nor have enough room (in the tube) to grow. What are the symptoms of an ectopic pregnancy? The early symptoms of an ectopic pregnancy are the same as a normal pregnancy, such as a missed period, breast tenderness, and sometimes, nausea. Symptoms of an ectopic pregnancy may include: - Vaginal bleeding - Cramping and pain in the lower abdomen (belly) Later symptoms of an ectopic pregnancy may include: - Sharp pain in the belly area - Heavy vaginal bleeding - Lightheadedness - Dizziness Who is at risk for an ectopic pregnancy? Any female can have an ectopic pregnancy, but certain conditions can put you at a higher risk. These conditions include: - Previous ectopic pregnancy - Pelvic infections in the past (such as chlamydia and gonorrhea) that may have caused scarring of the fallopian tubes - Scarring of the fallopian tube(s) from past surgery Can a fertilized egg survive outside of the uterus? A fertilized egg cannot live outside of the uterus. It needs space to grow and a source of nourishment. What are the types of treatment for ectopic (tubal) pregnancy? The type of treatment depends on when the ectopic pregnancy is diagnosed. If it is early, the standard treatment is a medicine called Methotrexate. This medicine works by stopping the egg from growing. If the ectopic pregnancy is advanced surgery will likely be needed to remove the egg (from the tube, abdomen, cervix, or ovary). In the case of a tubal pregnancy, the fallopian tube can burst and cause serious bleeding. If this happens, the fallopian tube will need to be surgically removed as this is a life-threatening emergency. Females are born with two fallopian tubes. If one is damaged or removed, the other tube should function normally. Miscarriage A normal pregnancy takes about 38 weeks for the fertilized egg to develop into a fetus, then a full term baby. However, there are times when the fertilized egg doesn’t continue to grow and the pregnancy is lost. An early pregnancy loss (before 20 weeks) is called a miscarriage. Sometimes a miscarriage happens before a teen or woman even knows she’s pregnant, and there is usually nothing that she did to cause it. Having a miscarriage is upsetting. It will take time to heal both physically and emotionally. What is the medical term for miscarriage? The medical term for miscarriage is “spontaneous abortion”, but it’s not the same thing as a therapeutic or planned abortion. A spontaneous abortion is when a pregnancy ends “spontaneously”, unexpectedly, or suddenly. There are different reasons why this happens, but most often the reason is unknown. What causes miscarriage? There can be different reasons that a pregnancy will end suddenly. Most of the time miscarriage happens because the fertilized egg or fetus is not growing or developing normally. If the fetus doesn’t form and the pregnancy tissue does not grow, this is called a “blighted ovum”. What is a blighted ovum? A blighted ovum is a fertilized egg that has a placenta but no embryo. The fertilized egg attaches itself to the inside of the uterus. The sac develops, but since there is no embryo, the pregnancy cannot continue. What happens when the fetus stops growing? If the fetus stops growing (early fetal demise) then there will be a miscarriage. The fetus is usually very small and if the tissue is passed it doesn’tlook like a fetus. What are other reasons for an early miscarriage or blighted ovum? - Most often the cause of a blighted ovum is unknown and will not occur again - Genetic factors such as a problem with the chromosomes (genes) of the fetus - Molar pregnancy also called GTD (gestational trophoblastic disease) What does NOT cause miscarriage? We know that normal activity, regular exercise, and most jobs do not cause miscarriage. There is also no proof that having sex will cause miscarriage. Who is at risk for having a miscarriage? Anyone can have a miscarriage, but a teen or woman is at a higher risk if she has one or more of the following conditions or behaviors: - Infection of the uterus (womb) or fetus - Health problems such as uncontrolled diabetes - Problems with the uterus (abnormal shape) - Problems with the cervix (second or third trimester) - Smoking - Abuse of drugs or alcohol What are the symptoms of miscarriage? Bleeding is the most common symptom of miscarriage, however some teens/women can have light bleeding during the first few months of pregnancy without problems. This may seem confusing. It may be helpful to think of the following symptoms as “warning signs” and a reason to call your health care provider. Warning signs of miscarriage: - Vaginal spotting or bleeding - Cramps - Fluid that suddenly gushes from the vagina - Thick bleeding (blood clots/tissue) from the vagina – call your health care provider right away! What will happen if I have to go to the hospital? You will need to have a pelvic exam to see if your cervix has dilated (opened) and/or a pelvic ultrasound. If your cervix has dilated, it’s likely that you’ve had a complete or partial miscarriage. If your health care provider feels that you have had a “complete” miscarriage, after you have been examined, you may not need to have a procedure. Sometimes the tissue doesn’t completely come out of the uterus (partial miscarriage). If this happens, you may need to have a routine procedure called a D & E. What is a D & E? A “D & E” is short for dilatation and evacuation. This procedure can be done in a health care provider’s office or an emergency room under local anesthesia (numbing medicine), or in an operating room at a hospital (under general anesthesia – while you are asleep). The cervix may need to be dilated (widened) and then any tissue left behind is removed. What happens after a miscarriage? After a miscarriage you will have some vaginal bleeding, but it shouldn’t be heavy. You may also have mild cramping in your abdomen (belly). This happens because your uterus (womb) is tightening and getting smaller (back to the shape and size it was before you got pregnant). You will need to see your health care provider for a follow-up appointment in a couple of weeks for a routine check-up or sooner if you have any of the following problems. Call your health care provider right away if you have: - Heavy vaginal bleeding - Fever and/or chills - Severe pain in your belly Your health care provider will give you specific instructions about how long you should stay home and rest, and when it is safe to be physically and sexually active. Can I get pregnant after a miscarriage? If you got pregnant once, you know that you are “fertile” (you ovulate and can get pregnant). It’s important to know that you can ovulate (make eggs) as early as 2 weeks after having a miscarriage. This means you can get pregnant right away if you are sexually active and you don’t use birth control. If you don’t want to become pregnant, talk to your health care provider about birth control. Why do I feel so sad? Whether or not your pregnancy was planned, it’s normal to feel sad when you find out that you have miscarried. Some of the feelings are due to the changes in hormones that come with pregnancy and miscarriage. You may experience a range of emotions from feeling relieved to being sad and upset.
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U oko 20-30 posto trudnica javlja se vaginalno krvarenje u prvih 20 tjedana trudnoće. Od toga, u oko polovice trudnica s krvarenjem u prvom trimestru trudnoće doći će do razvoja normalne trudnoće. Sukladno tome, krvarenje u ranoj trudnoći predstavlja relativno čest simptom, a kombinacijom ginekološkog pregleda, ultrazvučnog nalaza i određivanjem nivoa beta-HCG-a (humanog korionskog gonadotropina) i progesterona u serumu analiziraju se mogući uzroci krvarenja u ranoj trudnoći. Krvarenje nakon oplodnje Kod velikog broja žena, nakon oplodnje, odnosno tijekom usađivanja oplođene jajne stanice u zid maternice, dolazi do krvarenja različitog intenziteta koje nazivamo implantacijskim krvarenjem. Sam patofiziološki mehanizam ovog krvarenja nije razjašnjen. Trudnice ga obično primjete 6-12 dana nakon oplodnje, odnosno već u trećem tjednu trudnoće. Nekad se ovo krvarenje može poklopiti s terminom menstruacije koju očekujemo, pa može izazvati dvojbe i nesporazume. Za razliku od menstruacije, značajno je slabije i oskudnije. Obično traje jedan do nekoliko dana.Također, uz implantacijsko krvarenje mogu se javiti i grčevi u donjem dijelu trbuha, što je povezano s usađivanjem oplođene jajne stanice u maternicu i kontrakcijom, odnosno grčenjem mišića maternice. Iako je oskudno krvarenje najčešći simptom implantacijskog krvarenja, ono se može manifestirati i samo grčevima, bez krvarenja, iako rjeđe. Izvanmaternična trudnoća i druge komplikacije Međutim, krvarenje u ranoj trudnoći može biti povezano s brojnim, drugim etiološkim čimbenicima. Tako je krvarenje jedan od simptoma izvanmaternične trudnoće, kao i trudnoće unutar maternice gdje se plod ne razvija onako kako bi trebalo. U jednom od šezdeset slučajeva javlja se izvanmaternična trudnoća, u kojoj se oplođena jajna stanica smješta izvan maternice (većinom u jajovodu), gdje ne može opstati. Najčešći uzroci izvanmaternične trudnoće jesu infekcije ili malformacije jajovoda, a veći rizik za izvanmaterničnu trudnoću donosi i dob žene (iznad 35 godina starosti). Nadalje, pojava intrauterinog hematoma može biti slučajan nalaz na ultrazvučnom pregledu, ali može biti i praćena krvarenjem u ranoj trudnoći. Prema nekom autorima krvarenje prije devet tjedana trudnoće koje je uzrokovano intrauterinim hematomom povećava rizik za spontani pobačaj. Komplikacija trudnoće koja se često javlja sa simptomom krvarenja je spontani pobačaj. Definira se kao gubitak trudnoće koji završava spontanom ekspulzijom ploda nesposobnog za život, a pojavljuje se u oko 15 posto kliničkih trudnoća. Anomalije zametka i genetski čimbenici uzrok su ranih spontanih pobačaja u oko 70 posto slučajeva koji korelira s dobi trudnice. Smatra se da je uspješna trudnoća rezultat dobre integracije nekoliko kompleksnih čimbenika; kao što su hormonalni, genetski, imunološki i stanični. Krvarenje u ranoj trudnoći može biti i simptom opetovanih ili habitualnih pobačaja koji se definiraju kao dva, tri ili više gubitaka trudnoća u prvom trimestru koji se javlja u oko 1 posto parova, ali se nažalost uzrok habitulanog spontanog pobačaja uspije utvrditi samo u oko 50 posto parova. Kada je u pitanju krvarenje u ranoj trudnoći valja uvijek misliti i na upalne procese vrata maternice koji mogu biti etiološki čimbenik ove pojave, te na uznapredovali rak vrata maternice, koji je na sreću danas još uvijek rijedak u mladih žena, a može biti uzrokom krvarenja u ranoj trudnoći. Kada je potrebna terapija? Zaključno, krvarenje u ranoj trudnoći relativno je čest simptom koji može biti povezan s različitim etiološkim čimbenicima pa se terapijski pristup pokušava temeljiti na liječenju uzroka. Ako se radi o implantacijskom krvarenju, prijetećem ili započetom spontanom pobačaju terapija je konzervativna i ekspektativna: prije svega strogo mirovanje uz terapiju gestagenskim pripravcima (progesteronom) koji na određeni način desenzibiliziraju i opuštaju maternicu. Naime, progesteron djeluje na regulaciju inflamatornih posrednika u trudnoći, jedan je od čimbenika koji regulira trofoblasnu invaziju; ključni proces tijekom placentacije. Indirektno, preko različitih drugih spojeva progesteron ima sistemsko i lokalno (decidualno) imunoregulacijsko djelovanje. On se u terapiji koristi na različite načine i u različitim dozama. S druge strane, liječenje izvanmaternične trudnoće može biti medikamentozno i kirurško pri čemu je kirurško liječenje najčešći oblik terapije izvanmaternične trudnoće. Ukoliko se radi o trudnoći u kojoj se plod ne razvije uopće ili ne onako kako bi trebao (primjerice plod bez znakova vitalnost tj. plod bez srčane akcije) rješenje je evakuacija trudnoće, budući da spontana resorpcija ovakve trudnoće može ugroziti zdravstveno stanje trudnice tj. poremetiti njezin koagulacijski sustav. Opetovani ili habitualni pobačaji predstavljaju šaroliku skupinu pobačaja koji mogu imati različitu etiološku podlogu. Terapija aspirinom ili niskomolekularnim heparinom koristi se u žena s idiopatskim opetovanim pobačajima, kao i u onih s opetovanim pobačajima u kojih je dokazan tromboembolični etiološki čimbenik. Na kraju, liječenje antibioticima predstavlja terapiju izbora kod upalnih stanja dok je onkološko liječenje neophodno kod žena s rakom vrata maternice. Pročitajte što se još događa u trećem tjednu i pratite dalje razvoj svoje trudnoće! Jeste li vi imali implantacijsko krvarenje?