Brief Answer:
rest, precautions and medicines advised

Detailed Answer:
Hello mam, thanks for writing us your concern.
After reading your history the most probable cause for your bleeding is basically related to abnormal implantation of the placenta which is separating from its attachment time and again.

I have seen patients with similar history in my clinic and the best response is seen with HCG Injection every 5th day till 34 weeks of pregnancy and progesterone vaginal pessaries daily.
Along with these medicines-
- strict bed rest
- avoid intercourse
- avoid straining at stools
- keep a note of movements of the baby
- foot end elevation of bed by placing either wooden blocks below bed or pillows beneath your legs whichsoever is comfortable.

It will most probably stop in 2-4 weeks time with this treatment and in the meanwhile don't feel anxious as everything is fine till baby is growing properly with adequate daily movements.
Wish you best of luck.

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Brief Answer:
abnormal implantation

Detailed Answer:
Hi dear, I know that by your history as your doctor did a per speculum examination which is never attempted in low lying placenta.
By abnormal implantation I didn't mean lower segment implantation.
Abnormal implantation is when placenta is not able to attach deep into the layers of uterus so that there is proper gluing of both of then in order to exchange nutrients and waste products via blood.

And when blood barrier is not able to form in a proper way it separates in times of stress or exertion to give rise to repeated bleeding till the detachment seals properly.
It is usually too small to be detected on ultrasound and thank god it is small.
In case precautions are not taken then it can cause a bigger bleed.
In case you have any other question, I will be happy to help. Take care and all the best

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Brief Answer:
HCG is must, bed rest empirical role

Detailed Answer:
Hello dear.
I know there are differences in management protocols between gynecologists of different countries.
Regarding bed rest many new studies say that there is no role of bed rest but we still recommend it because when already doctors ask normal pregnant ladies to take extra sleep then why not extra bed rest in high risk pregnancies.
But as far as HCG is concerned it is very important for the replenishment of placental support and should be given.
As regards evidence of abnormal placental attachment there is a book ' XXXXXXX obstetrics' which is the bible of obstetricians worldwide in which it is explained in the topic on 'etiopathogenesis of pregnancy induced hypertension'
I understand your anxiety and will be happy to answer your questions over this issue in future also.
All the best.

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Brief Answer:
Discuss with your gynecologist

Detailed Answer:
Hi, don't be double minded as this abnormal implantation of placenta is a diagnosis of exclusion and then also management remains the same even after diagnosis has been delineated.
Regarding rest in high risk pregnancy difference will be seen even in XXXXXXX doctors so it is still an issue of debate so best is to follow a safe path.

Even for HCG, here in XXXXXXX everyone favours it as I have been in touch with many gynecologists in XXXXXXX Bombay and XXXXXXX but when I study on internet or research journals there are a few doctors across the world who deny the use of HCG anymore and favor progesterone in the form of pessaries or injections.

So i have given you my opinion which I follow with my patients and getting desirable results but you can discuss with your treating doctor and show our discussion to reach a final management plan.

I wish you all the best and hope to see you in good health soon.

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