Light bleeding week 4 pregnancy

Bleeding in Early Pregnancy: When Should you Worry?

Published Sep. 23, 2022

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• Pregnancy
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Light bleeding or spotting during your first trimester is common.

During pregnancy, your body changes. A lot. And in early pregnancy, you may deal with some pretty substantial hormonal shifts. Between mood swings, exhaustion and morning sickness, you might not feel your best. But there’s another symptom that can happen in early pregnancy that you might not be thinking about — bleeding or spotting. 

“Bleeding in early pregnancy happens to 20 to 40% of women,” says Deidre Heber, DO, OB-GYN at Geisinger. “Most of the time, it’s nothing to worry about.”

Potential causes of first trimester bleeding 

Bleeding during the first trimester can look different for everyone. The amount can range from light to heavy. For some, it can be intermittent. Others may have more constant bleeding or spotting. And it may or may not be painful. 

Here are a few things that might be behind it.

Implantation bleeding

Early in pregnancy (sometimes before you know you’re pregnant), you may have some spotting when your period is due. This common occurrence is called implantation bleeding. “It happens between 6 and 12 days after conception as the fertilized egg implants into your uterus,” Dr. Heber says. This bleeding is typically light and may last for a few days.

Cervical changes

During pregnancy, there’s increased blood flow to your cervix. Having sex or getting a Pap smear, which cause contact with the cervix, can trigger light bleeding. Other cervical changes that can trigger bleeding include: 

• Polyps
• Minor infections
• Cervical ectropion (when cells from the inside of the cervix move to the outside)

Hormones

In the early weeks of pregnancy, your body starts making the hormones you need to sustain a pregnancy. This change can cause your progestin levels to drop. That drop may lead to spotting or light bleeding.

Miscarriage

Since miscarriages are most common during the first trimester, worrying about bleeding is normal. Light bleeding or spotting doesn’t automatically mean you’re miscarrying. But if your bleeding is heavy, bright red or you’re passing clots and in pain, contact your healthcare provider. They can explain next steps.

Most women who miscarry go on to have healthy pregnancies. But having a miscarriage is a loss that families may need help handling. Don’t rush the grieving process, and find a support group or counselor if you feel you need it.

Ectopic pregnancy

An ectopic pregnancy happens when a fertilized egg implants outside the uterus, like in your fallopian tube. When that happens, it can lead to heavy bleeding, pain and other serious symptoms. “An ectopic pregnancy is an emergency,” says Dr. Heber. “If you have symptoms, contact your provider immediately.”

When to call the doctor about bleeding

Call 911 or go to the nearest emergency room if you have any of these symptoms:

• Severe pain or cramps low in the abdomen
• Severe bleeding, soaking greater than one heavy pad per hour, with or without pain
• Passage of blood clots or tissue
• Dizziness or fainting
• Chills
• Fever higher than 100. 4° F

If you’re pregnant and bleeding heavily, don’t use a tampon. Wear a pad instead. “Doctors need to know how much you’re bleeding to gauge the severity,” says Dr. Heber.

And if you’re passing tissue, consider bringing it in for testing.

Your doctor may use an ultrasound to determine the cause of your bleeding. Once they find the cause, they’ll work with you on a treatment plan.

Healthy parent, healthy baby

Building good habits now can help you have the healthiest pregnancy possible. Dr. Heber makes these suggestions to help you (and your baby) feel your best.

• Eat a nutritious, well-balanced diet
• Exercise regularly
• Avoid alcohol, recreational drugs and cigarettes
• Reduce caffeine intake to 1-2 cups a day
• Attend regular prenatal visits
• Take your prenatal vitamins

Next steps:

Meet Deidre Heber, DO
Learn about pregnancy care at Geisinger
Separating fact from fiction: 6 pregnancy myths

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Bleeding and/or pain in early pregnancy

• Reference Number: HEY-025/2022
• Departments: Gynaecology
• Last Updated: 31 May 2022

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Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your nurse/doctor but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is vaginal bleeding in early pregnancy?

Vaginal bleeding is common in early pregnancy and does not always mean there is a problem. However, bleeding can be a warning sign of a miscarriage.

What are the causes of early bleeding? 

There are a number of causes of bleeding in early pregnancy which include:

Spotting or bleeding may occur shortly after conception, this is known as an implantation bleed. It is caused by the fertilised egg embedding itself in the lining of the womb. This bleeding is often mistaken for a period, and it may occur around the time your period is due.

Hormonal bleeding is when some women experience a light bleed at around four to eight weeks of pregnancy, or around the time their period would have been due. This can be very confusing for women who are pregnant and is the reason many women do not realise they are pregnant for a while.  Again, it is totally normal. This usually settles around the 13^th week of pregnancy as by this time the placenta is sufficiently developed to produce all of the hormones needed to sustain the pregnancy.

After the egg is fertilised, the fertilised egg then goes on to implant itself into the lining of the womb (uterus). Sometimes this results in a little bleeding that shows up on an early scan as a haematoma (collection of blood). This is not anything to worry about. When it happens, the woman may notice a small amount of vaginal bleeding, but this is not necessarily the case.

The haematoma will gradually disappear and in most cases, the pregnancy remains safe.

Cervical Erosion (alternatively known as cervical ectropion) may be a source of spotting or bleeding. The blood supply to the womb and cervix is increased during pregnancy and the cervix may bleed harmlessly and painlessly. An erosion may cause bleeding following sexual intercourse; therefore, this type of bleeding must always be reported to your doctor.

Can bleeding indicate a miscarriage?

Not all bleeding in pregnancy is harmless, and it can be the first sign of a miscarriage. As many as 1 in 5 pregnancies are thought to end in miscarriage. The cause of miscarriage is not always known, but researchers have shown that in some cases there is a problem with the developing pregnancy, which means it is unable to develop normally. For most women, miscarriage is a very sad and upsetting experience.

Experiences of miscarriage vary. In some cases, there may be only very slight spotting, in other cases bleeding may stop and start or heavier bleeding with clots and cramping period type pains can occur. Sometimes there may be no bleeding at all.

For further information relating to miscarriage, please ask your nurse for further details.

What should I do if I experience bleeding during pregnancy?

If you experience bleeding, it is wise to have this checked out. If you have been seen in the Early Pregnancy Assessment Unit (EPAU) during your pregnancy, you may contact us directly, up to 15 weeks + 6 days of pregnancy. Your GP or midwife can also help you.

If you have been seen in the EPAU and you then experience more bleeding contact the EPAU. Depending on how much bleeding and for how long the nursing staff will decide if you need to be seen again. A rescan is not always necessary. Sometimes the nurse will advise that you monitor this bleeding at home.  A rescan will only be performed if bleeding heavy with clots. If there is a significant change in your symptoms, then the nurse will make an appointment to come to EPAU and be either rescanned or to be assessed by the doctor. If bleeding is unmanageable, then the nurse may advise to be assessed on ward 30 or the Emergency department depending on your symptoms.

What if I experience pain in early pregnancy?

If you experience pain that does not go away, or which you feel is becoming more severe, you should seek advice from your doctor, nurse or midwife. It is important that any serious causes of pain are excluded. For example, there is a need to rule out an ectopic pregnancy (this is where the pregnancy develops outside the womb).

What kind of pain may I feel? 

Some women experience abdominal (tummy) pain in early pregnancy. This may be low cramping pain, similar to that felt during a period, or a stitch like or stabbing pain on one or both sides of the tummy. Aches and pains may come and go or be present continuously.

What are the causes of abdominal and back pain?

Some of the aches and pains experienced during pregnancy are thought to be due to hormonal changes. Large amounts of the hormone progesterone are produced, which are needed to sustain pregnancy. In addition to this, progesterone acts on the muscles, ligaments and joints causing them to become slacker and more flexible. This hormonal effect is thought to be responsible for some of the stitch like pains that some women experience in the lower part of the tummy and in some cases this can be quite severe. The same hormones can be responsible for constipation during pregnancy; this can also cause abdominal pain.

The enlarging womb is made up of layers of muscles and is held in place in the pelvis by supporting ligaments. As the womb expands to accommodate the developing baby, it can pull on the ligaments and muscles, to cause these “growing pains”.

The backache that some women get in early pregnancy is also thought to be due to a hormonal effect, and the supporting muscles are softer.

Abdominal and/or backache can also be a sign of a urine infection. This may also cause burning or stinging when passing urine and the need to pass urine more frequently. You must inform your doctor of these symptoms, so that a urine test can be obtained, and treatment given if needed.

Pain on its own does not mean that a miscarriage will occur. However, if you experience bleeding as well as pain this could indicate a threatened miscarriage and you should always seek advice from your doctor, nurse or midwife.

Can I take pain relief medication during pregnancy?

If you find that you need to take pain relief medication to relieve any pain, it is safest to use something simple such as paracetamol. Drugs such as aspirin and ibuprofen should be avoided. If you find that you need a stronger pain relief medication, you must always check with your doctor, nurse or midwife first.

Scanning in early pregnancy

An ultrasound scan is used during pregnancy for a number of reasons. In the first three months of pregnancy, it can be used to check the presence of the baby’s heartbeat, which can be reassuring if you have experienced a problem, such as vaginal bleeding or pain. A scan will also be used to check to see if the pregnancy is in the correct place and to accurately predict the estimated date of delivery (the date the baby is due) by measuring the end points (size) of the embryo or fetus.

Will I have an ultrasound scan? 

Yes, if the nurse/doctor thinks it is appropriate for you to have a scan. 

What is an ultrasound scan? 

Ultrasound uses high frequency sound waves that are sent out from a transducer or probe. These sound waves are received back and converted into an image on a screen. 

Is it safe to have a scan in early pregnancy? 

Yes, it is safe, there is so far no evidence to suggest that an ultrasound scan is unsafe. 

What type of scan will I have?

A vaginal scan is the best method in early pregnancy (under 8 weeks) as it gives us a more accurate result at an earlier stage in pregnancy than an abdominal scan.   It may be a little uncomfortable, but it is safe to be done, you do not need a full bladder when having a vaginal scan. If you have concerns about a vaginal scan, please let the nurse, midwife doctor know.

What will the scan tell us?

A scan can only tell us how your pregnancy is at that particular time. Unfortunately, it is no guarantee that your pregnancy will continue successfully. If your symptoms persist or become worse, you must contact EPAU, midwife or your GP.

In later pregnancy ultrasound scanning is used to look more closely at the anatomy and organs of the developing baby. This is usually done between 18 – 21 weeks.

What if the scan confirms a miscarriage?

If the scan confirms that you have miscarried, the choices of how we can manage this will be discussed with you.

Occasionally, the scan may pick up an unexpected finding such as a cyst on the ovary. If this is the case, the staff will explain the findings and any necessary follow up.

Common abbreviations used on scans

LMP – Last menstrual period

FH – Fetal heart-rate

EDD – Estimated date of delivery

FM – Fetal movement

USS – Ultrasound scan

YS – Yolk sac

CRL – Crown to rump length (a measurement of the embryo/fetus used in early pregnancy)

BPD – Bi-Parietal Diameter

HC – Head circumference. Both of these measurements of the fetus are used in later pregnancy, after 12-14 weeks.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the:

Useful information

Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust can be found at:

www.hey.nhs.uk/content/services/gynaecology.

Information on Maternity Services at Hull University Teaching Hospitals NHS Trust can be found at:

www. hey.nhs.uk/maternity

www.womens-health.co.uk

www.nhs.uk

www.earlypregnancy.org.uk

www.patient.org.uk

www.screening.nhs.uk/annbpublications

This leaflet was produced by the Gynaecology Service, Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in May 2025.

Ref: HEY025/2022

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Bloody discharge during pregnancy ᐈ Blood during early pregnancy

Seeing bloody discharge, a pregnant woman is always frightened. They are considered a symptom of miscarriage and other equally serious pathologies. At the same time, in some cases, the appearance of a small amount of blood is considered the norm and does not pose a threat to the life and health of the fetus or the expectant mother.

In early pregnancy, bloody discharge occurs in 25% of women. In most cases, they are associated with the implantation of the fetal egg to the wall of the uterus. Also, scanty spotting may appear on the dates of the expected menstruation. If they end quickly, are not accompanied by pain, and the woman has not had miscarriages or pregnancy complications before, most likely she has nothing to worry about. However, it is necessary to consult an obstetrician-gynecologist and undergo an examination.

Why bloody discharge can appear and when it is dangerous, said Elena Petrovna Domnich, obstetrician-gynecologist of the highest category, gynecologist-endocrinologist, ultrasound specialist of the ADONIS medical center.

- Sometimes during pregnancy, a woman may experience spotting, but this should not be interpreted as menstruation. Menstruation occurs at the end of the menstrual cycle, during which the endometrium changes, first proliferative, then secretory. During the cycle, the endometrium prepares for pregnancy, and if it does not occur, then menstruation begins.

In the event of pregnancy, menstruation is not possible, although bleeding may occur at the expected time. Because of this, some women do not immediately know that they are pregnant. However, when the obstetrician-gynecologist at the reception asks them about the nature of the discharge, it always turns out that they are different from menstrual. As a rule, they are more scarce, pass faster and are not accompanied by other symptoms. Sometimes a woman says that her period was very recent, but at the time of examination and examination, we find that she is already 8 or 12 weeks pregnant.

- Bloody discharge is not common in pregnant women, but still it cannot be said that these are exceptional cases.

– Yes, but it is better to visit an obstetrician-gynecologist. There are cases when a woman is pregnant, but the test strip shows a negative result. To accurately determine whether there is a pregnancy, allows a blood test for the level of hCG.

- Yes, that's right. This is bleeding, not menstruation. It can be a symptom of a miscarriage, ectopic pregnancy, or other pathology. For diagnosis, you must consult a doctor.

- A pregnancy test is sometimes positive even if it is not. This happens if a woman has formed luteal cysts or developed a thyroid disease.

Bloody discharge during pregnancy requires contacting the antenatal clinic or the medical center where the woman was registered for pregnancy management. Sometimes they may not be dangerous, but without diagnosis, it cannot be ruled out that this is a symptom of a serious disorder.

Bleeding may occur with:

• threatened miscarriage;
• ectopic pregnancy;
• infectious diseases of the reproductive system;
• cysts;
• myomas;
• cervical erosion;
• placental abruption;
• threatened preterm birth.

You can watch the video version of Elena Petrovna Domnich's interview here. More helpful videos on our YouTube channel.

Pathological and physiological causes of bleeding during early pregnancy

The gestation period is a complex process that does not always go well. Every second woman has various complications. Most often, women go to the doctor with complaints of spotting. Why does bleeding occur during early pregnancy, how dangerous is it?

Causes of bleeding in pregnancy

Blood in the first trimester of pregnancy in the vaginal secretion is observed in 30% of expectant mothers. Bleeding can be weak, spotting, plentiful.

Most often, blood during early pregnancy is observed during implantation of the fetal egg. When the egg is attached, the vessels are often damaged, which leads to the appearance of blood secretions. They are similar to menstruation, last 1-2 days. This process is considered natural, does not indicate any pathologies.

Any bloody discharge during early pregnancy is a reason for an urgent appeal to a gynecologist. Even if there is no additional discomfort. At a remote consultation, our doctor will collect an anamnesis, draw up a clinical picture in order to identify the cause of bleeding. And he will select effective methods to eliminate the problem.

Blood during pregnancy - other common causes

In addition to the main ones, there are some other reasons why pathology can develop.

Bleeding in the first trimester can be caused by causes that appear at any gestational age. These are fibroids, polyps in the uterus and cervical canal, cardiovascular pathologies that are associated with a weakening of the endothelium.

Physiological or pathological bleeding during gestation - differences

Clinical manifestations of bleeding in pregnant women depend on the causes. Physiological discharge of blood from the genital tract in the early stages of gestation proceeds without deterioration in well-being. With bleeding caused by erosion, fibroids and polyps, there are also no additional discomfort. In this case, only a few drops of blood are released, it bleeds for a short time.

Abundant bleeding, similar to menstruation, against the background of a general satisfactory condition, occurs with a deficiency of progesterone.

Bleeding with spontaneous interruption is accompanied by constant or periodic pain in the lumbar region, abdomen. Disturbed by nausea, bouts of dizziness, slightly increased body temperature. Bleeding can be weak or intense, and clots are often observed in the discharge.

When a fertilized egg is fixed outside the uterus, internal bleeding often occurs, and discharge from the genital tract may appear much later. Characteristic manifestations - acute pain in the abdomen radiates to the anal region, right or left side, blood pressure decreases, cold sweat appears, fainting is possible. Significant blood loss leads to the development of a state of shock with a high probability of death.

Learn more about implantation bleeding

Why does it bleed at the initial stages of gestation? Most often, the appearance of spotting during pregnancy is associated with the implantation of the embryo. They occur 6-12 days after conception and are often one of the first signs of conception.

Usually, the appearance of spotting at the beginning of pregnancy coincides with the time of the onset of menstruation, if the cycle is regular. But discharge in pregnant women is not as abundant as menstrual bleeding. Duration - from several hours to three, with the first pregnancy up to 5 days.

How does implantation bleeding manifest?

• weak, pulling pain in the lower abdomen;
• headache, dizziness;
• sudden change of mood;
• bouts of nausea;
• increased sensitivity, swelling of the mammary glands;
• fatigue, drowsiness.

Important! When the embryo is implanted, little blood is released, usually these are small specks. The discharge may be pink, brown, orange, and there should be no clots.

Possible causes of early bleeding by week

The first months of pregnancy are the most difficult and dangerous. It is in the early stages that various pathologies and complications often appear.

Why blood may appear in the early stages during pregnancy:

1. At the 4th week of pregnancy, discharge with an admixture of blood may appear - this is implantation bleeding. Excessive bleeding is a dangerous sign, most often indicates a miscarriage. Spontaneous abortion can be caused by exercise, fever, infections, drugs or alcohol. Such bleeding is profuse, painful, blood clots are present.
2. The appearance of sanious discharge at the 5th week of pregnancy may be a sign of a missed pregnancy. The reasons are overwork, Rh conflict, bad habits, bacterial and viral diseases of the reproductive system, genetic disorders in the embryo. Symptoms - causeless fever, severe pain in the lower back and lower abdomen, the disappearance of signs of toxicosis.
3. Blood in the discharge at the 6th week of pregnancy appears with an ectopic attachment of the fetal egg, fetal fading, Rhesus conflict. Discharge with blood at 6 weeks of pregnancy is a reason for an urgent visit to the gynecologist.
4. At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
5. From the 8th week of pregnancy, one of the most dangerous periods of pregnancy begins. The formation of the placenta begins, the hormonal background changes. Bloody discharge appears with the threat of miscarriage or spontaneous abortion. Pregnancy is often not saved.

Pay attention! In the second trimester, bleeding occurs only in 5-10% of women. Most often this is due to late spontaneous abortion, isthmic-cervical insufficiency. The appearance of blood in the third trimester mainly occurs with presentation, placental abruption.

Early bleeding after IVF

The appearance of blood discharge during pregnancy on the 8-10th day after IVF is not considered a pathology, provided that the woman feels normal. After the introduction of the embryo into the uterine cavity, minor damage to the small uterine vessels often occurs. Brown, dark cream, pale pink, odorless discharge most often indicates a successful transplant, pregnancy.

If spotting after IVF is observed for 1-2 days, slight pulling pains in the lower abdomen are disturbing, this may be due to a progesterone deficiency. After the examination, the doctor will adjust the hormonal maintenance therapy.

Pink discharge on the 16th day after the transfer is a dangerous symptom. It may be a sign of detachment of the fetal egg, the threat of termination of pregnancy.

According to studies, uterine bleeding in the first trimester is a common occurrence in pregnancy after IVF. Discharge does not affect the incidence of adverse reproductive outcomes. The number of embryo rejections in women with and without uterine bleeding is approximately the same. Consult with our doctors by phone for more details.

Diagnostics

If blood has gone from the genitals of a pregnant woman, the doctor conducts an external and gynecological examination.

Analyzes and examinations:

• general and biochemical blood test;
• general urine analysis;
• tests for hCG, other hormones;
• Ultrasound of the pelvic organs;
• CTG is performed to assess the vital activity of the fetus.

Treatment

Methods of treatment depend on the results of the examination.

Bloody discharge in the first trimester - causes and therapeutic measures:

Complications and consequences

It is impossible to ignore bloody impurities in vaginal discharge during pregnancy. Without proper and timely assistance, the following complications may occur:

• miscarriage;
• intrauterine fetal death;
• the development of an infectious process, sepsis due to the remainder of dead tissues in the uterine cavity;
• profuse blood loss can lead to death.

Important! Urgent medical attention is needed in case of heavy bleeding, bright scarlet blood, presence of blood clots in the discharge. In life-threatening and fetal conditions, severe pain in the abdomen, lower back, convulsions, profuse cold sweat, and loss of consciousness are disturbing.

Methods of prevention

If there is blood in the first trimester, it is important to remain calm. Stress and anxiety will only exacerbate the situation. But any health problem is easier to prevent than to treat.

How to avoid bleeding during childbearing - recommendations from a gynecologist:

• eat right and balanced, give up junk and junk food, eat more fresh vegetables and fruits;
• observe the drinking regime;
• in the absence of contraindications, moderate physical activity is indicated - yoga, swimming, special gymnastics for pregnant women;
• more time to walk in the fresh air;
• avoid stress, overwork, observe the daily routine, get enough sleep;
• give up bad habits, do not be in smoky rooms;
• timely visit a gynecologist;
• according to the doctor's prescription, take vitamin complexes for pregnant women;
• do not self-medicate.

The prognosis for bleeding during gestation depends on the causes and timely visit to the doctor. Properly provided medical care can save the life of the fetus and the woman.

FAQ

Why is there blood from the genital tract during gestation?

+

The causes of bleeding in early pregnancy are different. Most often, spotting appears when the fetal egg is fixed, progesterone deficiency, with erosion of the cervix and polyps. Dangerous causes - ectopic, molar, miscarriage, miscarriage.

What to do if there is bleeding during pregnancy?

+

Much depends on the amount of blood released, general well-being. If the bleeding is not strong, not for long, the general condition is normal, it is enough to lie down and rest. Write down the date of the attack, inform the doctor at the next visit. But if even slight spotting during early pregnancy lasts more than 72 hours, is accompanied by cramping or acute pain, fever, you should immediately visit a gynecologist or call an ambulance.

How can you recognize a miscarriage?

+

With the threat of interruption, spotting is scanty, pain in the lower abdomen is absent or may be dull, aching. The condition is considered reversible, with timely treatment, pregnancy can be saved. If a miscarriage has begun, bleeding intensifies, cramping pain appears. The general condition is satisfactory. Urgent hospitalization is required, the probability of maintaining pregnancy is decided on an individual basis.

Expert opinion:

Bleeding during pregnancy is a dangerous symptom. Sometimes spotting can be caused by physiological reasons. But often such a symptom appears in life-threatening conditions for the woman and the fetus.

We publish only verified information

Article author

Menshikova Maria Viktorovna obstetrician-gynecologist

Experience 38 years

Consultations 1816

Articles 46

Specialist with extensive practical experience.

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