MSN > Women > Mother & Child Magazine

Pregnancy Bleeding: The Facts

Bleeding during pregnancy strikes fear in the heart of any pregnant woman. Whether you are in your first month or last, you know that it just can't be considered normal - after all, the first sign of pregnancy is usually an absence of bleeding! But bleeding doesn't always spell a tragic end for your pregnancy. Just ask your friends and you are likely to find that at least some of them have had similar experiences. However, it is vital that you seek medical attention immediately and follow your doctor's advice conscientiously.

First stop: your doctor

Bleeding during pregnancy should always be taken seriously. Dr. Nevine El Hefnawi, professor of obstetrics and gynecology at Cairo University, stresses, "Any pregnant woman who experiences bleeding should get in touch with her doctor immediately. 

If she can't find her doctor, she should go directly to the emergency room. There she will probably have an ultrasound to determine the condition and placement of the fetus, and sometimes a physical exam and/or lab tests to determine what is causing the bleeding."

Many different conditions might be responsible for causing your bleeding and only your doctor is going to be able to tell you what is behind it. Dr. El Hefnawi emphasizes, "There are many different reasons for bleeding to occur during pregnancy, ranging from the most serious to the most innocent. To help her doctor identify the reason for her bleeding, a woman should be able to describe it in detail.

" Your doctor will need to know what kind of bleeding you are experiencing, both in terms of amount (Is it heavy or light? Was it a one-time occurrence or is it ongoing?) and color (pink, bright red, brown). 

If you pass tissue or clots and are going to your doctor, bring it with you. You should also tell your doctor if the bleeding was accompanied by pain, and if it was, whether the pain occurred with the bleeding or before or after it, as well as being able to describe the type of pain that you feel.

Dr. El Hefnawi notes that doctors characterize bleeding into two categories: first trimester bleeding and mid to late pregnancy bleeding. They make this distinction because different causes are associated with the different stages of pregnancy.

 During the first trimester, causes of bleeding can range from the innocuous implantation, bleeding that sometimes occurs due to low pregnancy hormone levels right around when you would have expected your next period, to a threatened miscarriage. During middle to late pregnancy, placental problems are the most likely culprits.

First trimester bleeding

Most miscarriages occur before 13 weeks. But not all first trimester bleeding means you will miscarry, in fact, sources suggest that up to 10% of women experience first trimester bleeding, especially those pregnant with twins. Many of these pregnancies end up being successful ones. 

Spotting, a term for very light bleeding, is often caused by an internal exam or sexual intercourse. Other times, a polyp in the cervix is responsible for bleeding. Usually this kind of polyp doesn't require treatment during pregnancy.

In other cases, first trimester bleeding can be grave. One very serious condition that is discovered before or at 10 weeks is ectopic pregnancy in which the fertilized ovum implants outside the uterus, most commonly in one of the fallopian tubes. Ectopic pregnancy is often associated with IUD use. This condition is most often accompanied by pain. 

Cases of ectopic pregnancy require surgery, as the pregnancy cannot be saved. Quick attention is necessary because if the ovum is allowed to develop, it can cause irreparable damage to the fallopian tube.

Other serious conditions discovered in the first trimester include molar pregnancy, in which the uterus contains abnormal tissues instead of a baby, and blighted ovum, in which the embryo fails to develop.

Later bleeding

Miscarriages occasionally occur later in pregnancy, but more commonly placental problems are the source of bleeding. Placenta previa occurs when the placenta covers the cervix. When the cervix begins to thin and dilate in preparation for labor, it causes bleeding. Women who have had multiple pregnancies or delivered by Cesarean section are more likely to develop this condition. 

Placental abruption is another condition involving the placenta, in which the placenta separates from the wall of the uterus before it should, and the space fills with blood. High blood pressure, physical injury such as a car accident while you're pregnant, and smoking during pregnancy are risk factors for developing this condition. Both of these conditions can be dangerous to the mother's health and often require hospitalization.

More rarely, uterine rupture, in which the uterus rips open and the baby is expelled into the abdomen, or fetal vessel rupture, in which the blood actually comes from the fetus, are behind bleeding in late pregnancy. 

In late pregnancy, a little bit of blood accompanied by mucus may mean that the cervical plug has been dislodged because your cervix is softening in preparation for labor. Even though it is a normal part of labor, you should report it to your doctor, especially if you are not in active labor, as she may have special instructions for you.

Treatment

Your doctor will tell you what course you should follow. Pregnant women who experience bleeding are often advised to get bed rest, which can be very frustrating especially if you are working or have young children. 

If your doctor advises bed rest, do your best to follow instructions - enlist extra household help, whether by hiring help or asking a relative or friend to help out; entertain yourself with a good book or a few movies that you haven't been able to make time for; pick out your baby's name or do anything else that keeps your mind off being stuck in bed (see box for more tips to make the time go faster).

If bleeding occurs later in pregnancy and is associated with placental problems, you may be hospitalized and your doctor may decide to deliver your baby through Cesarean section if you are close to term.

In other cases, doctors may think it sufficient for you to abstain from sexual intercourse, stop exercising, avoid heavy lifting and generally take it easy.

In some cases, you may be told to take medication, but make sure to avoid taking any medication that your doctor has not specifically approved of.

What next?

While bleeding in early pregnancy sometimes ends in miscarriage, even if you have a miscarriage, remember that most women have a high chance of having a successful pregnancy after miscarriage. If your bleeding is a result of a condition that needs treatment, make sure to follow up with your doctor.

Read more:
Rh Testing

Seeing Your Baby for the First Time!

Overcoming Breastfeeding Myths