Vaginal bleeding in pregnancy would be a cause of concern for many expecting women. This is especially most important if you were trying so hard to become pregnant and end up seeing red spots during the first weeks.
Pregnancy bleeding, should it really be a cause for concern?
Pregnancy Bleeding in the first trimester is very common. Most of the time, it is really not very serious and does not signal a major problem. However, bleeding during the last trimester of pregnancy is something you need to worry about. It is advisable to let your physician know whenever you experience any bleeding.
First Trimester Pregnancy Bleeding
During the early weeks of pregnancy, the most common cause of light bleeding or spotting is due to implantation of the baby into your uterus. Secondly, since your cervix has lots of tiny blood vessels that develop during pregnancy, it’s not unusual to have slight bleeding after sexual intercourse or a pelvic exam during this time.
Other serious causes of early pregnancy bleeding are usually heavy and accompanied by severe abdominal cramps and/or lower back pain. These include ectopic pregnancy, early pregnancy loss, and rarely, infection.
Ectopic Pregnancy
Ectopic pregnancy is when your egg chooses to implant elsewhere other than within the uterus, for example, in your Fallopian tube, ovary, cervix or abdomen. This is often life-threatening, especially if the tube ruptures, causing massive bleeding.
In such a case, you will experience severe abdominal pain, back pain and/ or shoulder pain. However, at times, bleeding may be the only sign. So, it’s important to let your gynaecologist know right away.
Early Pregnancy Loss
Early pregnancy loss is when you are at risk for a miscarriage. This is accompanied by heavy bleeding and menstruation-like cramps. Sometimes all the products of conception get aborted completely by themselves. However, at times, you may require medication or a small surgery to clean the uterus completely. After a miscarriage, it is advisable to wait for a cycle or two before getting pregnant again.
Infection
Infection is a treatable cause of vaginal bleeding. Depending on the severity of infection, some might end up in miscarriage, while others require treatment with pregnancy-safe medications.
Second and Third Trimester Pregnancy Bleeding
Placental issues and preterm labour are important causes of bleeding during the second and third trimesters.
Placental Abruption
Placental Abruption is the early detachment of the placenta from the uterus before birth). It can result in heavy bleeding and lead to life-threatening complications if not identified early. Your doctor may plan for immediate delivery by Caesarian section.
Placental Previa
Previa happens when the placental edge lies very close to or covers your cervix completely or partially.
Placenta previa is usually accompanied by painless vaginal bleeding and, most of the time, resolves spontaneously as the lower part of your uterus stretches out. However, in cases where it doesn’t resolve on its own, you may require a Caesarian birth.
Placental Accreta
This happens when the placenta or part of it bites into your uterine wall.
Placenta Accreta is a much severe issue, where the placenta is inseparable from your uterus. In such a situation, you are at high risk for life-threatening bleeding during delivery, which would ultimately result in your uterus being removed.
However, Placenta Accreta is uncommon and occurs in only 0.2 percent of all pregnancies.
Preterm Labour
Lastly, bleeding towards the end of your pregnancy may signal preterm labour. It is referred to as “preterm” when labour starts prior to 37 weeks. Other symptoms of preterm labour include:
- Low backache
- Watery or bloody vaginal discharge
- Mild abdominal cramps
- Frequent contractions/tightening of the uterus may be painless or painful.
If preterm labour occurs too early for the baby to be delivered, medication may be given to prevent delivery. Bed rest and sufficient fluid intake are advised. In some cases, delivery is unavoidable, and the baby would require additional intensive care in the hospital.
REFERENCES:
Eyal K. Sheiner; Bleeding during Pregnancy: A Comprehensive Guide.
American College of Obstetricians and Gynecologists: “Early Pregnancy Loss,” “Bleeding During Pregnancy.” Sakornbut, E. American Family Physician, 2007; vol 75: pp 1199-1206.
Zeltzer J.S. “Vaginal bleeding in late pregnancy,” in Rakel R.E., Bope E.T. Conn’s Current Therapy, 2008, 60th ed., Saunders Elsevier, Philadelphia.
Written by: Sherina Paul Raj. MD, CRGS, RDMS (ObGyn)
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