Bleeding During Pregnancy

Vaginal bleeding can occur frequently in the first trimester of pregnancy and may not be a sign of problems. But bleeding that occurs in the second and third trimester of pregnancy can often be a sign of a possible complication. Bleeding can be caused by a number of reasons.

Some basic things to know about bleeding are:

  • If you are bleeding, you should always wear a pad or panty liner so that you can monitor how much you are bleeding and what type of bleeding you are experiencing.
  •  You should never wear a tampon or introduce anything else into the vaginal area such as douche or have sexual intercourse if you are currently experiencing bleeding.
  • If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your midwife or doctor immediately.

First Half of Pregnancy:

Threatened Miscarriage:

Typically this begins with bleeding, which may or maqy not be followed by accompanying cramps and lower backache within the next few hours or days. Bleeding can be a sign of miscarriage but does not mean that miscarriage is imminent.Bleeding alone even though heavy, is often transitory and frequently does not end in miscarriage. Studies show that 1 out of every 5 women experience some  bleeding (including spotting) in the first half of pregnancy. If ultra sound or doppler has confirmed that you have a live baby, your chances of carrying your baby to a verifiable age are 90%.

Options for treatment: Rest in bed, make sure you are getting enough protein, salt and calories in your diet and drink plenty of fluids. Taking 500g of Vitamin C with Bioflavanoids can help to strengtthen the placental bed.

To reassure yourself you could have an ultrasound performed, Ultrasound can confirm a pregnancy as early as 6 weeks. The fetal heart can only be heard with a doppler from between 10-12 weeks gestation onwards, earlier than this you will require an ultrasound to see the heartbeat.

Blood tests are another way of determining whether your pregnancy is continuing, these can be performed at most blood pathology laboratory and could be taken by a midwife, G.P, obstetrician, or at the laboratory itself. 2 tests need to be done 5 days apart  to determineif the pregnancy is still viable. This is an accurate and minimally invasive test. The test is known as a Quantitative Beta- hCG test and tests the amount of hCG hormone that is circulating in the blood. 5 days later when this test is repeated,

Inevitable Misscarriage: 

If bleeding steadily increases and is joined by cramps and pain, and especially if accompanied by cervical softening and dilation, the inevitable loss of the pregnancy is much more likely. If the miscarriage is inevitable, you still have some options . Some women choose to go in to hospital immediately and have their uterus emptied by having a D+C ( ie dilation of the cervix and scraping of the uterine wall to empty the uterus) or for a vacuum procedure, others will want to avoid surgical intervention  and let nature take its course.

There are good reasons for women who are not bleeding excessively to adopt a wait and see approach, as lonbg as problems do not arise that make a watch and wait plan unwise. Surgical intervention can damage the cervix or perforate the uterus, may introduce infection and is often a traumatic experience.

If you choose to wait and let things happen naturally, keep in touch with your caregiver. Do not try to manage a miscarriage yourself without any support people present. Keep warm, monitor the bleeding closely, Drink lots of fluids to keep yourself hydrated

Some reasonable guidelines regarding miscarriage are:

  • expect bleeding and cramping to increase until the bleeding is very heavy (soaking a pad every 30 minutes to an hour) and cramping is severe (usually worse than any menstrual cramps)
  • in most cases severe symptoms (as above) should not last more than an hour to an hour and a half, almost all women will have a complete miscarriage in this amount of time. If symptoms are less severe, a miscarriage can take longer, sometimes the fetus will be passed at one point and the placenta a few days later.The amount of bleeding and mother’s overall condition and signs of infection should be monitored throughout a prolonged miscarriage. If signs of infection become apparent or symptoms increase in severity without completing the miscarriage, you will need to go to hospital.
  • If bleeding continues and is more than slight or if pain is prolonged or severe, it is advisable to see a doctor The doctor will then need to determine whether the miscarriage is complete or incomplete. This is often determined by performing an ultrasound and an internal examination.
  • Generally three hours after it appears that everything has passed  the bleeding has slowed down. Pain and cramps will steadily decrease or cease, but slight tenderness may persist for as few days. If tenderness is more than slight or accompanied a fever or foul smelling discharge, further assessment for a possible infection is needed. Bleeding may continue as it would after a birth, however the placental site is small at this point, it should only be a light flow.

Ectopic Pregnancies:

Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The fallopian tube accounts for the majority of ectopic pregnancies. Ectopic pregnancies are less common than miscarriages, occurring in 1 of 60 pregnancies.

Signs of Ectopic Pregnancies:

  • Cramping pain felt low in the stomach (usually stronger than menstrual cramps)
  • Sharp pain in the abdominal area
  • Low levels of hCG
  • Vaginal bleeding

Women are at a higher risk if they have had:

  • An infection in the tubes
  • A previous ectopic pregnancy
  • Previous pelvic surgery

Molar Pregnancies:

Molar pregnancies are a rare cause of early bleeding. Often referred to as a “mole”, a molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).
Signs of a Molar Pregnancy:

  • Vaginal bleeding
  • Blood tests reveal unusually high hCG levels
  • Absent fetal heart tones
  • Grape-like clusters are seen in the uterus by an ultrasound

What are common reasons for bleeding in the first half of pregnancy?

Since bleeding that occurs in the first half of pregnancy is so common (20-40%), many wonder what the causes are besides some of the complications already mentioned. Bleeding can occur in early pregnancy due to the following factors, aside from the above mentioned complications:

  • Implantation bleeding is one of many normal pregnancy symptoms and can occur anywhere from 6-12 days after possible conception. Every woman will experience implantation bleeding differently—some will lightly spot for a few hours, while others may have some light spotting for a couple of days.
  • Some type of infection in the pelvic cavity or urinary tract may cause bleeding.
  • After intercourse (known as post-coital bleeding)some women may bleed because the cervix is very tender and sensitive. You should discontinue intercourse until you have been seen by your doctor. This is to prevent any further irritation—this can feel quite frightening, although having sexual intercourse does not cause miscarriage, it is advisable to let bleeding settle.

Second Half of Pregnancy:

Common conditions of minor bleeding include an inflamed cervix or growths on the cervix. Late bleeding may pose a threat to the health of the woman or the fetus. Contact your health care provider if you experience any type of bleeding in the second or third trimester of your pregnancy.

Placental Abruption:

Vaginal bleeding may be caused by the placenta detaching from the uterine wall before or during labour. Only 1% of pregnant women have this problem, and it usually occurs during the last 12 weeks of pregnancy.

Signs of Placental Abruption:

  • Bleeding
  • Stomach pain

Women who are at higher risks for this condition include:

  •  Having already had children
  • Are age 35 or older
  • Have had abruption before
  • Have sickle cell anemia
  • High blood pressure
  • Trauma or injuries to the stomach
  • Cocaine use

Placenta Previa:

Placenta previa occurs when the placenta lies low in the uterus partly or completely covering the cervix. It is serious and requires immediate care. It occurs in 1 in 200 pregnancies. Bleeding usually occurs without pain.
Women who are at higher risks for this condition include:

  • Having already had children
  • Previous cesarean birth
  • Other surgery on the uterus
  • Carrying twins or triplets

Preterm Labor:

Vaginal bleeding may be a sign of labour. Up to a few weeks before labour begins, the mucus plug may pass. This is normally made up of a small amount of mucus and blood. If it occurs earlier, you could be entering preterm labour and should see your midwife or doctor immediately.
Signs of Preterm Labor include these symptoms that occur before the 37th week of pregnancy:

  • Vaginal discharge (watery, mucus, or bloody)
  • Pelvic or lower abdominal pressure
  • Low, dull backache
  • Stomach cramps, with or without diarrhea
  • Regular contractions or uterine tightening

Sources :
Anne Frye : Holistic Midwifery
www.americanpregnancy.org