(Information for the public according to the American College of Obstetricians and Gynecologists – ACOG) – for more details, women should always consult their gynecologist.

Vaginal bleeding during pregnancy can have many causes. Some are serious and some are not. Some occur early in pregnancy, while others appear later. Light bleeding usually stops on its own. However, sometimes it can mean a risk for you and your baby. If bleeding occurs, you should contact your doctor immediately.

Below we will discuss:

• The causes of bleeding

• The symptoms

• What should be done

Light bleeding during pregnancy

Many women experience spotting or classic vaginal bleeding during the first 12 weeks of pregnancy. If you bleed during the early weeks of pregnancy, your doctor will perform a gynecological examination as well as a blood test to measure a hormone called human chorionic gonadotropin (hCG). This hormone is produced during pregnancy. You may need more than one blood test since hCG levels increase as pregnancy progresses.

An ultrasound may also be done to find the cause of the bleeding. Sometimes, however, the cause cannot be found.

If you experience bleeding during pregnancy, you may need special care. You are at higher risk of going into labor very early (preterm labor) or giving birth to a baby that is very small.

Miscarriage

Bleeding does not necessarily mean that a miscarriage will occur, but it may indicate that one is possible. About half of the women who bleed do not miscarry. If there is a problem with the pregnancy, the death of the embryo leads to the expulsion of tissue, and the pregnancy ends.

A miscarriage can happen at any time during the first half of pregnancy. Most occur during the first 12 weeks. Miscarriage occurs in 15–20% of pregnancies.

The signs of miscarriage include:

• Vaginal bleeding

• Cramping pain in the lower abdomen (often stronger than period pain)

• Tissue passing from the vagina

Many women who bleed have few or no cramps. Sometimes the bleeding stops and the pregnancy continues. Other times, the bleeding and cramps intensify, leading to miscarriage.

If you believe you have passed tissue, take it to your doctor for examination. If tissue remains in the uterus, bleeding often continues. The remaining tissue may need to be removed by a procedure called curettage or by suction in the operating room.

Most miscarriages cannot be prevented. It is often the body’s way of ending an abnormal pregnancy. There is no evidence that exercise or sexual activity causes bleeding. Having a miscarriage does not mean you cannot have children or that there is something wrong with your health. If you have two or three miscarriages in a row, your doctor will likely recommend tests to look for a cause.

Ectopic pregnancy

Another condition that can cause pain and bleeding in early pregnancy is an ectopic pregnancy. If the ectopic pregnancy develops in the fallopian tube, it can rupture and cause internal bleeding. This blood loss can lead to weakness, dizziness, or even shock. A ruptured ectopic pregnancy requires immediate treatment.

Ectopic pregnancy is less common than miscarriage. It occurs in about 1 in 60 pregnancies. Women are at greater risk if they have:

• A previous infection in the fallopian tubes (such as pelvic inflammatory disease)

• A previous ectopic pregnancy

• Previous surgery on the fallopian tubes

Molar pregnancy

A rare cause of early pregnancy bleeding is molar pregnancy. It is also known as gestational trophoblastic disease or simply “mole.” In this condition, abnormal tissue develops instead of an embryo. Molar pregnancy may require treatment with suction curettage or medication.

Bleeding in the second half of pregnancy

The causes of bleeding differ in the second half of pregnancy compared to the first. Common causes of minor bleeding include an inflamed cervix and cervical growths.

Late pregnancy bleeding may pose a threat to the woman or the baby. Hospital care may be required. Heavy vaginal bleeding is usually due to problems with the placenta. The two most common causes of late-pregnancy bleeding are placenta previa and placental abruption. Preterm labor can also cause vaginal bleeding.

Placental abruption

The placenta can cause bleeding at any time during pregnancy. Bleeding occurs due to partial detachment of the placenta from the uterine wall, not from its formation.

The placenta may detach from the uterus before or during labor, which can cause vaginal bleeding. Only about 1% of pregnant women experience this problem. It usually occurs during the last 12 weeks of pregnancy. Abdominal pain often occurs even without visible vaginal bleeding.

When the placenta detaches, the baby may receive less oxygen, which can pose a risk. If the detachment is small, there is no serious danger, but the pregnant woman needs close monitoring. Regarding how many days the bleeding lasts in a mild abruption, it is usually a few days, with most of the blood appearing at the beginning.

Women at higher risk include those who:

• Have had children before

• Are over 35 years old

• Have had a previous placental abruption

• Have sickle cell anemia

Placental abruption has been associated with:

• High blood pressure

• Blows or other trauma to the abdomen

• Cocaine use

• Smoking

Placenta previa

When the placenta is positioned low in the uterus, it may partially or completely cover the cervix. This condition is called placenta previa and can cause vaginal bleeding. Placenta previa is a very serious problem and requires immediate action.

It occurs in about 1 in 200 pregnancies. It is more common in women who:

• Have had more than one child

• Have had a cesarean section or other uterine surgery

• Have a twin or multiple pregnancy

The bleeding is usually painless.

Labor

Late in pregnancy, vaginal bleeding can be a sign of labor. A plug that covers the cervix during pregnancy is released right before or at the start of labor. A small amount of mucus mixed with blood passes through the cervix. This is a normal sign (also called the “bloody show”). It is not a problem if it happens a few weeks before your due date. If it happens earlier, it could indicate preterm labor. You should contact your doctor immediately, especially if you notice clots of blood during pregnancy.

Other signs of preterm labor include:

• Vaginal discharge

• Change in type (watery, mucous, or bloody)

• Increase in amount

• Pressure in the lower abdomen or pelvis

• Mild lower back pain

• Stomach cramps with or without diarrhea

• Regular contractions or uterine tightening

Take action

Call your doctor if you have bleeding in the second half of pregnancy. Hospitalization may be necessary to find the cause. An ultrasound may be performed, and you may need to stay in the hospital for several weeks. A blood transfusion may be required.

Conditions that cause bleeding in the second half of pregnancy may pose a risk to you and your baby. They can be very serious and may require preterm delivery, most often by cesarean section.

In conclusion…

Many women who experience bleeding during pregnancy have mild problems that require no treatment. There is also the saying among women that during pregnancy, some saw blood when the month changed, especially in the first trimester, without any issue. However, bleeding can sometimes be a sign of a serious problem. Whether it occurs early or late in pregnancy, bleeding should always be reported to your doctor. Your health and your baby’s health may depend on how quickly you receive treatment.

 

Dr. Babatsias
Dr. LAMBROS BABATSIAS
OBSTETRICIAN – GYNECOLOGIST SURGEON
Trained in London in Laparoscopy and Hysteroscopy (University Dept. of Obstetrics and Gynecology – Royal Free Hospital – London)

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