BLEEDING DURING PREGNANCY
What can cause bleeding during pregnancy?
Vaginal bleeding or spotting during pregnancy can have many causes. Some are serious and some are not. Bleeding may occur early or late in pregnancy. Many women have vaginal spotting or bleeding in the first 12 weeks of pregnancy. Bleeding of the cervix may occur during sex. An infection of the cervix also can cause bleeding. Slight bleeding often stops on its own. However, bleeding during pregnancy may mean something more serious. You may have a higher chance of going into labor too early (preterm labor), having an infant who is born too small, or having a miscarriage.
How is bleeding during early pregnancy checked?
If you are bleeding in early pregnancy, your health care provider may do a pelvic exam. You will be asked how much blood you have passed and how often bleeding has occurred. Your health care provider also will ask whether you have had any pain, and if so, its location and severity. A blood test may be done to measure human chorionic gonadotropin (hCG). This substance is made by your body during pregnancy. You may have more than one test because hCG levels increase throughout pregnancy. Your blood type also will be checked to see if you need treatment for Rh sensitization. Ultrasound may be used to find the cause of the bleeding. Sometimes the cause is not found.
When does miscarriage happen?
Miscarriage can occur any time in the first half of pregnancy. Most often it occurs in the first 13 weeks. It happens in about 15–20% of pregnancies.
What are the signs and symptoms of miscarriage?
The following signs and symptoms may indicate a miscarriage:
- Vaginal bleeding
- Cramping pain low in the abdomen (often stronger than period cramps)
- Passing tissue from the vagina
Many women with vaginal bleeding have little or no cramping. Sometimes the bleeding stops and the pregnancy continues normally. At other times, however, the bleeding and cramping may become stronger, leading to a miscarriage.
Is treatment needed after a miscarriage?
Dilation and curettage (D&C): a procedure in which the cervix is opened and tissue is gently scraped or suctioned from inside the uterus.
What is an ectopic pregnancy?
An ectopic pregnancy occurs when the fertilized egg does not implant in the uterus. Instead, it implants somewhere else, often in one of the fallopian tubes. An ectopic pregnancy causes pain and bleeding early in pregnancy.
What risks are associated with ectopic pregnancy?
A major risk with this type of pregnancy occurs if the fallopian tube ruptures. A rupture needs prompt treatment. There may be internal bleeding. Blood loss may cause weakness, fainting, pain, shock, or death.
How common are ectopic pregnancies and who is at risk?
Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women are at a higher risk if they have had
- an infection in the fallopian tubes (such as pelvic inflammatory disease)
- a previous ectopic pregnancy
- tubal surgery
What causes bleeding late in pregnancy?
Common problems that cause light bleeding include an inflamed cervix or growths on the cervix. These may be treated with medication. Heavy bleeding usually involves a problem with the placenta. The two most common causes at this time are placental abruption and placenta previa. Preterm labor also can cause such bleeding.
What is placental abruption?
The placenta is attached to the uterine wall. It may detach from the wall before or during labor. This may cause vaginal bleeding. It often causes pain, even if bleeding is light or not seen. When the placenta becomes detached, the fetus may get less oxygen. Prompt care is needed.
What is placenta previa?
When the placenta lies low in the uterus, it may cover the cervix. That means it partly or completely blocks the opening. This is called placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs without pain.
Can bleeding be a sign of labor?
In the later stages of pregnancy, vaginal bleeding can be a sign of labor. A small amount of mucus and blood passes from the cervix just before or at the start of labor. This is called the bloody show and is normal. It is not a problem if it happens within 3 weeks of your due date. If it happens earlier, you may be going into preterm labor. Other signs of preterm labor include the following:
- Vaginal discharge
- A change in the type of discharge (watery, mucus-like or blood-stained)
- An increase in the amount of discharge
- Pressure in the pelvis or the lower abdomen
- Low back pain
- Abdominal cramps, with or without diarrhea
- Frequent contractions or tightening of the uterus
If you have any of these signs or symptoms, contact your doctor as soon as possible.
Glossary
Cervix: the lower, narrow end of the uterus that projects into the vagina.
If tissue remains in the uterus after a miscarriage, the bleeding often continues. In that case your gynecologist may recommend one or more treatments. Medication may be used to help you pass the remaining tissue. The tissue can be removed by dilation and curettage (D&C), or by a suction device, a procedure called suction curettage. Sometimes more than one option is needed.
Ectopic pregnancy: a pregnancy in which the fertilized egg begins to grow somewhere other than inside the uterus, usually in one of the fallopian tubes.
Fallopian tubes: the tubes through which an egg travels from the ovaries to the uterus.
Human chorionic gonadotropin (hCG): a hormone produced during pregnancy. Detecting it is the basis of most pregnancy tests.
Miscarriage: the early loss of a pregnancy.
Placenta: tissue that provides nourishment to and takes waste away from the fetus.
Rhesus (Rh) sensitization: a condition in which a mother with Rh-negative blood produces antibodies that attack the Rh factor, a protein on red blood cells.
Ultrasound: an examination in which sound waves are used to look at internal structures. During pregnancy it can be used to examine the baby.
Uterus: the muscular organ in the female pelvis that holds and nourishes the developing baby during pregnancy.