Bleeding During Pregnancy


Bleeding During PregnancyBleeding affects 20% to 30% of all pregnancies. Up to 50% of those who bleed may go on to have a miscarriage (lose the baby). Of even more concern, however, is that about 3% of all pregnancies are ectopic in location (the fetus is not inside the uterus), and vaginal bleeding can be a sign of an ectopic pregnancy.

Out of all the women who experience vaginal bleeding in the first trimester, half will have a miscarriage. But the odds of other problems are lower: ectopic pregnancy occurs in 16 out of 1,000 pregnancies; molar pregnancy occurs in one out of 1,500 to 2,000 births; placenta previa happens in one of 200 births; and placenta abruptio happens in one of 150 births.


Bleeding associated with early pregnancy can be, either

  • Implantation bleeding: A small amount of spotting associated with the normal implantation of the embryo into the uterine wall, is called implantation bleeding. It is primarily caused in first trimester.  The bleeding is usually very minimal, but occurs on or about the same day as your period was due. This can be very confusing if you mistake it for simply a mild period and don't realize you are pregnant. This is a normal part of pregnancy and no cause for concern.

  • Threatened miscarriage: You may have a threatened miscarriage if you are having some bleeding or cramping, due to variation in hormonal cycles. The fetus is  inside the uterus (based usually on an exam using ultrasound), but the outcome of your pregnancy is still in question. This may occur if you have an infection, such as aurinary tract infection, become dehydrated, use certain drugs or medications, have been involved in physical trauma, if the developing fetus is abnormal in some way, or for no apparent reason at all. Threatened miscarriages are generally not caused by things you do, such as heavy lifting or having sex, or by emotional stress.

  • Molar Pregnancy: A molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).

  • Postcoital bleeding is vaginal bleeding after sexual intercourse. It may be normal during pregnancy.

  • Placenta previa: The placenta, is a structure that connects the baby to the wall of your womb, can partially or completely cover the cervical opening (the opening of the womb to the vagina). When you bleed because of this, it is called placenta previa. Late in pregnancy as the opening of your womb, called the cervix, thins and dilates (widens) in preparation for labor, some blood vessels of the placenta stretch and rupture. This causes about 20% of third-trimester bleeding and happens in about 1 in 200 pregnancies.

  • Placental abruption: This condition occurs when a normal placenta separates from the wall of the womb (uterus) prematurely and blood collects between the placenta and the uterus. Such separation is rare.

  • Uterine rupture: An abnormal splitting open of the uterus, causing the baby to be partially or completely expelled into the abdomen. Uterine rupture is rare, but very dangerous for both mother and baby. About 40% of women who have uterine rupture had prior surgery on their uterus, including Cesarean delivery. The rupture may occur before or during labor or at the time of delivery.

Precautions

  • Bleeding During PregnancyIf 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.

  • Never wear a tampon or introduce anything else into the vaginal area such as douche or sexual intercourse if you are currently experiencing bleeding.

  • You should contact your health care provider the same day you notice the spotting. Spotting can be a sign of ectopic pregnancy. If an ectopic pregnancy isnít treated, you can have life-threatening internal bleeding.

  • Stay in regular contact  with your health care provider. This is especially important if you have had prior pregnancies complicated by third-trimester bleeding.

  • Avoid bleeding in pregnancy by controlling your risk factors, especially the use of tobacco and cocaine.

  • If you have high blood pressure, work closely with your health care professional to keep it under control.

 

Your doctor may advise you to take time off work, stay off your feet, and avoid sexual intercourse. While it seems logical that rest would help stabilize a pregnancy, thereís no scientific evidence to show that bed rest makes a difference. If the bleeding is severe, you may need to be hospitalized and given a blood transfusion.
 

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Dated 10 January 2013

 


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