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 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 health care provider immediately.

First Half of Pregnancy:

Miscarriage

Bleeding can be a sign of miscarriage but does not mean that miscarriage is imminent. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy. Approximately half of pregnant women who bleed do not have miscarriages. Approximately 15-20% of all pregnancies result in a miscarriage, and the majority occur during the first 12 weeks.

Signs of Miscarriage include:

• Vaginal bleeding
• Cramping pain felt low in the stomach (stronger than menstrual cramps)
• Tissue passing through the vagina

Most miscarriages cannot be prevented. They are often the body's way of dealing with an unhealthy pregnancy that was not developing. A miscarriage does not mean that you cannot have a future healthy pregnancy or that you yourself are not healthy.

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 (20-30%), 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 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—having normal sexual intercourse does not cause a miscarriage.

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 labor. 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 labor. Up to a few weeks before labor 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 labor and should see your physician 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