Bleeding
during pregnancy is common, especially
during the first
trimester, and usually it's no cause for
alarm. But because bleeding can sometimes be a sign of something serious, it's
important to know the possible causes, and get checked out by your doctor to
make sure you and your baby are healthy.
Bleeding
in the First Trimester
About 20% of women have some
bleeding during the first 12 weeks of pregnancy. Possible causes of first trimester
bleeding include:
Implantation bleeding. You
may experience some normal spotting within the first six to 12 days after you
conceive as the fertilized egg implants itself in the lining of the uterus.
Some women don't realize they are pregnant because they mistake this bleeding
for a light period. Usually the bleeding is very light and lasts from a few
hours to a few days.
Miscarriage. Because miscarriage is most common
during the first 12 weeks of pregnancy, it tends to be one of the biggest
concerns with first trimester bleeding. However, first trimester bleeding does
not necessarily mean that you’ve lost the baby or going to miscarry. In fact,
if a heartbeat is seen on ultrasound, over 90% of women who experience first
trimester vaginal
bleeding will not miscarry.
Other symptoms of miscarriage
are strong cramps in the lower abdomen and
tissue passing through the vagina.
Ectopic pregnancy . In an ectopic pregnancy, the fertilized
embryo implants outside of the uterus, usually in the fallopian tube. If the
embryo keeps growing, it can cause the fallopian tube to burst, which can be
life-threatening to the mother. Although ectopic pregnancy is potentially
dangerous, it only occurs in about 2% of pregnancies.
Other symptoms of ectopic
pregnancy are strong cramps or pain in the lower abdomen, and lightheadedness.
Molar
pregnancy (also called gestational
trophoblastic disease). This is a very rare condition in which abnormal tissue
grows inside the uterus instead of a baby. In rare cases, the tissue is
cancerous and can spread to other parts of the body.
Other symptoms of molar
pregnancy are severe nausea
and vomiting, and rapid enlargement of the uterus.
Additional causes of bleeding
in early pregnancy include:
- Cervical changes. During
pregnancy, extra blood flows to the cervix. Intercourse or
a Pap test, which cause contact with the cervix, can trigger
bleeding. This type of bleeding isn't cause for concern.
- Infection. Any
infection of the cervix, vagina, or a sexually transmitted infection
(such as chlamydia, gonorrhea, or herpes) can cause
bleeding in the first trimester.
Bleeding
in the Second and Third Trimesters
Abnormal bleeding in late pregnancy
may be more serious, because it can signal a problem with the mother or baby.
Call your doctor as soon as possible if you experience any bleeding in your
second or third
trimester.
Possible causes of bleeding in
late pregnancy include:
Placenta previa. This condition occurs when the
placenta sits low in the uterus and partially or completely covers the opening
of the birth canal. Placenta previa is very rare in the late third trimester,
occurring in only one in 200 pregnancies. A bleeding placenta previa, which can
be painless, is an emergency requiring immediate medical attention.
Placental abruption. In about 1% of pregnancies, the
placenta detaches from the wall of the uterus before or during labor and blood pools
between the placenta and uterus. Placental abruption can be very dangerous to
both the mother and baby.
Other signs and symptoms of
placental abruption are abdominal
pain, clots from the vagina, tender
uterus, and back pain.
Uterine
rupture. In rare cases, a scar
from a previous C-section can tear open during pregnancy. Uterine rupture can
be life-threatening, and requires an emergency C-section.
Other symptoms of uterine
rupture are pain and tenderness in the abdomen.
Vasa previa. In this very rare condition, the
developing baby's blood vessels in the umbilical cord or placenta cross the
opening to the birth canal. Vasa previa can be very dangerous to the baby
because the blood vessels can tear open, causing the baby to bleed severely and
lose oxygen.
Other signs of vasa previa
include abnormal fetal heart
rate and excessive bleeding.
Premature
labor. Vaginal bleeding late in pregnancy
may just be a sign that your body is getting ready to deliver. A few days or
weeks before labor begins, the mucus plug that covers the opening of the uterus
will pass out of the vagina, and it will usually have small amounts of blood in
it (this is known as "bloody show"). If bleeding and symptoms of
labor begin before the 37th week of pregnancy, contact your doctor right away
because you might be in preterm labor.
Other symptoms of preterm labor
include contractions, vaginal
discharge, abdominal pressure, and ache
in the lower back.
Additional causes of bleeding
in late pregnancy are:
- Injury to the cervix
or vagina
- Polyps
- Cancer
What
to Do If You Have Abnormal Bleeding During Pregnancy
Because vaginal bleeding in any
trimester can be a sign of a problem, call your doctor. Wear a pad so that you
can keep track of how much you're bleeding, and record the type of blood (for
example, pink, brown, or red; smooth or full of clots). Bring any tissue that
passes through the vagina to your doctor for testing. Don't use a tampon or
have sex while you are still bleeding.
You should expect to receive an
ultrasound to identify what the underlying cause of your bleeding may be.
Vaginal and abdominal ultrasounds are often performed together as part of a
full evaluation.
Go to the emergency room or
call 911 right away if you are experiencing any of the following symptoms,
which could be signs of a miscarriage or other serious problem:
- Severe pain or
intense cramps low in the abdomen
- Severe bleeding,
whether or not there is pain
- Discharge from the
vagina that contains tissue
- Dizziness or fainting
- A fever of more than
100.4 or more degrees Fahrenheit and/or chills
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