BLEEDING DURING PREGNANCY




Pregnancy
is a physiological condition during which the mother nurtures her baby in the womb, the mother’s body provides the necessary conditions needed for the baby to grow. It is a period of emotional turmoil for the mother.

Any untoward signs or symptoms is a cause of fear and worry. The most common sign of a complication during pregnancy is bleeding, though the reasons could be several. Bleeding can be normal during the early stages of pregnancy. But it always has to be treated with caution. The causes and the treatment module varies depending on the stage of pregnancy.

Causes Of Bleeding

Causes Of Bleeding Varies With Each Trimester.

First Trimester:

Any bleeding that occurs during the first three months of pregnancy is first trimester bleeding. First trimester bleeding occurs in 20-30% of all pregnancy. The bleeding can vary from slight spotting to severe bleeding. Upto 50% of cases with first trimester bleeding go into miscarriages. Any tears in the vaginal wall can cause bleeding. Some women experience bleeding after coitus, due to tears on the delicate vaginal wall. Some of the causes of bleeding during first trimester are as follows.

Implantation Bleeding:

Implantation bleeding occurs during the normal implantation of the embryo into the uterine wall. It is normal and the bleeding is minimal. The bleeding occurs on or about the same day of your periods.

Miscarriage:

In threatened miscarriage the fetus is still inside the uterus but there is a chance that you may lose your pregnancy. This is usually caused due to certain infections like urinary tract infections, certain drugs, physical trauma, abnormal fetus or without any cause. Complete miscarriage is the most common cause of bleeding in the first trimester. The embryo is no longer inside the uterus. In complete miscarriage the bleeding and cramping stops. In incomplete miscarriage the embryo is not inside the uterus, but the cervix is open and the bleeding continues.

Missed Abortion:

In missed abortion the developing baby dies inside the uterus. It can occur during any stage of pregnancy. The causes are the same as threatened miscarriage. Missed abortion is also called intrauterine fetal demise.

Ectopic Pregnancy:

Ectopic pregnancy occurs when the fertized ovum implants outside the uterus. The fallopian tube is the most common site. The baby cannot develop in the tube and will die due to lack of nutrients. This is life threatening to the mother as well as it can cause tubal rupture. There are certain risk factors associated with ectopic pregnancy. There is usually a previous history of ectopic pregnancy, prior pelvic surgery, any pelvic inflammatory disease, intra uterine contraceptive devices or a history of infertility for more than two years.

Blighted Ovum:

This may occur if the fetus is abnormal and the embryo fails to develop in the proper location. But an ultrasound exam shows signs of an intrauterine pregnancy.

Molar Pregnancy:

This is a rare cause of bleeding in the first trimester. The ultrasound exam shows signs of pregnancy but the embryo is replaced by abnormal tissues. in some cases it can become cancerous and invade the uterine wall.

Second And Third Trimesters:





Photo Credit: Women-problems.com

Abnormalities or any problems associated with the placenta are the most common causes of bleeding in the later stages of pregnancy.

Placenta Previa:

When placenta covers the opening of the womb completely or partially, bleeding can occur. During the later stages of pregnancy the cervix dilates and causes rupture of the blood vessels of placenta, this is the cause for bleeding in placenta previa. Previous history of placenta previa or caeserian section and multiple pregnancies are risk factors.

Abruptio Placenta:

Sometimes the placenta can separate from the uterine wall prematurely causing bleeding. High blood pressure, trauma, cocaine or tobacco use can cause abruption of the placenta. Previous history of abruption is another risk factor for the same.

Preterm Labor:

A few days or weeks before delivery the mucus plug that covers the opening of the uterus goes off resulting in bleeding. This is a sign of labor. But if this bleeding happens before 37 weeks it is premature labor.

Rupture Of Uterus:

This is a very rare cause of bleeding. The uterine wall ruptures usually along a previous caeserian section scar and the baby is expelled partially or completely into the abdomen. Some other risk factors include more than 4 pregnancies, trauma, excessive use of oxytocin, certain forceps delivery.

Vasaprevia:

This is an extremely rare condition where the developing blood vessels of the umbilical cord or placenta pass over the opening of the uterus and cause bleeding.

Management Of Bleeding During Pregnancy

No amount of bleeding is normal in pregnancy. You should always stay alert when you experience any abnormal signs or symptoms. Some of these are severe bleeding, cramps, contractions, bleeding lasting more than 24 hours, fever, severe localized pain in abdomen, pelvis or back. Do not panic when you spot bleeding. Relax yourself.

Avoid strenuous exercises, lifting heavy weights, sex, douching or use of tampons. Drink plenty of water. It is advisable to use pads when there is bleeding. Keep a count on the number of pads you are using. In threatened miscarriage you can rest at home, but be aware of all signs and symptoms. Follow up is essential. Rest till pain or bleeding stops. Do not use tampons. Avoid sex. In incomplete miscarriage and a dilatation and curettage of the uterus needs to be done to remove all tissues. In complete miscarriage the patient can go home after it is confirmed that there are no more tissues left.

In missed abortion hospitalization and D&C needs to be done. However some prefer to wait for the tissues to pass out and avoid surgery. It all depends on the size and age of the fetus. In ectopic pregnancy surgery is done or the patient is given some medications. Pregnancy needs to be terminated. Molar pregnancy again require D & C. Follow up is essential to check for the development of cancer. Late pregnancy bleeding needs to be monitored carefully.

Immediate caeserian section needs to be done in placenta previa, abruptio placenta, vasa previa and uterine rupture. However, in placenta previa and abruptio placenta, if the pregnancy is less than 36 weeks, and the bleeding is minimal the patient can be monitored in a hospital. In the rupture of uterus, uterus must be removed. If the patient desires to have more children then uterus may be repaired. It is essential to be in touch with your doctor if you experience any complications. Hospitalization may be required at any stage. Try to avoid the risk factors and get lots of rest and nutrition for a safe pregnancy.