Bleeding in Pregnancy

Bleeding in pregnancy should never be ignored, however insignificant you think it might be.

Bleeding during pregnancy is always alarming and should never be ignored. Severe bleeding in the first trimester may be a sign of miscarriage and occurring after 24 weeks, could indicate premature labour.

Whether it is only a few spots or as much as menstrual period, it is important to seek medical advice at once to determine the cause. Apart from a threatened miscarriage, the most common sources of bleeding are your cervix or the placenta. It is very unusual for any blood to come from the baby.

Bleeding is the most common in the first trimester but it is not automatically a sign of miscarriage. There can be several causes and depending on the reason, your doctor may advise bed rest, an ultrasound scan or a visit to an obstetrician.

Implantation Bleeding

This is normally light and not as heavy as a period. It occurs when the embryo is embedding itself in the wall of the womb, and is not considered a threat to your baby’s wellbeing. Bed rest is advised to reduce the flow of blood to your womb that occurs when standing.

Cervical Bleeding

During pregnancy the rise in oestrogen can cause the cervix to become sensitive and reddened. This is quite common and occasionally there might be slight bleeding. If you have a history of abnormal smear tests, you should seek medical advice immediately.

Ectopic Pregnancy

For one percent of women, bleeding may indicate an ectopic pregnancy. This is when implantation occurs outside the womb, often in the fallopian tube. Sometimes an ectopic pregnancy aborts but in other cases the fallopian tube ruptures. This causes severe internal haemorrhaging and acute pain, without cramping. The pregnancy must be surgically terminated. Emergency surgery may be required and sometimes the fallopian tube may have to be removed.

Placenta Previa

A low-lying placenta is called placenta previa and occurs in one in 250 pregnancies. Bleeding is one of the first signs of placenta previa and an ultrasound will be advised. The placenta may be covering, or partially covering, the cervix entrance, preventing a normal vagina delivery. Once detected, regular scans will be done to see if the placenta moves upwards and away from the cervix as the womb expands. This movement can produce bleeding as a result of part of the placenta peeling away from the expanding womb wall. It may be relatively painless. If the placenta is still obstructing the cervix nearer the birth, a Caesarean will be advised.

Placental Abruption

Placental abruption can be serious and may necessitate an immediate delivery. Occurring in one in 200 pregnancies, it is most commonly associated with women who have high blood pressure. It occurs when the placenta detaches itself from the side of the womb. If this happens in one or two small sections, it may not cause a problem, but if as much as a third comes away, you may be hospitalised for the remainder of your pregnancy. In severe cases, a blood transfusion and an emergency caesarean may be needed.

Bleeding After Sex

Cervical bleeding can sometimes occur after sexual intercourse. Your doctor will advise abstinence until the bleeding stops.

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