Spotting and bleeding from the vagina during pregnancy is common. Almost 50% of the pregnant women experience vaginal bleeding and panic. Do you think this is a miscarriage symptom? Or is there any possibility of having periods during pregnancy? Well, before you get startled, know that vaginal bleeding during early pregnancy is not something that should worry you. It is in fact a good sign to show that you are a pregnant.
The bleeding may range from light bleeding or spotting to massive bleeding. Light spotting during pregnancy is not a matter of concern, but heavy bleeding can be an indication of a serious disorder. It is important to know the possible causes and undergo a check up to eradicate any complications.
The Difference Between Spotting And Bleeding:
If you observe brown or pink discharge similar to what you observe at the end of your menstrual period, it is spotting. If you observe a bright red discharge, it is bleeding. The amount of blood you notice is another warning sign. Spotting in pregnancy may not soak a sanitary pad, but bleeding does.
What Causes Spotting During Pregnancy?
Light spotting in early pregnancy is usually not a serious condition. It can happen at the same time your menstrual period would have been due and lasts for one to two days. The other causes of bleeding in early pregnancy can be any of the following:
1. Implantation Bleeding:
In the early pregnancy phase, about 20 to 30 % women may experience spotting because of implantation of the embryo into the uterine wall. It will occur around the time of your expected menstrual period. It can be confusing if you mistake it for a normal period before you realize you are a pregnant. This is normal during pregnancy and should not be a cause of worry.
During pregnancy, the flow of blood to the cervical region increases. Therefore, it is quite normal to observe light spotting after intercourse. Also, the region will be tender and any kind of minor stress can cause spotting. Sometimes, benign growths will occur on the cervix, known to be cervical polyps, which can also cause spotting after having intercourse.
3. Internal Pelvic Exam or Pap Smear:
Spotting after an internal pelvic exam or pap smear also holds the same reasons as above. The cervical region will become tender because of the increased blood flow and any bump to the region could cause spotting.
Conditions that are unrelated to pregnancy can also cause spotting. Vaginal infections like bacterial vaginosis or yeast infection or sexually transmitted diseases like herpes, chlamydia, gonorrhea or trichomoniasis can cause inflammation or irritation of the cervix. The inflammation can lead to spotting on being ruptured by sex or other stress.
[ Read: Infections During Pregnancy ]
5. Subchorionic Hemorrhage:
Chorion is the fetal membrane that encloses the placenta. Subchorionic hemorrhage is a condition wherein bleeding happens within the folds of the chorion and the placenta. It usually stops by itself and does not lead to problems during pregnancy. Still, a prompt diagnosis and required treatment is suggestible.
6. Nearing Labor:
As your body prepares for labor, you will pass your mucus plug, a state where your cervix begins to dilate. It will be soaked in blood, that is also called ‘bloody show’. Passing your mucus plug will not be a concern if you are already into 37 weeks of pregnancy. But, if there is heavy bleeding, be sure to consult a gynecologist.
What Causes Bleeding During Pregnancy?
Vaginal bleeding can occur at any time during pregnancy. It is rarely a sign of a serious condition, since it can accompany many pregnancy complications. But, it can sometimes be a sign of serious condition too. Therefore, it is important to understand the possible causes and get a check up done.
Bleeding In First Trimester Of Pregnancy:
Vaginal bleeding during pregnancy first trimester can be caused by various factors. Nearly 20 to 30% of pregnancies will be affected with bleeding during this phase.
1. Ectopic Pregnancy:
In an ectopic pregnancy, the fertilized egg implants outside the uterus, that is usually in the fallopian tube. You will usually notice cramping and a sharp pain in the lower abdominal region accompanied by dizziness, weakness and nausea. It can be life threatening to mother and requires immediate medical attention. Statistically, only 3% of pregnancies experience it.
Ectopic pregnancy can happen if you have had a history of the any of the following complications:
Prior ectopic pregnancy, ligation or Fallopian tube surgery, pelvic inflammatory condition, infertility for more than 2 years, smoking and having a birth control device placed in the uterus.
[ Read: Ectopic Pregnancy Symptoms ]
2. Molar Pregnancy:
Molar pregnancy is a rare condition that results when the placenta becomes a cystic mass from a malformed embryo. This is a type of tumor that occurs because of pregnancy hormones and is not life threatening at all. It happens within a few weeks of conception. In some cases, it can turn out to be abnormal and can spread throughout the body, the condition being diagnosed as gestational trophoblastic disease. You can observe vaginal bleeding within few weeks of conception if you happen to suffer from molar pregnancy.
One of the major concerns with bleeding during first trimester of pregnancy is that it can be a miscarriage as well. It is common to occur during the initial 12 weeks of pregnancy. If bleeding accompanies symptoms like cramping, lower abdominal pain and passage of tissue through the vagina, then there is a higher chance of miscarrying the baby. About 50% pregnant women who experience the symptoms along with vaginal bleeding, miscarry a baby.
[ Read: How To Cope With A Miscarriage ]
Bleeding In Second And Third Trimesters Of Pregnancy:
The common cause of bleeding during late pregnancy is due to placenta problems. Also, abnormal cervix or vagina can cause bleeding.
4. Placenta Previa:
This is the most common cause of bleeding during late pregnancy. In this condition, the placenta that usually connects the fetus to the womb will cover a part of the cervical opening. As a result, bleeding takes place. Later in pregnancy, the cervix becomes thin and dilates to prepare for labor. At this stage, the placenta stretches and ruptures causing heavy bleeding. The risk factors for this placenta previa condition include prior placenta previa, multiple pregnancies and prior cesarean delivery.
[ Read: How To Treat Placenta Previa ]
5. Placenta Abruption:
This condition occurs in the second half of pregnancy or the third trimester. It is an early separation of placenta from the uterus and it leads to blood collection in the region between the placenta and uterus. It is accompanied by cramps, pains in the abdominal region, tenderness in the uterus and back pain. If the separation is too little, it is not lethal for the baby. But, it will pose severe risks if the separation is large. The risk factors for this cause of vaginal bleeding include trauma, hypertension, usage of tobacco, cocaine and prior placenta abruption.
6. Uterine Rupture:
In rare conditions there will be an abnormal splitting of the uterus due to a scar from a prior C-section. It makes the fetus expel into the abdomen that can be quite dangerous for both the baby and the mother. The uterine rupture can occur before or during the labor time. There are certain other risk factors that include trauma, multiple pregnancies, using excess amounts of oxytocin medicine (strengthens contractions) and deliveries through forceps.
[ Read: Uterine Rupture During Pregnancy ]
7. Fetal Vesssel Rupture:
The developing blood vessels of the fetus may cross the opening of the birth canal. These are known to be vasa previa and can be lethal to the baby as blood vessels can tear open and bleed severely. This condition is also accompanied by abnormal fetal heart rate. It is a very rare condition that happens in 1 out of 5000 pregnancies.
8. Pre-term Labor:
If the delivery time falls between week 20 to week 37, it is considered a pre-term labor. It is accompanied by cramping, regular contractions, built-in pelvic pressure and back pain. A few days before your body prepares for labor, you will pass your mucus plug where bleeding starts. This is termed as a bloody show that requires an immediate contact with your health care provider.
Some other causes of bleeding in late pregnancy include:
- Injury to vagina or cervical region
- Varicose veins (abnormal veins with full of twists and turns)
[ Read: How To Avoid Premature Delivery ]
What Should You Know?
Light spotting is normal and nothing to be worried. Severe vaginal bleeding that soaks through the pad is a concern. Bleeding is not always a sign of miscarriage since some women suffer high bleeding still deliver healthy babies.
What Should You Do?
It is not possible to judge the right cause for vaginal bleeding since many factors can cause the condition. The universal advice is you should not hesitate to consult your doctor.
Use a pad as it helps you keep a track on how much you are spotting or bleeding. Examine the type of blood (whether it is brown, red, pink or full of clots). Bring all your issues to the doctor and do not indulge in sex or use a tampon when you are bleeding during pregnancy.
Your doctor will check the vagina and may suggest you to go for an ultrasound scan. Vaginal and abdominal ultrasounds occur together to evaluate the reason. Your doctor may also perform a few regular tests like blood and urine. These tests would help check the hormonal levels of pregnancy. Also, check for any of the following symptoms. If you experience them, they could be signs of miscarriage or any other serious condition.
- Severe cramps and pains in the lower abdomen
- Heavy bleeding
- Vaginal discharge that expels tissue
- High fever with 100.4 or more degree Fahrenheit
Vaginal Bleeding During Pregnancy: Self Care
If you bleed during the initial stages of pregnancy, you should take it easy until your doctor checks and gives you instructions. At the moment, just rest and relax. Do not take any heavy stress or indulge in strenuous exercises. Avoid sex, using a tampon and or contraception. Always keep your body cool by drinking plenty of water. Also, keep a check on the amount of pads you are using.
If you experience heavy bleeding during late pregnancy, you need to consult your doctor immediately.
Diagnosing Vaginal Bleeding During Pregnancy:
There are many diagnostic tests your doctor may take you through to evaluate the cause of the abnormal bleeding during pregnancy:
- Pap smear test is conducted to rule out cervical cancer. During this test, the tissue samples will be taken from the cervical region and tested for the presence of different infections like gonorrhea or chlamydia.
- A complete blood picture is done to rule out anemia (low red blood cell count) that results from severe blood loss.
- If there is something in the medical background of the patient that raises a doctor’s speculation, certain blood tests are done to rule out any blood clotting disorders.
- A blood test sample will be conducted to evaluate any thyroid abnormality, liver dysfunction or kidney abnormalities.
- A blood test to check the progesterone levels and daily body temperature to verify the actual ovulation date.
- A blood hormone test to suspect polycystic ovary.
- Pelvic ultrasound is conducted to check the complete medical history and pelvic examination.
- Endometrial sample test to rule out cancer in the uterus.
Vaginal Bleeding During Pregnancy Treatment:
The treatment depends on the actual cause of your bleeding. You may require medical tests and examinations.
Treatment For Early (First Trimester) Pregnancy Bleeding:
An ultrasound detects an ectopic pregnancy. The doctor may either prescribe you medications or take you into surgery.
You may be given methotrexate medication (trexall or rheumatrex), which destroys developing tissue.
Surgery is an option for those whose bodies are not susceptible to receive methotrexate treatment. Also, if you do not choose to take medication therapy, you may go for the surgical option. Laparoscopic surgery makes tiny incisions in the abdominal region through the fallopian tube and removes the ectopic pregnancy. The fallopian tube may also get damaged in this process since the ectopic pregnancy already creates damage to the tube.
If you are bleeding as a result of threatened miscarriage, your doctor may instruct you to take up some activities. He might suggest you take a complete home rest till the pain and bleeding subsides. You should avoid intercourse for at least three weeks. Also, do not use tampons or douche.
If this is the case, your doctor performs a procedure to remove fetal tissue in the uterus. This procedure called dilation and curettage (D&C) prevents further complications such as infection or hemorrhage.
If your bleeding is due to a missed abortion, your doctor may either suggest you for an admission or home treatment. This decision will be made only after discussing the benefits and risks of both the choices. The size and age of the fetus are important when going into the action.
In this case, the complete passage of fetus and adjoining tissues are removed. You will be sent to home only when the ultrasound shows no residual tissue.
In this case, an immediate D&C is done. This procedure is followed by hCG level blood tests to check for any remaining tumor.
Treatment For Late (Second&Third Trimester) Pregnancy Bleeding:
If you experience vaginal bleeding during late pregnancy, you will get a complete monitoring for signs of shock and blood loss. You will receive possible blood transfusions and IV fluids. Also, there will be a fetal check for signs of distress. The possible treatment depends on the cause and age of the fetus.
If this condition is the cause of bleeding, then doctors will always prefer to deliver the baby by cesarean. If you suffer from severe bleeding, you should go for an immediate delivery. If you have contractions, you will receive an IV to stop or reduce them. If your pregnancy is less than 36 weeks and bleeding is not severe, the doctor will monitor your blood count and baby’s heart rate. You will receive a medicine to make your baby’s lungs mature. When you reach exact 36 weeks, the doctor will again check for the condition of baby’s lungs and accordingly you will have a delivery.
In case of Plancental Previa, all deliveries will be cesarean because bleeding may cause a high risk to the fetus. In rare cases, when the placenta is not covering the cervical region, then you can go for a normal delivery. Through a cesarean delivery, you will lose about 3 pints of blood from the body.
In this case, vaginal delivery is preferred over cesarean delivery. If you experience severe bleeding, you will have a cesarean delivery. If your pregnancy is more than 36 weeks, you will receive IV medication for contractions to have a safe vaginal delivery. If your pregnancy is less than 36 weeks and bleeding is not severe, you will be hospitalized and checked for blood counts and baby’s heart rate. Also, you will receive a medication to make your baby’s lungs mature. Once they are mature, you will have a cesarean delivery.
If the tests result in a uterine rupture, you will have an immediate Cesarean delivery. Your surgeon may remove your uterus. But, if you want to have more children, your surgeon will go for the repair of the uterus. Also, you will require many blood transfusions since there will be a heavy loss of blood during the surgery.
Vaginal Bleeding During Pregnancy – Follow-Up:
After proper treatment, if you still notice any complications that may include abdominal pain, bleeding or fever, you should get yourself re-examined immediately.
- You may receive a bed rest with strict warning of not to place anything in the vaginal region.
- Avoid sexual intercourse, do not use tampons until the bleeding stops.
- You should meet your gynecologist within two days of treatment.
- If you receive treatment for ectopic pregnancy and still notice pain or weakness, you should meet the doctor immediately.
- If you had molar pregnancy, you would require a regular follow-up of b hCG levels to check for any tumor.
[ Read: Reasons For Bed Rest During Pregnancy ]
Vaginal Bleeding During Pregnancy – Prevention:
A great way to prevent pregnancy complications is to maintain a good relationship with your doctor and go for routine checkups. Note that this is important when you have had already experienced complications in your prior pregnancies.
The second way to assure a safe pregnancy is to control the risk factors. You should completely cut down cocaine and tobacco. If you are hypertensive, try to keep it under control by taking the complaint to your doctor.
A Final Word:
Any bleeding during pregnancy, no matter when you experience, you need to call your health care provider immediately, only to confirm nothing is wrong. You should be prepared to give out the answers in detail about the amount, color and period of bleeding to help your health care provider determine the cause.
If you had a miscarriage due to any of the above reasons, it does not mean that you are infertile. And know that you are not alone who suffer such a tragedy. Most women experience miscarriage at least once during their reproductive lifetime. Miscarriages can cause an emotional vacuum, but that is not the end of the world. You can become pregnant even after a miscarriage. A counseling session with the obstetrician or gynecologist is the best way to deal with pregnancy. All you need is a positive mindset and courage!
Most of the time, a little spotting doesn’t pose any health risk to you and your little one, though, bleeding can sometimes specify a difficulty with your pregnancy. If you are pregnant, you need to be conscious about your bleeding. If you experience any irregular bleeding or period during pregnancy, contact your doctor immediately.
Hope we cleared your doubts regarding vaginal spotting and bleeding during pregnancy. Take care of yourself! Have a happy and healthy pregnancy.
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