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Vomiting Blood During Pregnancy: What Is Normal And When To See A Doctor

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Morning sickness is a common symptom of pregnancy that is marked by nausea and vomiting. When vomiting becomes severe and extended, it could lead to vomiting of blood (hematemesis). This is a medical emergency that requires medical attention. In this MomJunction post, we tell you more about the causes, signs and symptoms, complications and ways to get relief from blood vomiting during pregnancy.

What Is Hematemesis (Vomiting Blood)?

Hematemesis refers to vomit that has a significant amount of bright red or gritty coffee ground blood. Usually, the bright red blood indicates any bleeding from the upper gastrointestinal tract, mostly from the esophagus, stomach, or duodenum. Coffee-ground hematemesis occurs when the stomach acids convert hemoglobin to hematin (1).

Is It Normal To Vomit Blood During Pregnancy?

Vomiting blood during pregnancy is not normal, and you should see a doctor in case you are vomiting chunks of blood. It may happen when you have severe morning sickness that irritates the esophageal lining, thus leading to bleeding (2). Gastrointestinal infections or other severe diseases may also lead to blood in the vomit. Should you see blood in your vomit, visit your doctor immediately for a proper diagnosis and remedy.

What Causes Hematemesis In Pregnancy?

The causes of blood in the vomit in pregnant women are the same as that of the general population i.e..people men and women who are not pregnant (3).

Common causes are likely to be:

  • Severe gastritis or peptic ulcer: Gastritis (inflammation of the stomach lining) or peptic ulcers (painful sores in the inner stomach lining) cause a burning sensation in your tummy and damage the artery. This could lead to blood vomiting.
  • Esophageal varices: These are the enlarged veins in the lower esophagus (food pipe), which bleed but may not cause any pain. They are usually caused by hypertension (high blood pressure ) or alcoholic liver disease (liver is damaged due to long term alcohol exposure). If the doctor suspects this, that doctor may ask you to get admitted to the hospital immediately.
  • Tear in the food pipe: Prolonged retching can cause a tear in the esophageal lining, thereby resulting in bleeding.
  • Severe gastro-esophageal reflux disease (GORD): Stomach acids leak out into the esophagus and irritate the lining, causing it to bleed.
  • Swallowed blood: In some cases, you are likely to swallow blood that might come out as blood vomiting. A severe nosebleed could be one such example.

Less common causes are likely to be:

  • Swallowing poisons such as arsenic or corrosive acids
  • Cancer of stomach or esophagus
  • Blood conditions such as thrombocytopenia, hemophilia, leukemia, and anemia

Signs And Symptoms That May Accompany Blood Vomiting

Along with blood in the vomit, you may experience some other symptoms depending on the cause of bleeding. They could be:

  • Nausea
  • Rapid heartbeat
  • Blurred vision
  • Dizziness
  • Confusion
  • Fainting
  • Clammy skin
  • Reduced urine output
  • Pain in upper abdomen

Diagnosis For Blood Vomiting During Pregnancy

Your doctor may ask about the color of the blood vomit, and the history of any injuries you have had in the present or past. Diagnostic tests performed during pregnancy are similar to tests performed on non-pregnant women. Only your doctor can suggest the required imaging test to diagnose the actual cause.

Some of the imaging tests you may be recommended include:

  • Ultrasound scan
  • X-ray
  • MRI scan
  • Endoscopy
  • Nuclear medicine scan
  • Blood tests

Complications Of Vomiting Blood

Some of the common complications of blood vomiting could be:

  • Choking, when the blood may collect in the lungs and impair your ability to breathe effectively.
  • Aspiration, where vomited blood is again drawn in through airways.
  • Anemia, deficiency of red blood cells may develop when there is rapid blood loss through vomiting.

To avoid these complications, pay attention when you are vomiting to check if there is blood, especially when you experience some of the symptoms mentioned above.

Treatment Of Hematemesis During Pregnancy

Management will depend on the severity of vomiting

In case of minimal blood loss, your doctor may prescribe medications. If there is significant blood loss, you might need a blood transfusion or a drip. In severe life-threatening cases, emergency resuscitation or a blood transfusion may be needed.

Treatment usually depends on the cause of blood vomiting. It may involve endoscopy to stop the bleeding by sealing an internal wound or emergency surgery to control severe bleeding (4).

Can You Prevent Throwing Up Blood While Pregnant?

Nausea and vomiting are common during pregnancy, but you can take a few measures to prevent them from becoming severe and resulting in blood vomits (6).

  • Maintain personal hygiene by washing your hands frequently before handling food, after using the toilet, or after handling the trash or contaminated surfaces.
  • Avoid being in contact with anyone who has gastroenteritis.
  • Do not prepare or handle food if you have GI infections.
  • Avoid public pools if you have infections
  • Avoid raw foods and cook meats thoroughly.
  • Avoid spicy foods that irritate the stomach or cause acid reflux.
  • Quit smoking and alcohol
  • Avoid over eating
  • Avoid inducing vomiting when you have too much nausea

Home Remedies To Deal With Blood Vomiting

Vomiting blood during pregnancy may warrant strict medical supervision. Loss of blood makes your body weak, which is not good for your baby’s health. Moreover, a bloody vomit also leaves an unpleasant feeling in your mouth.

Here are a few helpful remedies that might relieve you from the nauseous state in pregnancy:

  1. Saline water: Your body may deplete from fluids or undergo dehydration after recurrent vomiting. You may have to get intravenous fluids or ORS (oral rehydration solutions) that has electrolytes to gain the lost fluids and recover.
  1. Drink lots of water: Consider drinking more water, fruit juices, electrolyte solutions to recover from dehydration.
  1. Eat a well-balanced diet: A proper diet gives you the right amounts of essential nutrients and minerals to keep you healthy. You may feel nauseated when you wake up in the morning. Eating a toast or cracker might mitigate the feeling and could also offer energy.
  1. Avoid oily food, eat less: Stay away from fatty or spicy foods that could trigger bouts of vomiting during pregnancy. It is better to have boiled and somewhat bland foods. Eat small portions throughout the day and avoid eating large quantities before sleeping.
  1. Rest enough: Nausea due to vomiting can create stress, lack of sleep, and fatigue. Rest as much as you can and avoid stress as it could help in healthy fetal growth too.

Is Vomiting Blood A Sign Of Miscarriage?

Vomiting blood is not a sign of miscarriage. Vaginal bleeding, discharge, cramping, and a feeling of weakness are the usual symptoms you may experience in case of a miscarriage (5).

Vomiting blood in pregnancy is a serious condition. Get medical attention for proper diagnosis and treatment to avoid further complications. Take measures to help manage nausea and vomiting in pregnancy to minimize the risk of blood vomiting. If you do notice blood in your vomit, go to the doctor immediately.

References:

1. Shahana Shahid and Nishchay Chandra; Haematemesis in Pregnancy; Differential Diagnosis in Obstetrics & Gynaecology (Book); Taylor & Francis Group
2. Vomiting blood; U.S. Department of Health and Human Services National Institutes of Health (2018)
3. Vomiting blood (haematemesis); NHS (2019)
4. Vomiting Blood: Care and Treatment; Cleveland Clinic (2018)
5. Symptoms-Miscarriage; NHS (2018)
6. Diarrhoea and vomiting; Department of Health; Government of Western Australia

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