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Bleeding in pregnancy

A worried pregnant womanBleeding during pregnancy can be a terrifying ordeal for everyone involved, but it doesn't necessarily mean a miscarriage will occur. There are many reasons behind bleeding in pregnancy and the majority of the 1 in 10 women who experience it go on to have perfectly healthy babies...

Why does it happen?

Many women automatically presume they are witnessing the start of a miscarriage when they bleed during pregnancy, and sadly for some that is the case. However, there are many other causes for blood loss during pregnancy and it's surprisingly common for women to experience it during the first trimester when their body is rapidly changing and adapting to being pregnant.

Many causes of bleeding can be identified and rapidly dealt with but in some cases women can experience blood loss without any identifiable cause. And as odd as it seems, in some instances the cause will reveal itself after their baby arrives in the world, as this Netmums member found:- 

I suffered quite severe blood loss and mild abdominal pains around 8 weeks of pregnancy. I spent the car journey to the hospital in floods of tears whilst I struggled to come to terms with miscarrying but when I arrived the bleeding started to slow down, a scan showed that everything was normal and the doctor simply 'couldn't explain it'. Four weeks later I had a terrible bleed in the middle of the night and we resorted ourselves to the fact that this time it was the real deal - we were losing the baby. Surprisingly, the first thing the sonographer said the next morning was 'there's nothing wrong with that baby' - the relief was indescribable. Nine months later our beautiful daughter was born, though after a relatively natural birth, I had to have a manual removal for a retained placenta - a condition that was, according to my midwife 'quite possibly the cause of the bleeding'.

Helena G  

Bleeding in the first trimester

It can take a while for your body to recognise pregnancy - though you might be feeling all of those much talked about pregnancy symptoms such as sickness and fatigue, it can take a little longer for your new pregnancy hormones to actually bring your period to a complete halt. This can result in breakthrough bleeding around the time of your usual period and usually occurs anytime up to the fourth week of pregnancy. Other common causes are vaginal infections, implantation bleeding and cervical erosion which is the result of the egg firmly settling itself in your womb and your cervix starting to soften. 

More seriously, blood loss can be a sign of an ectopic pregnancy (when the foetus implants itself in the fallopian tubes instead of your womb) - a not so common condition that affects around 1 in 100 pregnant women and requires immediate medical treatment to remove it.

Whatever the cause, it can be a frightening experience, especially during the first few weeks when the risk of miscarriage is higher.

Here are a couple of experiences from Netmums members:

I am on my third pregnancy and although it never happened with the first two, this time I've been bleeding. I went to A&E and they referred me to the gynaecology unit where I had a scan and examination. They said it was where my placenta was low and to take it easy. It has stopped now but it worried the life out of me at the time. I hear so much now about women bleeding in pregnancy it seems to be quite common though it's certainly not nice...

Emma H

I am currently on my 4th pregnancy (7 wks), and with all 3 of my babies I have had bleeding on and off throughout the 9 months. The earliest it started was with my first around 6/7 weeks. I did get an internal scan where we found out she was well and she is now a healthy 5 year old! I have had various different types of bleeding - from spotting to full open flood gates, where I have been convinced I was miscarrying - but all of my pregnancies have continued fine, and so far, thank God, I have had 3 healthy children. I think from past experience, if the bleeding is accompanied with sharp pains, it may be something to be concerned about.

Faye M

Bleeding in later pregnancy

Blood loss in later pregnancy is generally a result of one of the following:-

Cervical ectropion - slight changes to the cervix can cause harmless bleeding and spotting in the second trimesters and it is also common in the first trimester following intercourse.

Placenta abruption is bleeding diagnosed normally after 22 weeks gestation and involves the placenta detaching itself from the inside of the womb. It can happen suddenly after a trauma or if the size of the uterus is reduced (for example when your waters break). Pre-eclampsia can also cause abruptions to the placenta.

You might experience bleeding with slight tummy pain or one or none of these symptoms at all. It can be pain free but the pain from an abruption can be difficult to endure, especially if the blood is being forced back into the muscles of the uterus. You will be scanned if any bleeding is diagnosed and your midwife may recommend an early delivery if necessary.

Placenta praevia - this is a relatively common condition that occurs when the placenta lies low in the womb and blocks the entrance to the cervix. Your midwife may identify this in the second trimester as this is when the lower part of the uterus grows and stretches which can cause bleeding. It's likely to be identified at the 20 week scan and your midwife may request you have a further scan in the last trimester to determine whether a natural delivery is possible. In most cases the placenta moves up in pregnancy but if it remains low, you may be advised to have a c-section.

Show - around the time of your baby's due date, you could experience what's known as a 'show' - the release of the mucus plug which seals the entrance to the cervix. Although it can be quite alarming when it happens, it's also cause for celebration - your baby is finally on its way!

Miscarriage - though the majority of miscarriages occur in the first trimester, some do happen in the later stages of pregnancy (though it's very uncommon for it to happen after 30 weeks).

What tests will I need to have?

If you notice bleeding, even very minor spotting, it's important to get it checked out immediately to rule out any serious problems. You will probably know by the way you feel if it's something to be concerned about and many women to report to instinctively realising when there is cause for concern, as Faye M explains:

The question the sonographers always asked me when I went for scans due to bleeding is do I still 'feel' pregnant -and I think this is a very good thing to ask. If in tune with your body, and you have had some good old pregnancy symptoms, again it is another way perhaps of shedding some light on the situation.

Your midwife or GP will need to check your stomach/pelvic region and you may need to have a vaginal examination, ultrasound or blood tests to check your hormone levels. The sonographer may advise you to have an internal scan to ensure they get the best possible view of the womb as these are generally more detailed and therefore better equipped to get to the root of the problem.   

Depending on the severity of the bleeding and the likely reasons behind it, you may be advised to stay at the hospital so you can be closely monitored for a while. If the condition poses a threat to the health and development of your baby, you may need to remain in hospital until the birth or be on strict orders to leave work and rest at home. 

Are you pregnant and concerned about something? Share your worries, make friends and find instant advice in our antenatal and early pregnancy forums.

If you have suffered a miscarriage and are struggling to cope, our Parent Support workers are on hand to help you get through those tough times. Find out more and get in touch here.

 

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