The following post is intended as information only, and is not intended to replace medical advice. If you have any questions or think you are having an emergency, please contact a medical professional.
When I was pregnant with my l’il bub, I was diagnosed with a subchorionic hematoma after I started bleeding before 7 weeks. The attending doctor who saw me stated it was too soon to tell if the pregnancy was viable, and called it a ‘threatened miscarriage’. I stayed home and relaxed (and cried) for a few days, but by the time my 9 week dating appointment came around, the hematoma was gone and the baby looked great. This was a huge relief for us as we had previously had a miscarriage a few months earlier.
Vaginal bleeding during pregnancy can be absolutely terrifying, and can occur for so many different reasons. Some vaginal bleeding however, is considered completely normal, and not usually a cause for concern. How do you know the difference? If bleeding occurs, take note of the amount, consistency and color of the blood as this can be valuable information for when you speak with your nurse, doctor or midwife. Here is a list of some of the most common (and a few uncommon) reasons for bleeding during pregnancy.
The First Trimester
Bleeding during the first trimester is usually not a cause for concern as it is very common. Some estimates are up to 20% of women will experience some form of vaginal bleeding or spotting during the first trimester. Spotting is typically light and scant compared to bleeding which can range from a light blood flow to a heavy bleeding. Take note of the color, consistency and severity of the bleeding. Scant dark brown to red blood is typically older blood and not a cause for concern when spotting. Deeper red blood that is heavy or has a lot of clotting may be a cause of concern. Call your doctor if you have heavy bleeding, clots, cramping or if you have any concerns.
– Sometimes, when the fertilized egg attaches to the uterine wall, it can cause small amounts of bleeding. It is typically light in color, though some women may mistake it for a light period. This is often one of the first signs of pregnancy women notice (though not all women will have implantation bleeding). Light implantation bleeding is not typically a cause for concern.
– A Chorionic Hematoma is a pooling of blood between the membrane (chorion) of the embryo and uterine wall. The most common is a subchorionic hematoma which is between chorion and the embryo, although retroplacental (behind the placenta and does not touch the gestational sac) and subamniotic (between the chorion and the amnion) can occur as well. Blood from the hematoma may drain and come out through the vagina, although this does not necessarily mean a miscarriage will occur. An ultrasound can identify if a chorionic hematoma has formed. Some studies have shown bed rest during the duration of bleeding increases the rate of full term pregnancies, however other studies have not shown a correlation.
– Heavy vaginal bleeding is not normal, and can be a sign of a miscarriage where the body expels the remains of an embryo and the lining of the uterus. In most cases, the body has recognized that the embryo was not compatible with life and has taken steps to correct the problem. Experiencing a miscarriage can be painful both physically and mentally. An ultrasound can typically diagnose a miscarriage by locating or not locating a heartbeat. In most cases, the body will complete the process on its own, but sometimes an intervention can be needed to make sure mother does not get an infection. Although most common in the first trimester, a miscarriage can occur at anytime.
– An ectopic pregnancy is when a fertilized egg implants itself outside the uterus. Without treatment, an ectopic pregnancy can be fatal to the mother (it is almost never viable for the embro). Early warning signs of an ectopic pregnancy is cramping and vaginal bleeding. Ultrasounds are able to verify the placement of the embryo.
– A molar pregnancy is when a sperm fertilizes an egg that has lost it’s DNA, but the cells continue to duplicate and form a mass. Vaginal bleeding may occur although it typically occurs during the fourth or fifth month of pregnancy. Most moles are benign, but in some cases may develop into cancer. An ultrasound followed up with a tissue examination can diagnose a molar pregnancy.
The Second Trimester
Bleeding (versus spotting) anytime after the first trimester is a cause for alarm. Call your doctor or visit the hospital immediately if you suspect any of the following conditions.
– Placental abruption occurs when the placenta separates from the uterus prior to delivery of the child. It typically occurs after 20 weeks gestation. The severity of the abruption, gestational age, and access to medical care can directly affect both mother and fetus survival rate. Early symptoms often go unnoticed, but can include cramping, vaginal bleeding, contractions, and decreased fetal movement. See your doctor immediately if you suspect placental abruption; medical intervention can greatly increase survival rate.
Hemorrhoids are inflames veins in the lower anus and rectum often caused by straining during bowel movements or increased pressure in pregnancy. They may cause pain, itch, or bleed. Typically blood is noticed on the feces or after wiping. Fortunately, hemorrhoids are not typically a cause for concern and can be treated over the counter. Speak with your doctor about pregnancy safe treatment options or if the pain or bleeding becomes severe.
The Third Trimester
– Placenta Previa occurs when the placenta lies on the lower half of the uterus, partially or completely cover the cervix (opening to the uterus). Although common in early pregnancy, as the uterus grows, the problem often corrects itself. However, if it does not correct itself as the due date approaches, it often requires medical intervention in the form of a c-section. Bright red bleeding typically starts to occur at around the 32 week mark, but can happen sooner. Women with placenta previa are at increased risk for placenta accreta, increta or percreta, in which the placenta grows into, on and through the uterus. All of these conditions can be life threatening.
– Vasa Previa is a condition where the blood vessels from the umbilical cord run in close proximity to the cervix. These blood vessels have little support and if damage around the cervix occurs (such as the mothers water breaking) these vessels tear, causing the baby to start bleeding. Unless an emergency c-section is performed, the baby can bleed out in a matter of minutes. It is an extremely rare condition. Mothers with placenta previa may be at an increased risk. If diagnosed early on in pregnancy, survival of both mother and fetus is around 97%. When a blood vessel ruptures, bleeding from the vagina may be a dark red color indicating it is from the child. Seek medical attention immediately.
– Premature labor is beginning labor before 37 weeks (before lung development). Women may notice a backache, cramping, contraction, bleeding, or her water breaking. It can occur for many reasons. Seek medical attention right away if you suspect you are in labor.
Mucus Plug/Bloody Show
– Again, bleeding during pregnancy isn’t always a bad thing. The bloody show is when the mother’s mucus plug (mucus that helps protect the uterus from bacteria and other invaders during pregnancy) fall out. Unfortunately, it is not a reliable sign of impending labor, as it can fall out weeks to months before a woman goes into labor. Sometimes, it doesn’t fall out until labor and delivery have already begun. Many women don’t notice the loss of their mucus plug. It is typically a small amount of pink tinted mucus.
After the baby is born, the uterus begins involution, a process in which the uterus shrinks backs down to it’s normal size. This includes shedding the lining of the uterus that has nourished baby. Bleeding and clotting can occur for up to six weeks, and some women find the contractions accompanying the process to be painful. For more information on postpartum bleeding or cramping, see my full article on postpartum bleeding (AKA lochia) or how to deal with afterpains
Unfortunately, there’s not much you can do to prevent vaginal bleeding aside from living a healthy lifestyle. Many of the conditions associated correlate with unhealthy lifestyle choices such as smoking, or doing illicit drugs. Women over the age of 35, women who are obese, have pre-eclampsia, and women carrying multiple children also may be at risk. Avoiding high risk physical activities such as riding a horse, rock climbing, fencing etc is also recommended. As always, make sure to attend all appointments with your midwife or doctor. Detecting a problem in advance can help the problem not to escalate into a life threatening issue.
Although bleeding during pregnancy can be a cause for concern, in most cases it is nothing to bee worried about. Life threatening complications are rare, and the majority of women will have safe pregnancies. However it’s a great idea to contact your midwife, doctor or nurse if you have any concerns, to rule out any problems.
Have you ever experienced any type of bleeding during pregnancy? What was your experience like? Let me know in the comments below.