Pregnancy and Bleeding

There are many different reasons that a woman may have vaginal bleeding during pregnancy. Some women can continue to have light periods or spotting during pregnancy, especially during the first few months. A pregnancy test would probably help to ease your mind. A visit to your practitioner may also be in order, either for early pregnancy care or to find out the reasons for your symptoms. Here is a comprehensive list of the many possible causes.

Early Pregnancy and Implantation Bleeding

Are you experiencing first trimester bleeding? It's estimated that 25% of all women have bleeding in early pregnancy. One possible cause of this bleeding is implantation bleeding.

What is Implantation Bleeding?

Implantation bleeding is lighter than menstrual bleeding, and consists of pink or brown colored blood. Implantation bleeding occurs when the trophoblast, or tissue that surrounds the egg, attaches to the endometrium and slowly eats its way into the lining. As it does so, it eats through the mother's blood vessels, forming blood lakes within itself. When these blood lakes form near the surface of the trophoblast, they often cause implantation bleeding.

Is it safe to travel in two wheeler during pregnancy

Remember, the difference between period and implantation bleeding is the amount; implantation bleeding is considerably lighter than menstrual bleeding. Menses and implantation bleeding should be different enough so that you can tell. Here are some frequently asked questions about spotting:

When does implantation bleeding occur?

Usually 5-12 days after ovulation, so just around the time that you would be getting your period. Bleeding during ovulation is something different.

What does implantation bleeding look like?

Implantation bleeding signs are a light pink or brown colored spotting.

How long does implantation bleeding last?

The duration varies for each woman.

Miscarriage

Bleeding while pregnant doesn't mean that miscarriage is certain, but it can occur. About half of the women who bleed do not have miscarriages. Miscarriage can occur at any time during the first half of pregnancy. Most occur during the first 12 weeks. Miscarriage occurs in about 15 to 20 percent of pregnancies. If you think you have passed fetal tissue, take it to the doctor's office so it can be examined.

Most miscarriages cannot be prevented. They are often the body's way of dealing with a pregnancy that was not normal. There is no proof that exercise or sex causes miscarriage.

Ectopic Pregnancy

Another problem that may cause pain and bleeding in early pregnancy is ectopic pregnancy. If pregnancy occurs in a fallopian tube, it may burst. Ectopic pregnancies are much less common than miscarriages. They occur in about one in 60 pregnancies.

Molar Pregnancy

A rare cause of early bleeding is molar pregnancy. It is also called gestational trophoblastic disease (GTD) or simply a "mole." It is the growth of abnormal tissue instead of an embryo.

Late Pregnancy

The causes of bleeding in the second half of pregnancy differ from those in early pregnancy. Common conditions that cause minor bleeding include an inflamed cervix or growths on the cervix.

Placental Abruption

The placenta may detach from the uterine wall before or during labor. This may cause vaginal bleeding. Only 1 percent of pregnant women have experienceplacental abruption. It usually occurs during the last 12 weeks of pregnancy. Stomach pain often occurs, even if there is no obvious bleeding.

Placenta Previa

When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa. It may cause vaginal bleeding. Placenta previa is serious and requires prompt care.

Labor

Late in pregnancy, vaginal bleeding may be a sign of labor. A plug that covers the opening of the uterus during pregnancy is passed just before or at the start of labor. A small amount of mucus and blood is passed from the cervix. This is called "bloody show." It is common. It is not a problem if it happens within a few weeks of your due date.

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Ectopic Pregnancy

What is an ectopic pregnancy?

It's a pregnancy that develops outside the womb, usually in one of the fallopian tubes. That is why it is also known as a tubal pregnancy. It happens in about two of every 100 pregnancies in India.

As the pregnancy grows, it causes pain and bleeding and, if not recognized, the tube can rupture, causing internal bleeding. This is a medical emergency and can be fatal. The pregnancy itself never survives -- it can't be moved to the womb and has to be removed.

When is it likely to happen?

An ectopic is most commonly found between the fourth and tenth week of pregnancy -- usually from weeks five to seven.

Why does it happen?

The fertilised egg normally spends four to five days travelling down the tube from the ovary to the womb where it implants and begins to develop. The most common reason for an ectopic pregnancy is when the fallopian tube has been damaged, and this causes a blockage or narrowing which prevents the egg from reaching its destination. Instead, it implants in the wall of the tube.

In a few cases, the egg implants in an ovary, in the cervix, directly in the abdomen, or even in an earlier c-section scar. In rare cases, a woman may have a normal pregnancy in her uterus and an ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it's more likely to happen if you've had fertility treatments, such as in-vitro fertilisation.

Who is at risk?

An ectopic pregnancy can happen to any woman, but there are circumstances, which make it more likely. These might include:

Þ If you've had pelvic inflammatory disease (which is most often caused by the sexually transmitted infection chlamydiaor or gonorrhoea) as this can cause damage and scarring to the fallopian tubes. Some experts believe that up to half of all ectopic pregnancies are related to the chlamydia infection. Experts also believe that if chlamydia has affected your fallopian tubes then your risk of an ectopic pregnancy is much increased.

Þ If you have tubal endometriosis. You may be more at risk because this increases the risk of scarring.

Þ If you've had any abdominal surgery, including an appendix removal or a caesarian section.

Þ If you have a contraceptive coil fitted. While this will prevent a pregnancy in the womb, it's less effective at preventing one in the tube.

Þ If you are taking the contraceptive mini-pill. This has been associated with a slightly higher rate of ectopic pregnancy.

Þ If you've had a previous ectopic pregnancy.

Þ If you are over 35.

Am I Pregnant?

What are the symptoms?

Þ One-sided pain in the lower abdomen that is severe and persistent is the most common symptom. Many women describe it as an intense stabbing pain. Any woman who experiences this and who could possibly be pregnant should see a doctor.

Þ Collapse, preceded by feeling faint, dizziness, diarrhoea, vomiting and/or pain.

Þ Vaginal bleeding. You might not know that you're pregnant and mistake this for a period, but the blood is usually different from a normal period - often dark and watery.

Þ Shoulder-tip pain. This can happen if there is internal bleeding which irritates other internal body organs, such as the diaphragm.

Þ Pain in the lower back

Þ Pain when having a wee or opening your bowels.

What should I do?

If you have any of these symptoms, go to hospital right away. You're likely to be referred for an ultrasound examination and a sensitive pregnancy test (unless the tube has ruptured, in which case you'll go straight to surgery).

The scan may be done using an intravaginal probe, as the pregnancy may not show up using an abdominal scan. You might also have a blood hormone test if the scan isn't conclusive.

How is it treated?

If an ectopic pregnancy is suspected you will probably be taken to theatre for a laparoscopic examination (where a narrow viewing instrument is put into your abdomen through a tiny cut) to inspect your tubes. If an ectopic is discovered, the surgeon can remove this using the laparoscope to cut the tube and remove the pregnancy, leaving the tube intact.

If the tube has ruptured, sometimes abdominal surgery is needed rather than laparoscopic surgery (although not always) to remove the pregnancy and tubal damage. In some cases, a blood transfusion may be needed to replace lost blood.

In some hospitals the drug methotrexate, which terminates the pregnancy, can be used instead of surgery. This treatment is most effective in very early pregnancy and it can be used where there is no bleeding and the tube has not ruptured. The pregnancy is lost and reabsorbed by the mother, who will then experience bleeding for a couple of weeks. Methotrexate may also be used if the ectopic is picked up very early on and the levels of the pregnancy hormone HCG are still fairly low.

However, do let your doctor know if you are breastfeeding an older child or if you have certain health conditions. In such cases, your doctor may not prescribe the medicine and would look at other options, which may include surgery.

Note: If your blood is Rh-negative, you'll need a shot of Rh immunoglobulin after being treated for an ectopic pregnancy (unless the baby's father is also Rh negative).

Will it affect my fertility?

The answer to this is yes, possibly.

If your fallopian tubes are undamaged after an ectopic pregnancy, then your chances of conceiving again remain the same. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced. Up to ten per cent of women may become infertile after an ectopic.

Some 65 per cent of women will conceive again within 18 months of an ectopic, but if both your fallopian tubes were damaged or ruptured, you may need to think about IVF treatment.

What are the chances of having another ectopic?

There's about a 10 per cent risk of having another one. However, the risk is difficult to generalise about because of the differences in individual circumstances and the extent of the damage that takes place. That means that your overall chances of having a normal pregnancy next time around are still high.

You should arrange for a follow up appointment and ask for clear advice about your own future pregnancies from a consultant obstetrician.

There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current chlamydia infection you can have a course of antibiotics to clear it up and reduce further damage to your tubes.

When you do become pregnant again, see your doctor as soon as you can as you would be referred to an early pregnancy unit for a scan to check that your pregnancy is developing in the right place.

How long should I wait before trying for another?

Normally women who've had a laparoscopy are advised to wait three to four months before trying to conceive again. If you have had abdominal surgery, it's best to wait for six months to allow scarring to heal.

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Pregnancy and Bleeding - II

Ectopic Pregnancy

An ectopic pregnancy occurs when fertilized egg does not implant in the uterus. Instead, it implants somewhere else, often in one of the fallopian tubes. An ectopic pregnancy causes pain and bleeding early in pregnancy.

A major risk with this type of pregnancy occurs if the fallopian tube ruptures. A rupture needs prompt treatment. There may be internal bleeding. Blood loss may cause weakness, fainting, pain, shock, or death.

Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women are at a higher risk if they have had

• an infection in the fallopian tubes (such as pelvic inflammatory disease)
• a previous ectopic pregnancy
• tubal surgery

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First Trimester Bleeding

You’ve shared the exciting news of your pregnancy with your friends and family. Then, one morning you wake up and notice a spot of blood on your underwear, and suddenly you're as frightened as you've ever been.

Don't panic. Although bleeding during pregnancy is never considered "normal," bleeding during the first trimester is very common. In fact, approximately one-quarter of all women who deliver healthy babies experience some bleeding in the first trimester.

Of course, bleeding can also be a sign of impending miscarriage, so it's important to discuss any bleeding with your midwife or doctor. She or he will probably wish to examine you (though not necessarily on an emergency basis), and will most likely order an ultrasound test to further evaluate your pregnancy.

What causes bleeding in the first trimester? And what type of bleeding is likely to indicate a miscarriage? One possible cause of light bleeding in the first trimester is related to the aggressive growth of the placenta. As the placenta establishes contact with the maternal circulation, some bleeding of the uterine wall may occur. This could cause retro-placental bleeding (a small collection of blood behind the placenta) and some of the blood may escape, causing vaginal bleeding.

There are several signs that may indicate the bleeding is a symptom of impending miscarriage. The most sensitive sign, and the one that your practitioner will probably ask you about first, is pain. In an impending miscarriage, bleeding is almost always associated with some lower abdominal cramping. Also, the volume of bleeding is generally quite a bit heavier in an impending miscarriage than in a normal pregnancy.

A blighted ovum is the most common cause of miscarriage. This term is somewhat misleading because it is not necessarily the ovum that is abnormal, but rather the combination of the ovum and sperm. The resulting chromosomal defect is so severe that although the pregnancy advances, development cannot proceed beyond the earliest stage. In most cases of blighted ovum, only the placental tissue, not the embryo, has developed. A blighted ovum does not indicate that either parent has a chromosomal abnormality. It affects only the fertilized ovum in question. There is no reason to believe that it will happen again in a future pregnancy.

This has important implications for dealing with miscarriage, both medically and psychologically. Because a blighted ovum is determined at the moment of conception, nothing can be done to prevent a miscarriage. If it's going to happen, it's going to happen. This also means that if you do have a miscarriage, you should never blame yourself. Virtually nothing you do can disrupt a normal pregnancy and, conversely, there is nothing you can do to save an abnormal one.

Lastly, bleeding may also be a sign of a much less common condition-ectopic pregnancy. Ectopic pregnancy, also known as tubal pregnancy, occurs when the fertilized ovum fails to travel all the way down the fallopian tube to the uterus. Instead, it implants in the wall of the fallopian tube. Such a pregnancy can never be successful. It may also cause serious health complications for the mother. An ultrasound test is often very helpful in diagnosing ectopic pregnancy.

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