Bleeding during Pregnancy - Reason, What to Expect, Solutions

Spotting in early pregnancy, i.e., the first trimester, is usually considered normal and does not indicate a serious issue. Although most causes of first-trimester spotting are not concerning, some might be. Therefore, it is always best to inform your doctor about any spotting or bleeding during pregnancy. 

Period-like bleeding is not usually a symptom of pregnancy. Therefore, if you experience anything more than spotting or bleeding that lasts longer than 24 hours, you should call your doctor immediately. Heavy bleeding or bleeding accompanied by pain during pregnancy may indicate a complication. 

Spotting or bleeding in early pregnancy or the first trimester is common and usually nothing to worry about. According to a research study, women who experience spotting in the first trimester have pregnancies similar to women who do not bleed. Possible causes of bleeding in the first trimester include:

Implantation Bleeding

Implantation is when the fertilised egg attaches itself to the uterine lining for oxygen and nutrition. It occurs about 6-12 days after conception, causing light spotting or bleeding. Implantation bleeding is considered a normal part of early pregnancy.

Occurring just before the expected period, this type of bleeding is usually mistaken for a light period due to their similar symptoms, such as:

1. Mild cramps
2. Pain in the lower back
3. Tender breasts
4. Headache
5. Nausea

However, some symptoms may distinguish implantation bleeding from menstrual bleeding. Implantation bleeding is usually light pink or dull brown (a colour lighter than period bleeding). Furthermore, it lasts only a few hours to a couple of days without heavy bleeding. 

Molar Pregnancy

1. Molar pregnancy is a rare but serious complication in almost 1 in every 1000 pregnant women. It is a condition in which the fertilised egg implants in your uterus, but the foetus may not grow at all.
2. Instead, a tumour may form due to a genetic error during fertilisation. A molar pregnancy can lead to a miscarriage in the first trimester. You may experience symptoms such as:
3. Bright red or dark brown bleeding
4. Pressure or pain in the lower stomach
5. Nausea
6. Vomiting

Ectopic Pregnancy

Another cause of bleeding during pregnancy is ectopic pregnancy. It is a condition in which the fertilised embryo implants outside of the uterus. Most ectopic pregnancies form in the fallopian tubes (slender tubes that connect the ovaries and the uterus).

If the embryo grows, the fallopian tube can burst, which is life-threatening for the mother. Although this condition is potentially dangerous, it occurs in only about 2% of pregnancies.

Since a baby can grow and develop only in the womb, it is important to treat ectopic pregnancies medically. The symptoms of ectopic pregnancy may include:

1. Light or heavy bleeding
2. Severe cramps
3. Sharp waves of pain
4. Rectal pressure

Subchorionic Haematoma

A subchorionic hematoma, or haemorrhage, occurs when blood forms between the uterus wall and the chorionic membrane (the outer layer of the foetal placenta that surrounds and protects the embryo) during pregnancy.

Smaller subchorionic haematomas are common. Women with these haematomas go on to deliver healthy babies. However, large haematomas cause heavy bleeding and increase the risk of miscarriage within the first 20 weeks of gestation. Symptoms of subchorionic haematoma include:

1. Light or heavy bleeding
2. Pink, red, or brown coloured bleeding
3. Pain in the lower stomach
4. Cramps

Cervical Polyps

1. Cervical polyps are noncancerous, finger-like growths on your cervix. Due to increased oestrogen levels, cervical polyps can get inflamed and irritated, leading to bright red blood during pregnancy. The doctor can easily diagnose these growths during a routine pelvic exam. 

Miscarriage

Heavy bleeding in early pregnancy, accompanied by pain, might indicate a miscarriage. Miscarriage usually starts as light bleeding that gets heavier. Most miscarriages cannot be prevented and happen during the first trimester of pregnancy. Symptoms of a miscarriage include:

1. Heavy vaginal bleeding
2. Bright red to brown coloured bleeding
3. Severe cramps
4. Pain in the lower abdomen
5. Sharp or dull pain in the lower back
6. Passing clots of blood or tissue

Sex or a Physical Exam

1. Pregnancy hormones make the cervix more tender than normal. Therefore, you may experience light bleeding shortly after sex. Physical tests like a pelvic exam or transvaginal ultrasound can also make your cervix bleed for the same reason.
2. However, it is usually not concerning. Bleeding generally happens once and goes away on its own. 

Infections

Bleeding in early pregnancy may also be caused by factors unrelated to the pregnancy, such as an infection. An infection in the pelvic area, bladder, or urinary tract can also result in spotting or bleeding during pregnancy.

Infections like chlamydia, gonorrhoea, STIs, UTIs, yeast infection or vaginitis (inflammation) can cause light bleeding. Symptoms of infections include:

1. Pink or red spotting or bleeding
2. Pain in the lower stomach
3. Itching
4. White discharge
5. Burning during urination
6. Sores or bumps on the vagina’s outer part

Bleeding later in pregnancy, i.e., in the second and third trimesters, is usually associated with more serious conditions than first-trimester light bleeding. Causes of bleeding in pregnancy during the second and third trimesters include:

1. Incompetent cervix: The cervix opens or dilates prematurely, leading to preterm birth. 
2. Placental abruption: It is a rare, dangerous condition in which the placenta detaches from your uterus wall before or during labour.  
3. Placenta previa: It is a condition in which the placenta covers a part or all of the cervix. It results in severe bleeding during pregnancy.
4. Vasa previa: In this condition, some of the placenta’s blood vessels go across your cervix. 
5. Preterm labour: Bleeding may occur when you go into labour before 37 weeks of pregnancy. Other symptoms of premature labour include contractions, cramping, or membrane rupturing. 
6. Problems with the cervix: Infection, inflammation, and growths on the cervix can cause bleeding, which is usually not serious.  
7. Bloody show: This is a common symptom during late pregnancy in which a small amount of blood and mucus plug is released from the vagina. It may happen a few days before contractions, signalling that the cervix is preparing for labour. 
8. Uterine rupture: It is a rare but life-threatening condition where the uterus tears open along the scar line from a previous C-section. 
9. Stillbirth (or intrauterine foetal death): A pregnancy loss after the 20th week of pregnancy can cause bleeding.  

Vaginal bleeding during pregnancy does not look the same for everyone. The appearance of the bleeding may vary depending on the cause and the time passed in the pregnancy. Your doctor will want to know how the blood looks to evaluate your symptoms and determine the cause. To determine how urgent your symptoms are, the doctor may need to know the following:

1. Colour of the blood: Blood during pregnancy may be pink, brown, or bright red. 
2. Blood consistency: The blood may be smooth, thick, or watery and contain clots. 
3. Amount of blood: You may experience a few drops (spotting) or heavy bleeding that fills a pad. 

A quick examination can help the doctor understand what is causing bleeding during pregnancy. Your healthcare provider may recommend the following tests:

1. Physical exam: The doctor will ask about your symptoms and bleeding. They will perform a vaginal examination to check your uterus’s size and the amount of bleeding. 
2. Blood test: The doctor will recommend blood tests to check your human chorionic gonadotrophin (hCG), the main hormone in pregnancy. High levels of hCG can indicate a molar pregnancy or twin or multiple pregnancies. Low levels of hCG can indicate abnormal growth, ectopic pregnancy, or a possible miscarriage.
3. Ultrasound scan: The doctor may use an ultrasound scan to see where the baby is and how it is growing. The test helps check the baby’s heartbeat, look for signs of an ectopic pregnancy or miscarriage, and the position and health of the placenta.  

The treatment for bleeding in pregnancy depends on the cause of the bleeding. Implantation bleeding does not need treatment as it is a normal process in early pregnancy and has no complications. Some first-trimester issues that cause bleeding, such as a cervical polyp, can be treated in your doctor’s office. Other issues may need further treatments, such as medications or surgery. Treatment options to stop bleeding during pregnancy include:

Home Care

Some treatments for vaginal bleeding during pregnancy that you can perform at home include:

1. Resting and relaxing
2. Taking some time off work and staying off your feet for a little while
3. Avoiding sex
4. Avoiding travel
5. Avoiding rigorous exercises and heavy lifting
6. Using pads rather than tampons when bleeding
7. Reporting any changes in your condition to the doctor

Monitoring

1. Use a panty liner or sanitary pad to keep track of the amount of bleeding. 

Medications

If the bleeding indicates a serious complication in which the pregnancy cannot continue safely, your doctor may prescribe medications. These medications may include:

1. Methotrexate (a drug that helps the body absorb harmful tissue and stop cells from dividing in an ectopic pregnancy)
2. Misoprostol (a drug used to end a dangerous pregnancy in the first seven weeks)

You will need follow-up appointments to evaluate your health after ending a pregnancy. Your healthcare provider will check for tissue or scarring in the womb. 

Surgery

Surgery for ectopic pregnancy is usually reserved for women who do not qualify for medical treatment with Methotrexate.

1. The surgery usually involves a laparoscopic procedure to remove ectopic pregnancy from the fallopian tube while saving as much of the tube as possible.
2. Furthermore, the treatment for a molar pregnancy also requires a Dilation and Curettage (D&C) surgery. It is a surgical procedure to remove tissue from inside the uterus. 

You should consult your healthcare professional if you experience bleeding at any stage during pregnancy. Even if bleeding during pregnancy is not serious at the moment, it can cause complications in the future. Call your healthcare professional immediately if you experience any of the following symptoms:

1. Heavy bleeding, with or without pain
2. Cramps or contractions
3. Pain in the pelvic area or abdomen
4. Fever of 100.4℉ or higher
5. Chills
6. Fainting or dizziness
7. Vaginal discharge that contains clots or tissue

Bleeding or spotting at any point during pregnancy can be alarming. Mostly, light bleeding and spotting are normal in early pregnancy. However, heavy bleeding during pregnancy may indicate a serious problem. Bleeding in early pregnancy can be caused due to reasons such as implantation, uterine infections, cervical polyps, ectopic pregnancies, miscarriages, etc. Bleeding later in pregnancy can result from conditions such as placental abruption, placenta previa, preterm labour, cervix problems, stillbirth, etc. 

You should always consult a doctor if you experience bleeding during pregnancy or have concerns regarding bleeding. Experts at HexaHealth can help resolve all your queries and help you manage the condition. We have a network of the best hospitals and doctors to rule out the possibilities of complications, find the cause of vaginal bleeding during pregnancy, and ensure you and your baby are healthy.