Bleeding During Pregnancy

What is bleeding during pregnancy?

Vaginal bleeding during pregnancy could either be harmless or of serious concern depending on the phase and trimester of pregnancy it is occurring in. In a majority of cases, bleeding in the very early stages of pregnancy is harmless. However, bleeding occurring at around 12 weeks of pregnancy typically indicates a miscarriage or ectopic pregnancy. Other reasons for bleeding during pregnancy include infection of the uterus, abnormality in the cervix, rupture of placenta, low-lying placenta, etc.

What are its main associated signs and symptoms?

Bleeding or spotting in the first and second weeks of pregnancy is usually not associated with other signs and symptoms. Signs and symptoms associated with bleeding in the later months of pregnancy could be indicators of serious conditions like abortion, ectopic pregnancy (attachment of embryo in locations other than uterus, commonly in fallopian tubes), etc. These symptoms include:

• Intense painful cramps in the lower abdomen (Read more: Abdominal cramps treatment)
• Discharge of tissue or blood clot
• Pain while passing urine and stools is associated with ectopic pregnancy
• Dizziness or fainting due to internal bleeding after rupturing of the fallopian tube in an ectopic pregnancy
• Pain in the shoulder is also common with rupture of fallopian tube in ectopic pregnancy

What are its main causes?

• Early pregnancy causes
  • Implantation (attachment of the embryo after fertilisation inside the uterus) leads to spotting up to the 1-2 weeks after fertilization
  • Increased blood supply to cervix leads to spotting or bleeding after sexual intercourse
  • Infection
  • Miscarriage or early loss of pregnancy
  • Ectopic pregnancy
• Late pregnancy causes
  • Cervical polyp or growth in the cervix and uterus (fibroids)
  • Ruptured placenta
  • Low-lying placenta
  • Preterm labour
  • Placenta accreta (placenta that enters the wall of the uterus and cannot be separated)

How is it diagnosed and treated?

Detailed history, symptoms, physical examination, examination of vagina and different investigations help doctors find the cause of bleeding during pregnancy.

• Examination of vagina helps in detecting the cause of bleeding such as infection, cervical polyp, cervical cancer, etc.
• Microscopic examination of the tissue sample from the vaginal blood for the presence of chorionic villi, which indicates abortion.
• Ultrasonography helps in detecting presence of gestational sac, foetal heart beat and ectopic pregnancy.
• Low or slow-rising levels of beta human chorionic gonadotropin indicate an impending miscarriage or ectopic pregnancy.

Treatment includes:

• Spotting due to implantation of embryo generally resolves without treatment.
• Treatment of bleeding resulting from a miscarriage or ectopic pregnancy includes:
  • When miscarriage is inevitable – allow expulsion of the tissue from the uterus either naturally, with medicines or by surgery.
  • Surgery is necessary to remove the leftover tissue in case of ectopic pregnancy.
  • Sometimes progesterone hormone and its altered forms are used for treating bleeding during pregnancy when threatened abortion is suspected.
  • Rh-immunoglobulin is administered to women with Rh-negative blood group to prevent future early pregnancy loss.

1. National Health Service [Internet]. UK; Vaginal bleeding in pregnancy
2. American College of Obstetricians and Gynecologists. Bleeding During Pregnancy. Washington, DC
3. American Academy of Family Physicians. First Trimester Bleeding. Am Fam Physician. 2009 Jun 1;79(11):985-992.
4. American College of Obstetricians and Gynecologists. Early Pregnancy Loss. Washington, DC
5. G. Dante et al. Use of progestagens during early pregnancy. Facts Views Vis Obgyn. 2013; 5(1): 66–71. PMID: 24753930