What are the common causes of vaginal bleeding during pregnancy. How to distinguish between spotting and heavy bleeding. When should you contact your healthcare provider immediately. What are the potential complications associated with late-term bleeding.

Understanding Vaginal Bleeding in Pregnancy: Spotting vs. Heavy Bleeding

Vaginal bleeding during pregnancy can be a concerning experience for expectant mothers. It’s essential to understand the difference between spotting and heavy bleeding to assess the severity of the situation:

• Spotting: A few drops of blood occasionally appearing on underwear, not enough to cover a panty liner.
• Bleeding: A heavier flow of blood requiring a liner or pad to prevent soaking clothes.

Approximately one in ten women experience vaginal bleeding during their third trimester. While it can be alarming, it’s crucial to remain calm and assess the situation carefully.

Common Causes of Vaginal Bleeding in Late Pregnancy

Several factors can contribute to vaginal bleeding in the later stages of pregnancy:

• Cervical dilation at the onset of labor
• Sexual intercourse (usually resulting in spotting)
• Internal examination by a healthcare provider
• Vaginal or cervical infections
• Uterine fibroids
• Cervical growths or polyps

In some cases, bleeding can be a sign of more serious complications that require immediate medical attention.

Serious Causes of Late-Term Bleeding: When to Be Concerned

While some causes of vaginal bleeding during pregnancy are relatively benign, others can pose significant risks to both mother and baby. Two serious conditions that may cause late-term bleeding include:

Placenta Previa

Placenta previa is a condition where the placenta grows in the lowest part of the uterus, covering all or part of the cervical opening. This can lead to bleeding, especially as the pregnancy progresses and the cervix begins to dilate.

Placental Abruption

Placental abruption occurs when the placenta separates from the inner wall of the uterus before the baby is born. This can be a life-threatening emergency for both mother and child, often accompanied by severe abdominal pain and heavy bleeding.

If you experience heavy bleeding or any bleeding accompanied by pain, contractions, or other concerning symptoms, seek medical attention immediately.

Assessing Vaginal Bleeding: What Your Healthcare Provider Needs to Know

When reporting vaginal bleeding to your healthcare provider, they may ask several questions to assess the situation:

1. Are you experiencing cramping, pain, or contractions?
2. Have you had any other bleeding during this pregnancy?
3. When did the bleeding begin, and is it constant or intermittent?
4. How much bleeding is present? Is it spotting or heavier?
5. What is the color of the blood (dark or bright red)?
6. Is there an odor associated with the blood?
7. Have you experienced any dizziness, fainting, nausea, vomiting, or diarrhea?
8. Have you had any recent injuries or falls?
9. When did you last have sexual intercourse, and did you bleed afterward?
10. Can you feel the baby moving?
11. Have you experienced any other complications during the pregnancy?

Providing accurate and detailed information will help your healthcare provider determine the best course of action.

Home Monitoring vs. Seeking Immediate Medical Attention

In some cases, minor spotting can be monitored at home, especially if it occurs after sexual intercourse or a medical examination. To monitor bleeding at home:

1. Put on a clean pad and check it every 30 to 60 minutes for a few hours.
2. If spotting or bleeding continues, call your healthcare provider.

However, certain situations require immediate medical attention. Call 911 or your local emergency number if:

• The bleeding is heavy
• Your abdomen feels stiff and painful
• You’re experiencing strong and frequent contractions

For any other bleeding, contact your healthcare provider right away. They will advise you on whether to go to the emergency room or the labor and delivery area of your hospital, and whether it’s safe for you to drive yourself or if you should call an ambulance.

Preventing and Managing Vaginal Bleeding During Pregnancy

While not all causes of vaginal bleeding can be prevented, there are steps you can take to reduce your risk and manage any bleeding that does occur:

• Attend all prenatal appointments and follow your healthcare provider’s recommendations
• Avoid smoking, alcohol, and illicit drugs during pregnancy
• Maintain a healthy diet and exercise routine as advised by your doctor
• Be cautious during sexual activity and discuss any concerns with your healthcare provider
• Report any bleeding or spotting to your doctor, even if it seems minor
• Rest and avoid strenuous activities if you experience any bleeding

By staying vigilant and maintaining open communication with your healthcare team, you can help ensure the best possible outcome for you and your baby.

Diagnostic Procedures for Vaginal Bleeding in Pregnancy

If you experience vaginal bleeding during pregnancy, your healthcare provider may recommend various diagnostic procedures to determine the cause and assess any potential risks. These may include:

Ultrasound

An ultrasound can provide valuable information about the position of the placenta, the baby’s health, and any potential sources of bleeding. It’s a non-invasive procedure that uses sound waves to create images of the uterus and developing fetus.

Physical Examination

Your healthcare provider may perform a gentle physical examination to check for any visible sources of bleeding and assess the health of your cervix. This examination can help rule out certain causes of bleeding and provide important information about your pregnancy’s progress.

Blood Tests

Blood tests can help determine if you’re experiencing any complications related to bleeding, such as anemia or changes in your blood clotting factors. These tests may also check your hormone levels to ensure your pregnancy is progressing normally.

Fetal Monitoring

If there are concerns about your baby’s well-being, your healthcare provider may recommend fetal monitoring to assess the baby’s heart rate and movement. This can help determine if the bleeding is affecting the baby and if any immediate interventions are necessary.

The specific diagnostic procedures recommended will depend on your individual situation, the severity of the bleeding, and your stage of pregnancy.

Treatment Options for Vaginal Bleeding in Pregnancy

The treatment for vaginal bleeding during pregnancy depends on the underlying cause and the gestational age of the fetus. Some possible treatment options include:

Bed Rest

In cases of mild bleeding or certain conditions like placenta previa, your healthcare provider may recommend bed rest to reduce the risk of further bleeding and complications.

Medications

Depending on the cause of bleeding, your doctor may prescribe medications to address underlying issues such as infections or to help maintain the pregnancy.

Rh Immunoglobulin

If you have Rh-negative blood and experience bleeding during pregnancy, you may need an injection of Rh immunoglobulin to prevent complications in future pregnancies.

Emergency Cesarean Section

In cases of severe bleeding or complications that threaten the health of the mother or baby, an emergency cesarean section may be necessary.

Your healthcare provider will discuss the most appropriate treatment options based on your specific situation and the potential risks and benefits of each approach.

Long-term Effects and Follow-up Care After Vaginal Bleeding in Pregnancy

Experiencing vaginal bleeding during pregnancy can be a stressful event, and it’s important to understand the potential long-term effects and necessary follow-up care:

Emotional Impact

Many women who experience bleeding during pregnancy may feel anxious or stressed about the health of their baby. It’s important to discuss these feelings with your healthcare provider and consider seeking support from a mental health professional if needed.

Increased Monitoring

After a bleeding episode, your healthcare provider may recommend more frequent prenatal visits or additional ultrasounds to closely monitor your pregnancy’s progress and ensure the well-being of both you and your baby.

Lifestyle Modifications

Depending on the cause of bleeding, you may need to make temporary or long-term lifestyle changes, such as avoiding strenuous activities or modifying your sexual activity.

Future Pregnancy Considerations

If you experienced a serious complication like placenta previa or placental abruption, your healthcare provider may discuss how this might affect future pregnancies and what precautions you may need to take.

Remember that every pregnancy is unique, and the long-term effects and necessary follow-up care will vary based on your individual circumstances. Maintain open communication with your healthcare team to ensure you receive the most appropriate care throughout your pregnancy and beyond.

Vaginal bleeding in late pregnancy: MedlinePlus Medical Encyclopedia

One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away.

You should understand the difference between spotting and bleeding:

• Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.
• Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus.

Mid- or late-term bleeding may also be caused by:

• Having sex (most often just spotting)
• An internal exam by your provider (most often just spotting)
• Diseases or infections of the vagina or cervix
• Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

• Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
• Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

To find the cause of your vaginal bleeding, your provider may need to know:

• If you have cramping, pain, or contractions
• If you have had any other bleeding during this pregnancy
• When the bleeding began and whether it comes and goes or is constant
• How much bleeding is present, and whether it is spotting or a heavier flow
• The color of the blood (dark or bright red)
• If there is an odor to the blood
• If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
• If you have had recent injuries or falls
• When you last had sex and if you bled afterward
• If you’re feeling the baby move
• If you’ve had other complications during the pregnancy

A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:

• Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
• If spotting or bleeding continues, call your provider.
• If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.

For any other bleeding, call your provider right away.

• You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
• Your provider will also tell you whether you can drive yourself or you should call an ambulance.

Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn’s Current Therapy 2023. Philadelphia, PA: Elsevier 2023:1273-1276.

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 173.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae.  In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 43.

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Bleeding during pregnancy: When to worry about spotting in pregnancy

A little light bleeding or spotting during pregnancy is common, especially during the first trimester. Heavier or more consistent bleeding could signal a problem with the pregnancy. Early pregnancy bleeding can happen when the fertilized egg implants, or it could be from something more serious like a miscarriage or ectopic pregnancy. Common causes of bleeding later in pregnancy include placental problems or preterm labor. Any bleeding is worth letting your doctor know about as soon as possible, especially if it’s heavy or it doesn’t stop.

Is it normal to have spotting during pregnancy?

A little light bleeding or spotting during pregnancy is common, especially in early pregnancy. Up to one in four pregnant women have some light bleeding in their first trimester. But even if the bleeding seems to have stopped, call your doctor, just to make sure everything is okay.

Spotting or light bleeding in pregnancy is probably from something minor. But it could also be a sign of a serious problem, such as an ectopic pregnancy, a miscarriage, or an infection.

Your doctor may want to do some tests, which can include a physical exam, an ultrasound, and blood tests, to check how well you and your baby are doing and to rule out any complications.

If you’re actively bleeding or you have severe pain and can’t reach your doctor, head to the emergency room right away.

What’s the difference between spotting and bleeding during pregnancy?

Spotting is very light bleeding, similar to what you may have at the very beginning or end of your period. It will look like small drops of blood on your underwear, varying in color from pink to red to brown (the color of dried blood). Pregnancy spotting is common, especially during the first three months.

Bleeding means that you need to wear a panty liner or pad to avoid soaking your underwear. And heavy bleeding will soak through one or more pads. Continued or heavy bleeding could signal a problem with your pregnancy, which is why it’s important to share with your doctor right away.

Early pregnancy bleeding: What causes it?

The most common causes of light spotting or bleeding during early pregnancy include:

Implantation. Some women have spotting even before they know they’re pregnant, about a week or so after they ovulate. It’s called “implantation bleeding” because it happens when the fertilized egg burrows (or implants) into the blood-rich lining of the uterus, a process that starts just six days after fertilization.

If you have a day or two of spotting in the week before your period is due, take a home pregnancy test. If the result is negative, wait a few days or a week. If your period doesn’t start when you expect it, try testing again.

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Subchorionic hematoma. Also called a subchorionic hemorrhage, this kind of bleeding can happen when the outer layer of the amniotic sac (chorion) separates from the wall of the uterus. It’s usually harmless and stops on its own. Small collections of blood like this early on are typically harmless. But if the collection of blood is larger, it will take longer to reabsorb, or go away. This can raise the risk of miscarriage or preterm labor, so your doctor may want to check on it regularly with ultrasound.

Miscarriage. Spotting or bleeding in the first trimester, especially if you also have abdominal pain or cramping, can be an early sign of miscarriage. But it isn’t necessarily a sign, and actually, about half of women who miscarry don’t have any bleeding prior to diagnosis. Other signs of a possible miscarriage are discharge of liquid or tissue from your vagina, and no longer feeling any pregnancy symptoms (like morning sickness). If feeling better is your only symptom, however, try not to worry! Many pregnant women don’t experience nausea in the first trimester and have very healthy pregnancies.

Ectopic pregnancy. Early pregnancy bleeding also can warn of an ectopic pregnancy – when the embryo implants outside the uterus, usually in one of the fallopian tubes. Sometimes bleeding is the only sign, but other common symptoms include pain in the belly, pelvis, or shoulder. An ectopic pregnancy can be life-threatening, so let your doctor know right away if you have bleeding or moderate to severe pain in your first trimester.

Molar pregnancy. This rare complication happens when the placenta doesn’t develop properly, and it can’t sustain the embryo. A molar pregnancy can be serious, and it needs prompt treatment.

Infection. An infection can irritate or inflame your cervix and make it more likely to bleed, especially after you have sex. These are some of the infections that can cause bleeding:

• Chlamydia
• Gonorrhea
• Herpes
• Yeast infection
• Trichomoniasis

Because certain infections can cause pregnancy complications, your doctor might prescribe antibiotics or another treatment.

You might also notice some spotting or light bleeding after sexual intercourse or a pelvic exam. More blood flows to your cervix during pregnancy, so it’s not unusual. A cervical polyp (a noncancerous growth on the cervix) can also cause spotting or bleeding after sex or an exam.

What causes second or third trimester bleeding?

Bleeding later in pregnancy might also be nothing to worry about. Light bleeding could be a sign of harmless inflammation, a cervical polyp, or other changes in your cervix. And a few days before your delivery date, bloody discharge called “show” is a sign that your cervix is getting ready for labor.

Heavy bleeding late in your pregnancy is a more worrisome sign. It’s worth making a call to your doctor right away.

Here are some common causes of bleeding in your second and third trimesters:

Placental problems. Bleeding or spotting after the first trimester can be a sign of a problem with the placenta, such as:

• Placenta previa, when the placenta partially or fully covers the cervix; usually this is diagnosed at your mid-pregnancy ultrasound or anatomy scan. Your placental location will continue to be monitored as pregnancy progresses, and your obstetrician will recommend that you abstain from intercourse as long as the placenta is over or near the cervix.
• Placenta accreta, when the placenta becomes abnormally embedded in the uterine wall. Although this is a rare complication, the risk slowly increases with each cesarean delivery.
• Placental abruption, when the placenta entirely or partially separates from the wall of the uterus. This is more likely to occur as a result of trauma (car accident, domestic violence), uncontrolled hypertension, or labor.

Late miscarriage. Most miscarriages happen in the first trimester, but bleeding between 13 weeks and the middle of your pregnancy can be a sign of late miscarriage.

Preterm labor. Bleeding is one sign of preterm labor (labor that starts before 37 weeks). Other symptoms are:

• Abdominal pain, cramps, or contractions
• Low backache
• Changes in vaginal discharge
• Pressure in your pelvis or lower abdomen

How much bleeding during pregnancy is normal?

Some light bleeding is normal, especially early in your pregnancy when the fertilized egg implants. But really, bleeding can happen at any point in your pregnancy, and for many different reasons. And because some causes are more serious than others, it’s always a good idea to let your doctor know about it.

Heavier bleeding that soaks through a pad, or bleeding that doesn’t go away is more concerning. It could signal a serious problem with your pregnancy that needs immediate medical attention. Calling your doctor right away or going to an emergency room could help you head off a problem and protect both your health and your baby’s.

When should I call my doctor about spotting or bleeding during pregnancy?

Any type or amount of bleeding in pregnancy is worth calling your doctor about, to make sure that nothing is wrong. This is important, even if your last ultrasound showed that your baby is healthy and growing according to schedule.

Heavy or consistent bleeding is a reason to call immediately. Your doctor can check for any problems, and either reassure you that you’re ok, or treat the problem.

When you call your doctor, let them know how long you’ve been bleeding and how much you’ve bled. Also tell them about other symptoms, like cramps, that you’ve had along with the bleeding. Also, be sure to be honest with them about recent sexual activity and medical history when you call.

Lastly, whenever the bleeding occurs, if your blood type is RH-negative, your doctor will want to make sure you get a Rhogam shot to protect future pregnancies. Call your doctor if you are RH-negative and have bleeding anytime in pregnancy. If you are RH-positive, this isn’t something you have to worry about.

Learn more:

• Pregnancy symptoms you should never ignore
• Vaginal discharge during pregnancy
• Rectal bleeding during pregnancy

Bleeding during early pregnancy: causes, symptoms and treatment

This disease is treated by Gynecologist

Bleeding during pregnancy is always an alarm. It does not matter how long it occurred and how intensely. In no case should this phenomenon be left unattended. Even women who already have experience of pregnancy will not be able to determine the cause of the bleeding themselves.

Moreover: its intensity does not always indicate how serious the situation is: intense bleeding may not be dangerous, and poor discharge may be the result of an extremely difficult situation. A woman who is faced with such a problem should immediately contact a doctor and follow all his appointments, and if necessary, go to the hospital.

Symptoms depending on time and type

The appearance of bleeding in early pregnancy can be due to various reasons: from spontaneous abortion to tubal (ectopic) pregnancy. Depending on what caused it, the discharge is strong, accompanied by pain in the lower abdomen, but it can also be low-intensity, smearing.

In the later stages, the appearance of blood should always be alarming, since the situation poses a threat to both the expectant mother and the baby. The external picture and causes may be the same as in the first trimester, but doctors will have a different goal and treatment tactics. If, with bleeding during the development of pregnancy in the early stages, the task is to preserve it, then closer to childbirth, doctors decide on urgent delivery.

Causes of bleeding during early pregnancy

The most common causes of bleeding in relatively early pregnancy include the following.

Spontaneous abortion (miscarriage). In general, about 80% of all miscarriages occur at the beginning, in the first weeks after conception. Bleeding in this case is intense, accompanied by pain. If fragments of the fetal egg remain in the uterine cavity, this can lead to inflammation. Therefore, after a miscarriage, a woman must undergo an examination. In addition, the doctor will give recommendations, say whether it is possible to avoid termination of pregnancy in the future and whether it is necessary to pause before the next attempt.

Ectopic pregnancy – attachment of the embryo outside the uterine cavity, for example, in the fallopian tube. As the embryo grows, its walls stretch, and this is why the tube eventually bursts. This is accompanied by bleeding, which is usually mild and painful.

Vesical skid is a pathology in which the chorionic villi (fetal part of the placenta) degenerate into fluid-containing vesicles. In this case, the discharge usually becomes dark in color, pathology leads to the death of the fetus.

Implantation , that is, the introduction of the embryo into the mucous membrane. The process may be accompanied by a small amount of blood, the woman marks her traces on the linen.

Pathologies of the cervix .

If we single out the most common cause of bleeding during early pregnancy, then this will be chorion detachment. It is caused by endocrine, immunological, genetic disorders, infections, etc.

Bleeding in the 2nd and 3rd trimesters

Most of the bleeding in late pregnancy is associated with placental abruption and its supply.

Placental abruption is a serious condition when, at more than 20 weeks’ gestation, the placenta moves away from the uterine wall. It can be caused by trauma, chronic infections, circulatory disorders, endocrine diseases (such as diabetes), uterine tumors, and other causes. Blood discharge may be bright scarlet or dark, but is painless.

Placental abruption is dangerous for the baby, as its nutrition and oxygen supply are disrupted.

Placenta previa is an organ arrangement in which the placenta is attached to the lower segment of the uterus. As the uterus grows, the placenta quite often “pulls up”, move up. But it can remain in the lower segment and close the internal os of the uterus. In this case, the woman bleeds, the discharge has a bright scarlet color and can proceed without pain.

Disease diagnosis

Obstetrician-gynecologists who see pregnant women at the GMS Clinic use two main diagnostic methods: chair examination and ultrasound.

During a gynecological examination, the doctor assesses the condition of the cervix (if a miscarriage occurs, it opens), as well as the tone of the uterus. Ultrasound makes it possible to assess the state of the muscular layer of the uterus – the myometrium, to see the embryo, to determine what exactly caused the bleeding, and in the later stages – to observe the position of the placenta.

The advantage of observation at the GMS Clinic is that all obstetrician-gynecologists are proficient in ultrasound diagnostics and, if necessary, can do it during an appointment. A woman does not need to make an additional appointment and wait for an appointment, the doctor will do the examination in the same office. If necessary, the patient can just as quickly pass all tests, blood tests and others, and get the results.

Also, the benefits of monitoring pregnancy in GMS Clinic are:

• availability of a prenatal diagnostic room, where on the day of the examination you can get the results of expert ultrasound and biochemical genetic screening;
• the presence of its own laboratory, thanks to which a woman can do all the necessary tests in one clinic;
• the ability to constantly receive advice and assistance: if necessary, the expectant mother can go to a day or round-the-clock hospital, her doctor is in touch with her during the day, and at night you can contact the specialist on duty;
• observation in a single highly professional women’s center, where a woman can apply at the stage of pregnancy planning or simply undergo regular examinations.

Thanks to such an integrated approach, the expectant mother can be sure that doctors will not miss any nuances of pregnancy and provide the necessary consultations at any time.

Treatment

If the diagnosis showed that the pregnancy was not interrupted, then the doctor’s first recommendation is bed rest. At GMS Clinic, a woman who comes in with bleeding and other problems at an early stage is offered hospitalization in her own hospital. This is the preferred option for patients who have small children at home. If the home environment allows for peace, then hospitalization is not necessary.

Medical treatment is carried out in two directions:

• antispasmodic therapy – doctors prescribe drugs that relieve tension in the uterus;
• preparations of progesterone, which is called the “essential hormone of pregnancy.” It is produced by the ovaries, adrenal glands, and also the placenta. It reduces muscle tone, and its deficiency is one of the causes of bleeding and miscarriage.

The remaining possible treatment options are selected by the GMS Clinic doctor when it is determined what led to the bleeding. If it is an infection, diseases of the blood coagulation system and other pathologies, then the treatment is aimed at eliminating them.

What to do if you bleed during pregnancy

Women who observe pregnancy should consult a doctor at the first alarming symptoms of bleeding. Even if your doctor is not receiving an appointment at this moment, the clinic always has gynecologists on duty who will provide the necessary assistance around the clock. Our clinic employs leading specialists in miscarriage who diagnose and prescribe treatment even in the most difficult cases. If hospitalization is needed, then GMS Clinic has a day and night hospital, where the woman will be under constant control.

Cost of admission

Prices for the most requested services are indicated. You can be served under a VHI policy, pay separately for each visit, conclude an agreement for an annual medical program or make a deposit and receive services at a discount. On weekends and holidays, the clinic reserves the right to charge an additional fee according to the current price list. Services are provided on the basis of a concluded agreement.*

MasterCard, VISA, Maestro, MIR plastic cards are accepted for payment.

Doctors

• Morozova Anna Vladislavovna

  Medical Director of GMS IVF. Reproductologist, obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound doctor

• Leites Tatyana Ivanovna

  Head of the Center for Obstetrics and Gynecology, Leading Specialist

• Lvova Alesya Gennadievna

  Head of Department, Leading Reproductologist, Obstetrician-Gynecologist, Ultrasound Doctor

• Koltunova Alevtina Aleksandrovna

  Head of operative gynecology at GMS Hospital. Obstetrician-gynecologist, oncogynecologist, leading specialist, ultrasound doctor

• Shamugiya Nato Livterovna

  Leading reproductive specialist, obstetrician-gynecologist, ultrasound specialist

• Alimkhadzhieva Milana Abdullaevna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Barteneva (Samsonova) Oksana Vladimirovna

  Obstetrician-gynecologist, gynecologist-surgeon

• Bendusov Ivan Alekseevich

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Volkova Maria Viktorovna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Glukhov Alexey Sergeevich

  Obstetrician-gynecologist, ultrasound doctor

• Golubeva Olga Nikolaevna

  Obstetrician-gynecologist, ultrasound doctor, physiotherapist

• Deilidko Ella Nikolaevna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Zhordanidze Diana Omarovna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Kazaryan Serine Mishikovna

  Leading specialist. Obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound doctor

• Kikina Yulia Alekseevna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Klimenko Maria Petrovna

  Reproductologist, obstetrician-gynecologist, ultrasound doctor

• Korennaya Vera Vyacheslavovna

  Obstetrician-gynecologist, gynecologist-surgeon, ultrasound doctor

• Kuchukova Madina Yusupovna

  Obstetrician-gynecologist, endoscopic surgeon, sonographer

• Ledentsova Natalya Leonidovna

  Obstetrician-gynecologist, ultrasound doctor

• Lyubimkina Elena Viktorovna

  Obstetrician-gynecologist, doctor of integrative medicine

• Minka Ekaterina Evgenievna

  Obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound doctor

• Samsonova Irina Alekseevna

  Obstetrician-gynecologist

• Silenko Svetlana Georgievna

  Deputy Head of Obstetrics and Gynecology. Obstetrician-gynecologist, ultrasound doctor

• Sosnova Elena Alekseevna

  Obstetrician-gynecologist, gynecologist-endocrinologist

• Aleksandra G. Shushkova

  Obstetrician-gynecologist, reproductologist, ultrasound specialist

Bleeding during pregnancy. What is Bleeding During Pregnancy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Bleeding during pregnancy is a sign that can occur regardless of the period of embryogenesis and indicates ongoing changes in the woman’s body. It can be observed with spontaneous miscarriage, ectopic pregnancy, Rh conflict, placenta previa and other conditions. This manifestation can develop against the background of general well-being or be accompanied by painful sensations in the lower abdomen, lower back, and sacrum. Diagnosis of bleeding during pregnancy is carried out on the basis of data from a gynecological examination, an ultrasound assessment of the condition of the patient and the fetus. The treatment of this pathological symptom is determined by its cause and is prescribed exclusively by a specialist.

• Causes of bleeding during pregnancy
• Classification and symptoms of bleeding during pregnancy
• Diagnosis and treatment of bleeding during pregnancy
  • Prognosis and prevention of bleeding during pregnancy
• Prices for treatment

General

Bleeding during pregnancy is an obstetric symptom, indicating the possible development of a number of disorders, the cause of which can be both physiological changes in the body of a woman after conception, and pathological conditions. Only an obstetrician-gynecologist can finally find out the etiology of such a manifestation after a complete examination. Bleeding during pregnancy occurs in about one in five patients. In 50%, they indicate pathological changes and end in spontaneous miscarriage. In half of the patients, the symptom is physiological in nature. Bleeding occurs more often in the first and third trimester of embryogenesis.

The danger of bleeding during pregnancy lies in the fact that a variety of factors can provoke them, including those that pose a threat to the mother and fetus. In some situations, there are no other pathological signs. Any bleeding during pregnancy should be a reason for immediate medical attention. Only a specialist is able to assess the danger to the health of a woman and the fetus, as well as decide on further tactics. Timely assistance provided even with an abnormal course of pregnancy allows you to continue its management and save the life of the child.

Bleeding during pregnancy

Causes of bleeding during pregnancy

Bleeding during pregnancy can occur at any time of embryogenesis, develops both against the background of physiological changes in the woman’s body, and as a result of the formation of a certain obstetric pathology. In the early stages, half of the women have a slight separation of blood due to the implantation of the fetal egg in the uterine cavity. Such bleeding during pregnancy is often regarded by the patient as menstrual, so she does not seek medical help, which in the future may make it difficult to determine the timing of embryogenesis. A similar symptom is possible with insufficient production of progesterone in the early stages of gestation.

The most common cause of abnormal bleeding during pregnancy in the first trimester is spontaneous miscarriage. This symptom appears both with a just-started and with a complete abortion. Approximately 6 weeks after conception, the symptom occurs with an ectopic attachment of the fetal egg. Also, bleeding during pregnancy at this time may indicate an Rhesus conflict, fetal fading. Similar manifestations are characteristic of women suffering from varicose veins that feed the uterus. In this case, bleeding during pregnancy is due to increased blood supply to the tissues.

Bleeding during pregnancy in the second trimester is diagnosed much less frequently, in about 5-10% of all cases of gestation. As a rule, the symptom is caused by pathological changes and in most cases indicates spontaneous late abortion or isthmic-cervical insufficiency. Sometimes the separation of blood from the genital tract is observed during intrauterine death of the fetus. Bleeding during pregnancy in the third trimester also always speaks of the development of gestation pathology. The most common cause is placenta previa. In this case, the embryonic organ completely or partially covers the uterine os, while due to the high load on the lower segment, placental micro-ruptures occur, which causes a similar sign.

Less commonly, bleeding during pregnancy in the third trimester is due to premature detachment of a normally located placenta. In this situation, there is a high threat to the life of the fetus. The danger also lies in the fact that initially internal bleeding develops during pregnancy or the formation of a hematoma, and only then the blood flows out. The rarest, but most dangerous for the life of the mother and child, the cause of the development of this symptom is uterine rupture. Such a complication is diagnosed in the presence of a scar on the myometrium and tissue overstretching, provoked by polyhydramnios, large fetuses or multiple pregnancies. It is extremely rare that bleeding during pregnancy occurs due to a violation of the integrity of the membranes or umbilical cord vessels.

Also, bleeding during pregnancy can be triggered by causes that appear at any stage of embryogenesis. Such reasons include benign neoplasms – fibroids, polyposis growths in the cervical canal and uterine cavity. Often bleeding during pregnancy occurs in women with cervical erosion. Sometimes a sign occurs due to increased blood circulation in the pelvic organs. The risk of developing a symptom is also present with violent sexual intercourse, significant physical exertion, concomitant cardiovascular diseases associated with a weakening of the endothelium.

Classification and symptoms of bleeding during pregnancy

Depending on the origin of bleeding, two groups can be distinguished:

• Physiological bleeding during pregnancy – occurs due to the restructuring of the body, does not pose a threat to the health and life of the fetus or mother.
• Pathological bleeding during pregnancy – indicate its abnormal course, may be accompanied by a risk to the life and health of the woman and baby, require immediate medical attention.

The clinic of bleeding during pregnancy directly depends on the cause of this symptom. Isolation of blood from the genital tract in the early stages of embryogenesis, provoked by physiological changes, proceeds against the background of general well-being. Bleeding during pregnancy, which has developed due to the presence of polyps, erosion, fibroids in most cases also does not cause disturbances in well-being. In this case, there is a slight release of biological fluid – just a few drops, the symptom is of a short-term nature. More abundant, similar to menstrual, will be bleeding during pregnancy associated with a deficiency of progesterone.

In the case of bleeding during pregnancy associated with its spontaneous interruption, the patient is worried about constant or cramping pain in the lumbosacral region, abdomen. Additionally, nausea, dizziness, malaise, and a slight increase in body temperature may occur. Bleeding during pregnancy in this case can be of varying intensity, often in the discharge there are pieces of tissue. With an ectopic attachment of the fetal egg, as well as with a rupture of the uterus, a serious threat to the life of a woman arises. In such a situation, internal bleeding initially develops during pregnancy, and only then do pathological discharges from the external genital tract appear. There is acute pain in the abdomen with irradiation to the anal region, the lateral parts of the body. With significant blood loss, a state of shock occurs with a threat of death.

Bleeding during pregnancy in the later stages is also not always accompanied by a detailed clinical picture. In the case of placenta previa, this is the only symptom that should cause alertness in a woman and become a reason for contacting an obstetrician-gynecologist. As for the premature detachment of a correctly attached placenta, in this case, bleeding during pregnancy develops against the background of uterine hypertonicity, there is pain in the abdomen, deterioration in general well-being. During cardiac monitoring of the fetus, there is a violation of the heart rate, motor activity.

Diagnosis and treatment of bleeding during pregnancy

To identify the cause of bleeding during pregnancy, a gynecological examination of a woman is performed. With changes in physiological origin, no deviations from the norm can be detected. With pathological bleeding during pregnancy against the background of spontaneous abortion, an opening of the cervix is ​​observed. An increase in the tone of the myometrium may indicate the onset of placental abruption. Of the laboratory diagnostic methods, an analysis is used to determine the concentration of hCG (human chorionic gonadotropin). With ectopic pregnancy and bleeding, this figure will be reduced. Instrumental diagnosis of bleeding during pregnancy is to conduct an ultrasound scan. Using this method, it is possible to assess the state of the myometrium and the embryo, the level of blood flow in the vessels, the exact localization of the placenta and (possibly) its incipient detachment. Using CTG, the diagnostician can make a conclusion about the vital activity of the fetus.

Treatment of bleeding during pregnancy also depends on the cause of the symptom. If there are no pathological changes or the manifestation is provoked by damage to the polyp, medical attention is not required. In rare cases, the doctor recommends its removal. Expectant tactics are also used in case of cervical erosion. Her cauterization is carried out after childbirth. Bleeding during pregnancy against the background of the threat of miscarriage and placenta previa requires immediate hospitalization in an obstetric hospital, followed by the appointment of drug treatment. To reduce uterine tone, sedatives, tocolytics are used. Pregnancy management in this case requires careful monitoring by a specialist.

Bleeding during pregnancy caused by ectopic attachment of the ovum, scar rupture, or completed spontaneous abortion requires hospitalization and surgical treatment. After removal of the remnants of fetal tissues or emergency delivery, antibiotic therapy is prescribed. In this case, stopping bleeding during pregnancy is carried out in different ways, depending on its intensity, often ligation of the uterine arteries is performed. With premature detachment of the placenta, an emergency caesarean section is indicated.

Prognosis and prevention of bleeding during pregnancy

Bleeding during pregnancy is usually accompanied by a favorable prognosis.