Are blood clots normal in early pregnancy. How can pregnant women reduce their risk of developing blood clots. What are the signs and symptoms of blood clots during pregnancy. When should you seek medical attention for bleeding with clots in the first trimester.

Understanding Blood Clots and Pregnancy

Blood clots are a natural bodily response to stop bleeding after injury. However, during pregnancy, the risk of developing problematic blood clots increases significantly. Pregnant women are five times more likely to experience blood clots compared to non-pregnant women. This heightened risk extends up to three months postpartum.

But why does this happen? The body prepares for potential blood loss during childbirth by increasing its clotting ability. Additionally, the growing fetus can press on blood vessels, potentially impeding blood flow in the pelvic region. Reduced mobility, often associated with pregnancy and postpartum recovery, can also contribute to blood clot formation.

What are blood clots?

A blood clot, or thrombosis, occurs when blood transforms from a liquid to a solid state, forming a mass. While this process is crucial for healing wounds, problematic clots can partially or completely obstruct blood flow in veins or arteries, leading to serious health complications.

Risk Factors for Blood Clots During Pregnancy

Several factors can increase a woman’s likelihood of developing blood clots during pregnancy:

• Pre-existing health conditions (e.g., thrombophilia, hypertension, diabetes)
• Family history of blood clotting disorders
• Obesity or being overweight
• Certain medications (e.g., birth control pills, estrogen hormones)
• Smoking
• Surgical procedures, such as cesarean sections
• Dehydration
• Prolonged immobility

Understanding these risk factors is crucial for expectant mothers and healthcare providers to implement appropriate preventive measures.

Recognizing the Signs and Symptoms of Blood Clots

Early detection of blood clots is vital for prompt treatment and prevention of complications. Common symptoms include:

1. Swelling in one leg or arm
2. Pain or tenderness in the affected limb
3. Warmth or redness in the affected area
4. Shortness of breath
5. Chest pain or discomfort
6. Rapid heartbeat
7. Coughing up blood

If you experience any of these symptoms during pregnancy or in the postpartum period, seek medical attention immediately.

Blood Clots vs. Normal Pregnancy Bleeding

Distinguishing between normal pregnancy bleeding and potentially dangerous blood clots is crucial. While some light spotting can be normal in early pregnancy, heavy bleeding with large clots warrants medical evaluation.

Is it normal to pass small blood clots during early pregnancy?

Passing small blood clots during the first trimester can be normal, especially if accompanied by light spotting. However, if you’re experiencing heavy bleeding with large clots, it’s essential to consult your healthcare provider promptly. This could indicate a more serious condition, such as a miscarriage or ectopic pregnancy.

Preventing Blood Clots During Pregnancy

Taking proactive steps to reduce the risk of blood clots is crucial for a healthy pregnancy. Here are some preventive measures:

• Stay hydrated by drinking plenty of water
• Maintain regular physical activity as advised by your healthcare provider
• Avoid sitting or standing for prolonged periods
• Wear compression stockings if recommended
• Follow a healthy diet and maintain a healthy weight
• Quit smoking and avoid secondhand smoke
• Take blood-thinning medications if prescribed by your doctor

Remember, prevention is key in managing the risk of blood clots during pregnancy.

Treatment Options for Blood Clots in Pregnancy

If a blood clot is suspected or diagnosed during pregnancy, prompt treatment is essential. The primary treatment options include:

1. Anticoagulant medications (blood thinners)
2. Compression stockings
3. Close monitoring and follow-up care
4. In severe cases, hospitalization may be required

Treatment plans are tailored to each individual’s specific situation, considering factors such as the stage of pregnancy and the location and severity of the clot.

Are blood thinners safe during pregnancy?

While some blood thinners can pose risks to the developing fetus, certain types are considered safe for use during pregnancy. Low molecular weight heparin (LMWH) is often the preferred choice for pregnant women due to its lower risk of crossing the placenta. Your healthcare provider will carefully weigh the benefits and risks before prescribing any medication.

The Impact of Blood Clots on Pregnancy Outcomes

Blood clots can have serious consequences for both the mother and the developing fetus. Potential complications include:

• Miscarriage
• Preterm labor
• Intrauterine growth restriction
• Placental abruption
• Pulmonary embolism
• Deep vein thrombosis

Early detection and proper management of blood clots can significantly reduce the risk of these adverse outcomes.

When to Seek Medical Attention

Knowing when to seek medical help is crucial for managing blood clots during pregnancy. Contact your healthcare provider immediately if you experience:

1. Heavy bleeding with large clots
2. Severe abdominal pain
3. Chest pain or difficulty breathing
4. Swelling, pain, or tenderness in one leg
5. Persistent headaches or vision changes

Remember, it’s always better to err on the side of caution when it comes to your health and the health of your baby.

Can blood clots during pregnancy be life-threatening?

Yes, in severe cases, blood clots during pregnancy can be life-threatening. Conditions such as pulmonary embolism, where a clot travels to the lungs, can be particularly dangerous. This underscores the importance of early detection, prompt treatment, and ongoing monitoring throughout pregnancy and the postpartum period.

Postpartum Blood Clot Risk

The risk of blood clots doesn’t end with delivery. In fact, the first six weeks postpartum are a particularly high-risk period. Factors contributing to this increased risk include:

• Hormonal changes
• Decreased mobility during recovery
• Potential complications from cesarean sections
• Dehydration

New mothers should remain vigilant for signs of blood clots and continue following preventive measures during this critical period.

The Role of Genetic Factors in Pregnancy-Related Blood Clots

Genetic predisposition can play a significant role in the development of blood clots during pregnancy. Inherited thrombophilias, such as Factor V Leiden mutation or Prothrombin gene mutation, can increase the risk of clotting events.

Should women with a family history of blood clots undergo genetic testing before pregnancy?

Women with a family history of blood clots or thrombophilias should consider genetic testing before conception or early in pregnancy. This information can help healthcare providers develop appropriate management strategies to reduce the risk of complications. However, the decision to undergo genetic testing should be made in consultation with a healthcare professional, considering individual circumstances and risk factors.

Balancing the Benefits and Risks of Preventive Measures

While preventing blood clots is crucial, it’s important to balance the benefits of preventive measures with potential risks. For example, while blood thinners can effectively reduce clot formation, they may increase the risk of bleeding complications. Healthcare providers must carefully assess each patient’s individual risk profile to determine the most appropriate preventive strategy.

How do doctors determine the need for blood thinners during pregnancy?

The decision to prescribe blood thinners during pregnancy is based on a comprehensive evaluation of risk factors, including:

• Personal or family history of blood clots
• Presence of inherited thrombophilias
• Previous pregnancy complications related to blood clots
• Other medical conditions that increase clotting risk

Doctors weigh these factors against the potential risks of anticoagulant therapy to determine the most appropriate course of action for each individual patient.

The Psychological Impact of Blood Clot Risk During Pregnancy

The increased risk of blood clots during pregnancy can cause significant anxiety and stress for expectant mothers. This psychological burden can have negative effects on both maternal and fetal well-being. Healthcare providers should address these concerns and provide appropriate support and resources to help women manage anxiety related to blood clot risk.

How can pregnant women cope with anxiety related to blood clot risk?

Coping strategies for managing anxiety about blood clot risk during pregnancy include:

1. Education: Understanding the risks and preventive measures can help alleviate fears
2. Open communication with healthcare providers
3. Relaxation techniques such as deep breathing and meditation
4. Joining support groups for high-risk pregnancies
5. Focusing on positive health behaviors and preventive measures

Remember, while the risk of blood clots is real, most pregnant women, even those with risk factors, have healthy pregnancies with proper care and management.

Emerging Research and Future Directions in Pregnancy-Related Blood Clot Prevention

The field of maternal-fetal medicine continues to evolve, with ongoing research aimed at improving our understanding and management of blood clot risk during pregnancy. Some areas of current interest include:

• Development of more precise risk assessment tools
• Investigation of novel anticoagulant therapies with improved safety profiles
• Exploration of the role of micronutrients in blood clot prevention
• Studies on the long-term effects of pregnancy-related blood clots

These advancements hold promise for enhancing the care and outcomes for pregnant women at risk of blood clots.

What new treatments for blood clots during pregnancy are on the horizon?

While current treatments primarily rely on traditional anticoagulants like heparin, researchers are exploring new options that may offer improved efficacy and safety. Some promising areas of investigation include:

1. Direct oral anticoagulants (DOACs) adapted for use in pregnancy
2. Targeted therapies based on individual genetic profiles
3. Novel delivery methods for anticoagulants to minimize fetal exposure
4. Combination therapies that address multiple aspects of clot formation

While these potential treatments are still in various stages of research and development, they represent exciting possibilities for the future of managing blood clot risk during pregnancy.

The Importance of Interdisciplinary Care in Managing Pregnancy-Related Blood Clots

Effective management of blood clot risk during pregnancy often requires a collaborative approach involving multiple healthcare specialties. This interdisciplinary care team may include:

• Obstetricians
• Hematologists
• Maternal-Fetal Medicine specialists
• Genetic counselors
• Pharmacists
• Mental health professionals

By working together, these specialists can provide comprehensive care that addresses all aspects of a woman’s health during pregnancy, including blood clot risk.

How does an interdisciplinary approach benefit pregnant women at risk for blood clots?

An interdisciplinary approach offers several advantages in managing blood clot risk during pregnancy:

1. Comprehensive risk assessment drawing on diverse expertise
2. Tailored treatment plans that consider all aspects of maternal and fetal health
3. Coordinated care to ensure consistent management throughout pregnancy and postpartum
4. Access to specialized knowledge and the latest research findings
5. Holistic support addressing both physical and psychological needs

This collaborative approach can lead to improved outcomes and a more positive pregnancy experience for women at risk of blood clots.

The Global Perspective: Blood Clot Risk in Pregnancy Across Different Populations

The risk of blood clots during pregnancy varies across different populations and geographic regions. Factors such as genetic predisposition, lifestyle habits, and access to healthcare can influence the prevalence and outcomes of pregnancy-related blood clots. Understanding these differences is crucial for developing targeted prevention and treatment strategies.

How does the risk of blood clots during pregnancy vary across different ethnic groups?

Research has shown that the risk of pregnancy-related blood clots can vary among different ethnic groups. For example:

• Some studies suggest that women of African descent may have a higher risk of venous thromboembolism during pregnancy compared to Caucasian women
• Certain genetic mutations associated with increased clotting risk, such as Factor V Leiden, are more common in some populations than others
• Cultural practices and lifestyle factors that vary among different ethnic groups can influence blood clot risk

These differences underscore the importance of individualized risk assessment and culturally sensitive care in managing blood clot risk during pregnancy.

Patient Empowerment: The Role of Self-Advocacy in Managing Blood Clot Risk

While healthcare providers play a crucial role in managing blood clot risk during pregnancy, patient empowerment and self-advocacy are equally important. Pregnant women can take an active role in their care by:

1. Educating themselves about blood clot risk and prevention
2. Communicating openly with healthcare providers about concerns and symptoms
3. Adhering to prescribed treatments and preventive measures
4. Maintaining a healthy lifestyle
5. Seeking support when needed

By taking an active role in their care, pregnant women can contribute significantly to reducing their risk of blood clots and improving overall pregnancy outcomes.

How can pregnant women effectively communicate their concerns about blood clot risk to healthcare providers?

Effective communication with healthcare providers is crucial for managing blood clot risk during pregnancy. Here are some strategies for pregnant women to communicate their concerns:

• Keep a symptom diary to track any unusual changes or experiences
• Prepare a list of questions before each appointment
• Be honest and thorough when discussing personal and family medical history
• Don’t hesitate to ask for clarification if something is unclear
• Bring a support person to appointments if desired
• Advocate for referrals to specialists if you feel additional expertise is needed

Remember, healthcare providers are partners in your care, and open, honest communication is key to ensuring the best possible outcomes for you and your baby.

Blood clots and pregnancy | March of Dimes

Anyone can develop a blood clot but pregnant women are at higher risk during pregnancy and after giving birth.

Blood clots can cause other health problems in pregnancy but there are ways to prevent and protect you and your baby.

It is important to know the signs of a blood clot and factors that may increase your risk for a blood clot.

Tell your health care provider if you or someone in your family has had problems with blood clots.

A blood clot (also called a thrombosis) is a mass or clump of blood that forms when blood changes from a liquid to a solid. The body normally makes blood clots to stop the bleeding after a scrape or cut. But sometimes blood clots can partly or completely block the flow of blood in a blood vessel, like a vein or artery.

Anyone can develop a blood clot, but you are at higher risk for a blood clot during pregnancy and up to 3 months after giving birth to your baby.   Most women with blood clotting conditions have healthy pregnancies. But these conditions may cause problems for some pregnant women. In severe cases, they can cause death for both mom and baby. But testing and treatment can help protect and save both you and your baby.

If you’re pregnant or trying to get pregnant and have had problems with blood clots in the past, tell your health care provider at a preconception checkup (before pregnancy) or at your first prenatal care checkup.

If you or someone in your family like your parent, brother or sister has had problems with blood clots, talk to your provider.  Blood clots may run in your family.  You may also talk to your provider about getting a blood test to see if you have a thrombophilia. This is a health condition that increases your chances of making abnormal blood clots. Some pregnant women with thrombophilias need treatment with medicines called blood thinners. They stop clots from getting bigger and prevent new clots from forming.

Why are pregnant women at greater risk for blood clots?

Pregnant women are 5 times more likely to experience a blood clot compared to women who are not pregnant.  This may be because:

• When you’re pregnant, your blood clots more easily to lessen blood loss during labor and delivery.
• In pregnant women, the blood may flow less to the legs later in pregnancy because the growing baby presses upon blood vessels around your pelvis. 
• When you’re pregnant you may experience less movement or immobility (not moving a lot) like when you’re on bed rest or recovering from giving birth.

What are other reasons people may be at risk for having blood clots?

Certain things make you more likely than others to have a blood clot. These are called risk factors. Having a risk factor doesn’t mean for sure that you’ll have a blood clot. But it may increase your chances. Talk to your provider about what you can do to help reduce your risk.

Risk factors for blood clots include:

• Having certain health conditions, like a thrombophilia, high blood pressure, diabetes or being overweight or obese. A family history of blood clotting problems also increases your chances of blood clots.
• Taking certain medicines, like birth control pills or estrogen hormones. These medicines can increase the risk of clotting. If you’ve had problems with blood clots or thrombophilias or have a family history of these conditions, birth control pills may not be safe for you to use. Talk to your provider about other birth control options.
• Smoking. Smoking damages the lining of blood vessels, which can cause blood clots to form.
• Having surgery, like a cesarean section (also called c-section). A c-section is a surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors help prevent blood clots in women during a c-section. This may include using compression devices that put pressure on your legs to help keep your blood flowing during the c-section.
• Being dehydrated. This means you don’t have enough water in your body. Dehydration causes blood vessels to narrow and your blood to thicken, which makes you more likely to have blood clots.
• Not moving around much. This may be because you’re on bed rest during pregnancy or recovering from surgery or an accident. Being still for long periods of time can lead to poor blood flow, which makes you more likely to have blood clots. Even sitting for long periods of time, like when traveling by car or plane for 4 hours or more, can increase your chances of having a blood clot.
• Having a baby. You’re more likely to have a blood clot in the first 6 weeks after birth than women who haven’t given birth recently.

What problems can blood clots cause during pregnancy?

If you have a blood clot or a kind of thrombophilia called antiphospholipid syndrome (also called APS), you may be more likely to have complications that can affect your health and your baby’s health, including:

Blood clots in the placenta. The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. A blood clot in the placenta can stop blood flow to your baby and harm your baby.

Heart attack. This usually happens when a blood clot blocks blood and oxygen flow to the heart. Without blood and oxygen, the heart can’t pump blood well, and the affected heart muscle can die. A heart attack can lead to lasting heart damage or death.

Intauterine growth restriction (also called IUGR). This is when your baby grows poorly in the womb.

Miscarriage.  A miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.

Placental insufficiency. This is when the placenta doesn’t work as well as it should so your baby gets less food and oxygen.

Preeclampsia. This condition that usually happens after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has both protein in her urine and high blood pressure.

Premature birth. This is when your baby is born before 37 weeks of pregnancy.

Pulmonary embolism (also called PE). An embolism is a blood clot that moves from where it formed to another place in the body. When the clot moves to a lung, it’s a PE. PE can cause low oxygen levels in your blood and damage your body organs. It’s an emergency and a leading cause of death during pregnancy. Signs and symptoms of PE may include:

• Trouble breathing
• Fast or irregular heartbeat
• Chest pain
• Fainting
• Coughing up blood

Stillbirth. This is when a baby dies in the womb before birth but after 20 weeks of pregnancy.

Stroke. This happens when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. Pregnancy and childbirth cause strokes in about 8 in 100,000 women. Stroke can cause lasting damage to the body or death.

Thrombosis. This happens when a blood clot forms in a blood vessel and blocks blood flow. It most often happens in the deep veins of the legs but can be in other places of the body:

• Cerebral vein thrombosis (also called CVT). This happens when a blood clot forms in a vein in the brain. CVT can lead to stroke. Signs and symptoms include headache, vision problems and seizures.   
• Deep vein thrombosis (also called DVT). This happens when a blood clot forms in a vein deep in the body, usually in the lower leg or thigh. DVT can be diagnosed with ultrasound or other imaging tests. Signs and symptoms may include warmth and tenderness over the vein and pain, swelling or skin redness in the affected area.

Venous thromboembolism (also called VTE). This happens when a blood clot breaks off and travels through blood to vital organs, like the brain, lungs or heart. This condition includes DVT and PE. VTEs that block blood vessels in the brain or heart can cause stroke or heart attack.

How are these conditions treated?

Your provider may use tests like ultrasound or magnetic resonance imaging (also called MRI) to find out if you have a blot clot or clotting conditions. Ultrasound uses sound waves and a computer screen to make a picture of a baby in the womb. MRI uses magnets and computers to make a clear picture of the inside of the body. These tests are painless and safe for you and your baby.

If you’re pregnant and have a clotting condition, you may need to go for prenatal care checkups more often than women who don’t have these blood clot conditions. At these visits, your provider checks your blood pressure and can use other tests, like blood tests, to monitor your health.

Your provider also checks your baby’s health in the womb using tests like:

• Ultrasound to check your baby’s growth and development. She may use a special kind of ultrasound called Doppler to check your baby’s blood flow in the umbilical artery, a blood vessel in the umbilical cord. The umbilical cord connects your baby to the placenta. It carries food and oxygen from the placenta to the baby.
• Fetal heart rate monitoring (also called a nonstress test or NST). This test checks your baby’s heart rate in the womb and sees how the heart rate changes when your baby moves. Your provider uses this test to make sure your baby’s getting enough oxygen.

During pregnancy your provider may give you a blood thinner called heparin (low-molecular weight heparin or unfractionated heparin). If you have APS, your provider may instruct you to take heparin along with low-dose aspirin. Your provider also may refer you to a hematologist. This is a doctor who treats blood conditions.

After you give birth, your provider may continue to treat you with heparin. Or she may treat you with a blood thinner called warfarin. Warfarin is safe to take after pregnancy, even if you’re breastfeeding. Warfarin is not safe to take during pregnancy because it may cause birth defects.

Don’t take combined hormonal methods of birth control during the first 21-42 days after delivery. The risk of DVT is highest in the first 21 days. 

How can I safely keep up with my prenatal care appointments during the COVID-19 pandemic?

During the coronavirus disease 2019 pandemic (COVID-19) your prenatal care visits may change. Ask your provider how he will monitor your health and do the tests you need while keeping you and your baby safe from COVID-19.

Providers are taking steps to prevent the spreading of COVID-19 by using telehealth or telemedicine. Telehealth or telemedicine are health visits where you talk to your provider by phone or by videocall, instead of going to his office.  You will need either a phone, tablet or computer for a telehealth visit and in some cases you may need access to the internet. Let your provider know if you are unable to have telehealth visits due to lack equipment or any other reason. Ask any questions you may have about keeping up with your ultrasounds and other tests while avoiding getting COVID-19.

What can I do to reduce my risk of blood clots?

• Know  the signs and symptoms of a blood clot.  On an affected limb like a leg or arm, you may notice swelling, pain or tenderness that was not caused by an injury, warm skin when you touch it or redness and discoloration. Contact your provider if you experience any of these symptoms.
• Talk to your provider about your risk. If you or a family member like a parent, brother or sister have had blood clots before, tell your provider. 
• Move or stretch on long trips. If you sit for more than 4 hours on a trip, try to move your legs often. If you can walk around, you may do so. If you can’t, you may try seated leg stretches like extending your legs straight out and moving your ankles to move your toes toward and away from you. You may also pull your knee to your chest and hold it there with your hands for 15 seconds. 
• Follow other travel tips for reducing risk of blood clots. These include drinking lots of fluids like water, wearing loose-fitted clothing or wearing special stockings that compress your legs below the knee. Talk to your provider before trying these stockings.
• Follow your provider’s instructions during pregnancy and after giving birth.  Your provider may give you medications like blood thinners or ask you to come in for additional prenatal care checkups.   

Last reviewed September 2022

More information

• Shane Foundation
• Stop The Clot, Spread the Word™ campaign

Vaginal bleeding in early pregnancy: MedlinePlus Medical Encyclopedia

Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen any time from conception (when the egg is fertilized) to the end of pregnancy.

Some women have vaginal bleeding during their first 20 weeks of pregnancy.

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.

Ask your health care provider more about the difference between spotting and bleeding at one of your first prenatal visits.

Some spotting is normal very early in pregnancy. Still, it is a good idea to tell your provider about it.

If you have had an ultrasound that confirms you have a normal pregnancy, call your provider the day you first see the spotting.

If you have spotting and have not yet had an ultrasound, contact your provider right away. Spotting can be a sign of a pregnancy where the fertilized egg develops outside the uterus (ectopic pregnancy). An untreated ectopic pregnancy can be life-threatening for the woman.

Bleeding in the 1st trimester is not always a problem. It may be caused by:

• Having sex.
• An infection.
• The fertilized egg implanting in the uterus.
• Hormone changes.
• Other factors that will not harm the woman or baby.
• A threatened miscarriage. Many threatened miscarriages do not progress to pregnancy loss.

More serious causes of first-trimester bleeding include:

• A miscarriage, which is the loss of the pregnancy before the embryo or fetus can live on its own outside the uterus. Almost all women who miscarry will have bleeding before a miscarriage.
• An ectopic pregnancy, which may cause bleeding and cramping.
• A molar pregnancy, in which a fertilized egg implants in the uterus but will not come to term.
• Formation of a blood clot between the amniotic sac and the wall of the womb called a subchorionic hematoma.

Your provider may need to know these things to find the cause of your vaginal bleeding:

• How far along is your pregnancy?
• Have you had vaginal bleeding during this or an earlier pregnancy?
• When did your bleeding begin?
• Does it stop and start, or is it a steady flow?
• How much blood is there?
• What is the color of the blood?
• Does the blood have an odor?
• Do you have cramps or pain?
• Do you feel weak or tired?
• Have you fainted or felt dizzy?
• Do you have nausea, vomiting, or diarrhea?
• Do you have a fever?
• Have you been injured, such as in a fall?
• Have you changed your physical activity?
• Do you have any extra stress?
• When did you last have sex? Did you bleed afterward?
• What is your blood type? Your provider can test your blood type. If it is Rh negative, you will need treatment with a medicine called Rho(D) immune globulin to prevent complications with future pregnancies.

Most of the time, the treatment for bleeding is rest. It is important to see your provider and have testing done to find the cause of your bleeding. Your provider may advise you to:

• Take time off work
• Stay off your feet
• Not have sex
• Not douche (NEVER do this during pregnancy, and also avoid it when you are not pregnant)
• Not use tampons

Very heavy bleeding may require a hospital stay or surgical procedure.

If something other than blood comes out, call your provider right away. Your provider will do an exam to look at your cervix.

Your provider will check to see if you are still pregnant. You will be closely watched with blood tests to see if you are still pregnant.

If you are no longer pregnant, you may need more care from your provider, such as medicine or possibly surgery.

Call or go to your provider right away if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis

If you cannot reach your provider, go to the emergency room.

If your bleeding has stopped, you still need to contact your provider. Your provider will need to find out what caused your bleeding.

Miscarriage – vaginal bleeding; Threatened abortion – vaginal bleeding

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.

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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What is implantation bleeding? – IVF center Generation NEXT

How our body functions and what changes occur in it every month is always interesting. Especially during the period when we are pregnant or hope to become pregnant. Almost certainly never do we monitor our condition so carefully and closely as during the period when we hope to become pregnant. From feeling tired to feeling slightly nauseous, the smallest signs are examined and tested for their significance. In this article, we will look at some of the most common implant bleeding problems. This problem is frightening and confusing if the desired pregnancy has already occurred.

Thus, we will try to figure out what are the symptoms and signs of implantation bleeding, how to recognize the earliest signs of implantation and pregnancy? Such self-control in people undergoing assisted fertility treatment can be much stronger, which is understandable. In this context, we will consider whether any other symptoms of implantation should be expected during pregnancy, and if so, how.

What is implantation bleeding?

About 30-40% of women experience a slight loss of blood after the embryo is implanted in the uterus. This phenomenon is known as implantation bleeding. Since this happens at the beginning of the cycle, it may even be the first sign of realizing that you are pregnant. Bleeding usually occurs in the first weeks of pregnancy, as the uterus is an organ rich in blood vessels that can easily “damage”. When the embryo sticks to the inner wall of the uterus, the small veins and arteries that normally connect to the endometrium rupture, and this can cause bleeding. If this occurs, usually 6-10 days after fertilization, then it usually coincides with the theoretical date of menstruation, and therefore can be confused with its onset. There is no set pattern, and implantation bleeding may occur in one or all of a particular individual’s pregnancies.

How to recognize implantation bleeding?

The first question for many people is how to recognize that this is implantation bleeding and not just the start of a cycle, in other words, how do these types of bleeding differ? The most common reason for confusion here is that bleeding occurs 10-14 days after conception, around the time that menstruation would have occurred if conception had not occurred. However, vaginal bleeding can occur anytime during the first 8 weeks of pregnancy. Blood loss may last 1-3 days, and the amount of discharge is usually less than during menstruation, although the color may be darker. It may look like a light spot or light continuous bleeding, and blood may or may not be mixed with mucus. The color may vary depending on how long it took to leave the body. Fresh bleeding looks red, it may look pink or orange if mixed with other vaginal discharge, and old blood may look brown due to oxidation.

How severe can implantation bleeding be? Can implantation bleeding have clots?

Usually, the bleeding that occurs as a result of the implantation of the embryo in the uterus is manifested by a spot or light bleeding. Usually it is not strong and does not have clots, as in a normal cycle. If you suspect you may be pregnant and are bleeding heavily with clots, you should see your doctor as this could signal problems or even the onset of a premature miscarriage. On the other hand, if you have no other reason to suspect that you are pregnant, this type of bleeding is more likely to just be the start of your cycle.

What are other symptoms of implantation in early pregnancy?

Since implantation bleeding only occurs in about a third of pregnancies, you are likely to be among the majority who do not experience it. However, your vigilance for the signs and symptoms of successful implantation is probably still massively high! So what are other early signs that you might be pregnant? They may include:

Morning sickness

This can start as early as 4 weeks after conception (10-14 days after embryo transfer), although more often it happens after about 6 weeks. Luckily for those who go through this, morning sickness is usually temporary and usually improves by 16-20 weeks of pregnancy.

Sensitivity to smells and tastes

Sudden sensitivity to smell and taste can be a sign of early pregnancy and no doubt contributes to the long tales of pregnancy “cravings” for certain foods. Both heightened sensitivity and morning sickness are the result of hormonal changes taking place in your body.

Frequent urination

It seems strange when your baby is still very young, but the need to urinate more often in early pregnancy is one of the most common symptoms. It is also the result of hormonal changes that cause faster blood flow through the liver and kidneys to remove waste as efficiently as possible. In addition, the uterus rapidly increases in size even at this early stage of pregnancy and therefore puts more pressure on the bladder, especially at night.

Soreness of the mammary glands

The well-known symptom of breast tenderness is another sign of early pregnancy. This is the result of an increase in blood flow and fluid retention in the mammary glands against the background of a sharp increase in the level of female sex hormones in the blood serum.

Stomach cramps

Spasms may occur on their own or be accompanied by slight bleeding, which may be a signal of implantation. You might think that all these possible early signs and symptoms of pregnancy will help to be easily confident in its onset. But the fact is that some symptoms are also present in some people as a harbinger of their normal monthly cycle in premenstrual syndrome. Thus, despite all the possible clues, the only way to be sure of pregnancy is to take a pregnancy test, and with it, confirm the pregnancy with your doctor.

Is implantation bleeding the same when you are undergoing IVF treatment?

People undergoing IVF or any other assisted fertility treatment often wonder if pregnancy symptoms will be the same if embryo transfer and implantation is successful. In a word, yes. While some stages of IVF are drug-driven, and even though the actual pairing of the egg and sperm takes place in the laboratory, the end result is identical.

Let’s look at a summary of the steps that led to the implantation of the embryos. The first step is ovarian stimulation, which causes the ovaries to produce a number of oocytes. Then, when the oocytes have reached a suitable stage of maturity, they are retrieved during ovarian puncture in order to be fertilized with prepared sperm in the embryology laboratory. This is the point at which fertilization occurs and embryos are formed. They are cultivated – “grow” in special incubators and pass the necessary tests (if a genetic study of the embryos is performed). The healthiest and most viable embryo is then transferred into the woman’s uterus. This is, in a nutshell, the final stage of the process. The implantation of the embryo into the uterine wall after it has been transferred is not part of the assisted reproduction process; it is something that happens naturally in the same way as in normal conception. This final stage is not guaranteed as a result of IVF treatment, just as unprotected sex during ovulation is not guaranteed to lead to pregnancy. This explains the absolute similarity of symptoms in the case of assisted reproduction and natural pregnancy, which you can expect, including any bleeding during implantation.

What you need to know about bleeding in the 1st trimester of pregnancy

Bleeding or spotting occurs in 20-30% of women in the first trimester of pregnancy. Although any bleeding before 20 weeks of gestation is by definition a “threat of miscarriage”, the type of bleeding present is of great importance. Some causes of first trimester bleeding are serious, while others are not. Since it is difficult to tell the difference between “normal” and serious bleeding during pregnancy, consultation with a doctor is essential in every case.

Possible causes of bleeding in the first trimester.

Implantation bleeding is a non-hazardous bleeding that occurs when an embryo is implanted into the lining of the uterus (endometrium). This happens during the expected day of menstruation, i.e. even before a woman realizes that she is pregnant. In fact, this type of bleeding is often mistaken for a scanty period. It is quite difficult to distinguish between implantation bleeding and menstruation, since they have similar symptoms: mild pulling pains in the lower abdomen and lower back, headache, mild nausea, breast engorgement. But the discharge from implantation bleeding is scant in quantity, usually lighter than during menstruation – from light pink to dull brown, and, as a rule, short – from several hours to several days.

Bleeding due to changes in the cervix. In early pregnancy, the cervix becomes loose and its blood supply is greater than before pregnancy. Anything that can irritate the cervix, any physical impact (vaginal examination, swabs, exercise or sexual intercourse) can lead to bleeding from the cervix, which can be considered an injury. This type of bleeding does not pose a threat to pregnancy and, as a rule, they stop by the end of the first trimester, when the woman’s body begins to get used to all the changes that occur during pregnancy. In very rare cases, bleeding from the cervix after physical impact may be due to cervical cancer.

Bleeding due to cervical polyp. A cervical canal polyp is a benign growth of tissue that occurs in approximately 2 to 5% of women. Bleeding can be triggered by sexual intercourse or vaginal examination. In addition, polyps can become inflamed and lead to bright spotting. They are often not dangerous for pregnancy, and are easily diagnosed during a routine examination of the cervix in the mirrors.

Bleeding due to infection. Any infection in the vagina, such as bacterial vaginosis or a sexually transmitted infection such as chlamydia, gonorrhea, or herpes, can cause bleeding in the first trimester. In addition to pink to red blood spots, there may be other symptoms such as: itching; burning sensation when urinating; slight pulling pains in the lower abdomen; soreness in or around the vagina. While this bleeding has nothing to do with pregnancy, the infection must be treated as soon as possible to stop the bleeding.

Bleeding from the urinary tract or rectum. These bleedings are often mistaken for vaginal bleeding, although they are not related to pregnancy. They are found on toilet paper after visiting the toilet. Bright red blood from the rectum or urethra may be caused by a urinary infection, a bladder or rectal polyp, hemorrhoids, or a fissure in the rectum. Although such bleeding is not a cause for concern regarding the safety of pregnancy, it is necessary to consult a doctor for examination and choice of treatment.

Bleeding associated with chemical pregnancy. A chemical pregnancy is a type of miscarriage where bleeding and lower abdominal pain occur immediately after a very early positive pregnancy test. A miscarriage occurs because the fertilized egg has not been fully implanted in the uterus. If the fetal egg is completely out of the uterus, then only dynamic control is carried out to reduce the level of beta-hCG. In case of incomplete miscarriage, medical or surgical removal of the remnants of the fetal egg is carried out.

Subchorial hemorrhage or subchorial hematoma occurs when the chorion (placenta) slightly exfoliates from the wall of the uterus, and a cavity filled with blood forms in the gap between them.
These hematomas vary in size. The most common are small hematomas, which dissolve on their own and have little effect on the course of pregnancy. Large – can cause severe bleeding, lead to a significant detachment of the chorion, and in the future – to a miscarriage. These hematomas are often asymptomatic and are detected only by ultrasound.

Bleeding associated with spontaneous miscarriage is one of the most serious bleeding problems in the first trimester and occurs in 15-20% of women. In addition to severe bleeding, the symptoms of a miscarriage are severe cramps in the lower abdomen and lower back, radiating to the vagina. Although miscarriage is most common during the first 12 weeks of pregnancy, however, bleeding doesn’t always mean it will happen. If the ultrasound determines the fetal heartbeat and the cervix is ​​\u200b\u200bclosed, then at 90% of cases manage to keep the pregnancy.

Ectopic pregnancy – when the embryo is implanted outside the uterus (in the fallopian tube, ovaries, abdominal cavity). This type of pregnancy cannot develop normally and can lead to life-threatening bleeding for the mother. Suspicion of an ectopic pregnancy causes a beta-hCG level above 1500-2000 mIU per ml, but according to ultrasound, a fetal egg in the uterus is not detected. Symptoms of an ectopic pregnancy include bleeding, cramping, and sharp pains in the abdomen. In these cases, careful monitoring is necessary, and if the diagnosis is confirmed, surgical treatment is necessary.

Bleeding due to gestational trophoblastic disease (also called hydatidiform mole). This is a very rare condition when an anomaly occurs during fertilization in which a fertilized egg forms in the uterus without an embryo, and abnormal tissue grows inside the uterus.