What causes blood clots in early pregnancy. How to recognize dangerous bleeding during pregnancy. When is spotting normal in the first trimester. What are the signs of miscarriage or ectopic pregnancy.

Understanding Vaginal Bleeding in the First Trimester

Vaginal bleeding during pregnancy, especially in the first trimester, is a common occurrence that affects approximately 20% of women. While often harmless, it can be a source of anxiety for expectant mothers. Understanding the potential causes and knowing when to seek medical attention is crucial for ensuring the health and safety of both mother and baby.

Common Causes of First Trimester Bleeding

• Implantation bleeding
• Miscarriage
• Ectopic pregnancy
• Molar pregnancy
• Cervical changes
• Infections

Is implantation bleeding normal? Implantation bleeding is a common and typically harmless occurrence that happens when the fertilized egg attaches itself to the uterine lining. This usually occurs within 6 to 12 days after conception and can be mistaken for a light period. The bleeding is generally very light and lasts from a few hours to a few days.

How can you differentiate between implantation bleeding and a potential miscarriage? While implantation bleeding is light and brief, miscarriage bleeding tends to be heavier and may be accompanied by strong cramps in the lower abdomen and the passing of tissue through the vagina. However, it’s important to note that not all bleeding indicates a miscarriage. In fact, if a heartbeat is detected on ultrasound, over 90% of women experiencing first trimester bleeding will not miscarry.

Recognizing Signs of Ectopic Pregnancy

What is an ectopic pregnancy and why is it dangerous? An ectopic pregnancy occurs when the fertilized embryo implants outside of the uterus, typically in the fallopian tube. This condition, affecting about 2% of pregnancies, can be life-threatening if the fallopian tube ruptures due to the growing embryo.

How can you identify an ectopic pregnancy? The primary symptoms include:

• Vaginal bleeding
• Strong cramps or pain in the lower abdomen
• Lightheadedness

If you experience these symptoms, especially in combination, it’s crucial to seek immediate medical attention. Early detection and treatment of ectopic pregnancies can prevent serious complications and preserve fertility.

Molar Pregnancy: A Rare but Serious Condition

What characterizes a molar pregnancy? Also known as gestational trophoblastic disease, a molar pregnancy is a rare condition where abnormal tissue grows inside the uterus instead of a developing fetus. In some cases, this tissue can become cancerous and spread to other parts of the body.

How can you recognize a molar pregnancy? The symptoms often include:

• Vaginal bleeding
• Severe nausea and vomiting
• Rapid enlargement of the uterus

Early detection and treatment of molar pregnancies are essential to prevent potential complications and ensure the mother’s health. If you suspect you might have a molar pregnancy, consult your healthcare provider immediately for proper diagnosis and care.

Second and Third Trimester Bleeding: Potential Causes and Risks

While first trimester bleeding is often less concerning, vaginal bleeding in the second or third trimester requires immediate medical attention. What are the potential causes of late pregnancy bleeding?

Placenta Previa

What is placenta previa? This condition occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. Although rare in the late third trimester (occurring in only 1 in 200 pregnancies), placenta previa can cause painless bleeding and requires immediate medical attention.

Placental Abruption

What happens during a placental abruption? In about 1% of pregnancies, the placenta detaches from the uterine wall before or during labor. This can lead to bleeding and pooling of blood between the placenta and uterus. Placental abruption can be dangerous for both mother and baby, with symptoms including:

• Abdominal pain
• Vaginal blood clots
• Tender uterus
• Back pain

Uterine Rupture

Can previous C-sections increase the risk of uterine rupture? In rare cases, a scar from a previous cesarean section can tear open during pregnancy. This life-threatening condition requires an emergency C-section. Symptoms of uterine rupture include vaginal bleeding, pain, and tenderness in the abdomen.

Vasa Previa

What is vasa previa and why is it dangerous? This rare condition occurs when the baby’s blood vessels in the umbilical cord or placenta cross the opening to the birth canal. Vasa previa can be extremely dangerous for the baby if these blood vessels tear, potentially leading to severe blood loss and oxygen deprivation.

Preterm Labor: Recognizing the Signs

Can vaginal bleeding be a sign of preterm labor? In some cases, bleeding late in pregnancy may indicate that your body is preparing for delivery. A few days or weeks before labor begins, you may notice the passage of the mucus plug, often accompanied by small amounts of blood (known as “bloody show”).

When should you be concerned about preterm labor? If you experience bleeding and symptoms of labor before the 37th week of pregnancy, it’s crucial to contact your healthcare provider immediately. Other signs of preterm labor include:

• Regular contractions
• Pelvic pressure
• Lower back pain
• Changes in vaginal discharge

When to Seek Medical Attention for Pregnancy Bleeding

How do you know when bleeding during pregnancy requires immediate medical attention? While some light spotting can be normal, especially in the first trimester, there are certain situations where you should seek medical help right away:

• Heavy bleeding (soaking through a pad in less than an hour)
• Bleeding accompanied by severe abdominal pain or cramping
• Bleeding with fever or chills
• Passing tissue or large clots
• Any bleeding in the second or third trimester

What should you do if you experience abnormal bleeding during pregnancy? First, try to stay calm. Put on a pad to monitor the amount of bleeding, and contact your healthcare provider immediately. They may ask you to come in for an examination or go to the emergency room, depending on your symptoms and stage of pregnancy.

Preventing and Managing Pregnancy Complications

While not all pregnancy complications can be prevented, there are steps you can take to promote a healthy pregnancy and reduce risks:

1. Attend all prenatal appointments
2. Follow a healthy diet and exercise routine as recommended by your doctor
3. Avoid smoking, alcohol, and illicit drugs
4. Take prenatal vitamins as prescribed
5. Manage any chronic health conditions
6. Report any unusual symptoms to your healthcare provider promptly

How can you prepare for potential pregnancy complications? It’s essential to educate yourself about the signs and symptoms of various pregnancy complications. Keep emergency contact numbers readily available, and have a plan in place for getting to the hospital quickly if needed.

Understanding Blood Clots During Pregnancy

Why are pregnant women at higher risk for blood clots? Pregnancy increases the body’s blood clotting ability to prevent excessive bleeding during childbirth. However, this natural change also increases the risk of developing harmful blood clots, particularly in the deep veins of the legs or pelvis (deep vein thrombosis or DVT).

What are the signs of a blood clot during pregnancy? Symptoms of a blood clot may include:

• Swelling, usually in one leg
• Leg pain or tenderness
• Redness or discoloration of the skin
• Warmth in the affected area

If you experience these symptoms, especially if they worsen or are accompanied by chest pain or shortness of breath, seek medical attention immediately. Prompt treatment is crucial to prevent potential complications such as pulmonary embolism.

Preventing Blood Clots During Pregnancy

How can pregnant women reduce their risk of blood clots? While some risk factors, such as a family history of clotting disorders, can’t be changed, there are steps you can take to lower your risk:

• Stay active and avoid prolonged periods of sitting or standing
• Stay hydrated
• Wear compression stockings if recommended by your doctor
• Follow any prescribed medication regimens for clot prevention

Your healthcare provider may recommend additional preventive measures based on your individual risk factors and medical history.

Coping with Pregnancy Anxiety and Stress

How can expectant mothers manage anxiety related to pregnancy complications? It’s natural to feel worried about potential problems during pregnancy, but excessive stress can be harmful. Here are some strategies to cope with pregnancy-related anxiety:

• Practice relaxation techniques such as deep breathing or meditation
• Engage in gentle exercise, like prenatal yoga or walking
• Join a support group for expectant mothers
• Talk to a therapist or counselor specializing in pregnancy-related issues
• Educate yourself about pregnancy and childbirth through reputable sources
• Communicate openly with your partner and healthcare provider about your concerns

Remember, while it’s important to be aware of potential complications, most pregnancies progress without major issues. Focus on taking care of yourself and your baby, and don’t hesitate to reach out for support when needed.

The Role of Prenatal Care in Monitoring Pregnancy Health

Why is regular prenatal care crucial for detecting and managing pregnancy complications? Prenatal check-ups allow your healthcare provider to monitor your health and your baby’s development closely. These visits typically include:

• Blood pressure checks
• Urine tests to detect infections or preeclampsia
• Measurements of your baby’s growth
• Listening to the baby’s heartbeat
• Ultrasounds to assess fetal development and placenta position

How often should you have prenatal check-ups? The frequency of prenatal visits typically increases as your pregnancy progresses:

• Weeks 4-28: Once a month
• Weeks 28-36: Every two weeks
• Weeks 36 to birth: Weekly

Your healthcare provider may recommend more frequent visits if you have a high-risk pregnancy or develop complications. These regular check-ups are essential for early detection and management of any potential issues, ensuring the best possible outcome for you and your baby.

Navigating Pregnancy After Previous Complications

How does a history of pregnancy complications affect future pregnancies? If you’ve experienced complications in a previous pregnancy, such as miscarriage, preterm labor, or preeclampsia, you may be at higher risk for similar issues in subsequent pregnancies. However, many women go on to have healthy pregnancies after experiencing complications.

What steps can you take to ensure a healthy pregnancy after previous complications? Here are some strategies:

• Schedule a preconception consultation with your healthcare provider
• Address any underlying health conditions before becoming pregnant
• Consider genetic counseling if appropriate
• Follow a healthy lifestyle, including proper nutrition and exercise
• Attend all recommended prenatal appointments
• Be vigilant about monitoring for signs of complications
• Discuss any concerns or anxieties with your healthcare provider

Remember, each pregnancy is unique, and having had complications in the past doesn’t necessarily mean you’ll experience them again. Work closely with your healthcare team to develop a personalized care plan that addresses your specific needs and risks.

The Importance of Postpartum Care and Follow-up

Why is postpartum care crucial, especially after experiencing pregnancy complications? The postpartum period, also known as the “fourth trimester,” is a critical time for maternal health and well-being. This is particularly true for women who have experienced complications during pregnancy or childbirth.

What should postpartum care include? Comprehensive postpartum care should address:

• Physical recovery from childbirth
• Emotional and mental health
• Infant care and feeding
• Birth control and family planning
• Management of any ongoing health conditions

How long should postpartum care continue? While the traditional six-week postpartum check-up is important, the American College of Obstetricians and Gynecologists now recommends ongoing care during the first 12 weeks after birth, with a comprehensive assessment no later than 12 weeks postpartum.

For women who experienced complications during pregnancy or childbirth, this extended care is particularly crucial. It allows for continued monitoring of any residual health issues, ensures proper healing, and provides an opportunity to address any concerns about future pregnancies.

Empowering Yourself with Knowledge and Support

How can expectant mothers take an active role in their prenatal care? Being an informed and engaged patient is crucial for a healthy pregnancy. Here are some ways to empower yourself:

• Educate yourself about pregnancy and potential complications using reliable sources
• Prepare questions for your healthcare provider before each appointment
• Keep a pregnancy journal to track symptoms, concerns, and questions
• Build a support network of family, friends, and other expectant mothers
• Consider taking childbirth education classes
• Research your options for labor, delivery, and postpartum care

Remember, you are your own best advocate. Don’t hesitate to speak up if you have concerns or feel that something isn’t right. Trust your instincts and communicate openly with your healthcare team.

By staying informed, vigilant, and proactive, you can navigate the challenges of pregnancy with confidence. While complications can be scary, remember that most pregnancies result in healthy babies and mothers. With proper care and support, you can maximize your chances of a safe and joyful pregnancy experience.

Vaginal Bleeding and Blood Clots During Pregnancy

Written by Stephanie Watson

In this Article

• Bleeding in the First Trimester
• Bleeding in the Second and Third Trimesters
• What to Do If You Have Abnormal Bleeding During Pregnancy

Bleeding during pregnancy is common, especially during the first trimester, and usually it’s no cause for alarm. But because bleeding can sometimes be a sign of something serious, it’s important to know the possible causes, and get checked out by your doctor to make sure you and your baby are healthy.

About 20% of women have some bleeding during the first 12 weeks of pregnancy. Possible causes of first trimester bleeding include:

Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you conceive as the fertilized egg implants itself in the lining of the uterus. Some women don’t realize they are pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts from a few hours to a few days.

Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns with first trimester bleeding. However, first trimester bleeding does not necessarily mean that you’ve miscarried or will miscarry. In fact, if a heartbeat is seen on ultrasound, over 90% of women who experience first trimester vaginal bleeding will not miscarry.

Other symptoms of miscarriage are strong cramps in the lower abdomen and tissue passing through the vagina.

Ectopic pregnancy. In an ectopic pregnancy, the fertilized embryo implants outside of the uterus, usually in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life-threatening to the mother. Although ectopic pregnancy is potentially dangerous, it only occurs in about 2% of pregnancies.

Other symptoms of ectopic pregnancy are strong cramps or pain in the lower abdomen, and lightheadedness.

Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can spread to other parts of the body.

Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the uterus.

Additional causes of bleeding in early pregnancy include:

• Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test, which cause contact with the cervix, can trigger bleeding. This type of bleeding isn’t cause for concern.
• Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Abnormal bleeding in late pregnancy may be more serious because it can signal a problem with the mother or baby. Call your doctor as soon as possible if you experience any bleeding in your second or third trimester.

Possible causes of bleeding in late pregnancy include:

Placenta previa. This condition occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. Placenta previa is very rare in the late third trimester, occurring in only one in 200 pregnancies. A bleeding placenta previa, which can be painless, is an emergency requiring immediate medical attention.

Placental abruption. In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labor and blood pools between the placenta and uterus. Placental abruption can be very dangerous to both the mother and baby.

Other signs and symptoms of placental abruption are abdominal pain, clots from the vagina, tender uterus, and back pain.

Uterine rupture. In rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section.

Other symptoms of uterine rupture are pain and tenderness in the abdomen.

Vasa previa. In this very rare condition, the developing baby’s blood vessels in the umbilical cord or placenta cross the opening to the birth canal. Vasa previa can be very dangerous to the baby because the blood vessels can tear open, causing the baby to bleed severely and lose oxygen.

Other signs of vasa previa include abnormal fetal heart rate and excessive bleeding.

Premature labor. Vaginal bleeding late in pregnancy may just be a sign that your body is getting ready to deliver. A few days or weeks before labor begins, the mucus plug that covers the opening of the uterus will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as “bloody show”). If bleeding and symptoms of labor begin before the 37th week of pregnancy, contact your doctor right away because you might be in preterm labor.

Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and ache in the lower back.

Additional causes of bleeding in late pregnancy are:

• Injury to the cervix or vagina
• Polyps
• Cancer

Because vaginal bleeding in any trimester can be a sign of a problem, call your doctor. Wear a pad so that you can keep track of how much you’re bleeding, and record the type of blood (for example, pink, brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for testing. Don’t use a tampon or have sex while you are still bleeding.

Your doctor might recommend that you rest as much as you can and avoid exercise and travel.

You should expect to receive an ultrasound to identify what the underlying cause of your bleeding may be. Vaginal and abdominal ultrasounds are often performed together as part of a full evaluation.

Go to the emergency room or call 911 right away if you have any of the following symptoms, which could be signs of a miscarriage or other serious problem:

• Severe pain or intense cramps low in the abdomen
• Severe bleeding, with or without pain
• Discharge from the vagina that contains tissue
•  Dizziness or fainting
• A fever of more than 100. 4 or more degrees Fahrenheit and/or chills

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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

Bleeding during early pregnancy. Causes, symptoms of spotting in the first trimester

Bleeding during early pregnancy occurs with spontaneous miscarriage, Rhesus conflict, ectopic pregnancy. A condition occurs regardless of the timing of pregnancy. The gestation period is a complex process that does not always go well. Every second woman has various complications. Most often, women go to the doctor with complaints of spotting. Why does bleeding occur during early pregnancy, how dangerous is it?

General information

Bleeding during pregnancy is considered an obstetric symptom, indicating disorders in the woman’s body. Causes can be physiological changes or pathologies. Bleeding is observed in every fifth pregnant woman. In 50% of cases, they indicate the presence of pathology and end in spontaneous abortion. In the remaining 50% of women, this symptom is physiological. Most often, bleeding occurs in the 1st and 3rd trimesters.

Causes

Blood in the first trimester of pregnancy in the vaginal secretion is observed in 30% of expectant mothers. Bleeding can be weak, spotting, plentiful.

Most often, blood during early pregnancy is observed during implantation of the fetal egg. When the egg is attached, the vessels are often damaged, which leads to the appearance of blood secretions. They are similar to menstruation, last 1-2 days. This process is considered natural, does not indicate any pathologies.

Blood during pregnancy can appear with the following pathologies:

1. Excessive exercise, deep penetration during intercourse . If the cervix is ​​damaged, slight red discharge occurs, which disappears within two hours.
2. Progesterone deficiency . With a low level of the hormone, the body starts the process of menstruation. Bloody discharge during pregnancy appears when the uterine mucosa is exfoliated. The situation may adversely affect the implantation of the fetal egg.
3. Miscarriage . Occurs in 2-8% of pregnant women. It is characterized by pain in the lower abdomen, which is rapidly increasing, bloody discharge at the beginning of pregnancy. The causes of the pathological condition can be different – infectious diseases, fetal malformations that are incompatible with life, dehydration, abdominal trauma, taking certain drugs.
4. Ectopic pregnancy . Dangerous condition, urgent hospitalization is required.
5. Aborted miscarriage . Blood discharge during pregnancy, abdominal pain are the main manifestations of intrauterine development of the fetus.
6. Infections . To avoid dangerous complications, it is necessary to treat diseases. Parents of both sexes should be tested.
7. Complete or partial blistering . Pathology of the chorion, in which the size of the villi increases, bubble expansions form. The risk group includes women with ovarian dysfunction, inflammatory diseases of the reproductive system, and a history of cystic mole. Bleeding is profuse and constant, characteristic blisters are present. The symptoms of early toxicosis are very pronounced, the size of the uterus, the hCG indicators do not correspond to the gestational age.
8. Cervical cancer . Pregnant women are rarely diagnosed. The risk group includes women with a large number of abortions and childbirth, often changing sexual partners.
9. Subchorionic hematoma . Hemorrhage around the placenta most often resolves on its own. But it increases the risk of preterm birth and other complications.
10. Cervical erosion . Detected in 50% of women. For pregnant women, the disease is not dangerous, but constant medical supervision is needed.
11. Bleeding in the first trimester can be caused by causes that appear at any gestational age. These are fibroids, polyps in the uterus and cervical canal, cardiovascular pathologies that are associated with a weakening of the endothelium.

Any bloody discharge during early pregnancy is a reason for an urgent visit to a gynecologist. Even if there is no additional discomfort. At a remote consultation, our doctor will collect an anamnesis, draw up a clinical picture in order to identify the cause of bleeding. And he will select effective methods to eliminate the problem.

Varieties

The clinical picture of the pathological condition depends on the causes. So, when physiological changes occur against the background of general well-being. Depending on the origin of bleeding are divided into:

Depending on the type, bleeding is divided into internal – indicate placental abruption, external – from the vagina, mixed – both internal and external bleeding appear.

Physiological or pathological bleeding during gestation – differences

Clinical manifestations of bleeding in pregnant women depend on the causes. Physiological discharge of blood from the genital tract in the early stages of gestation proceeds without deterioration in well-being. With bleeding caused by erosion, fibroids and polyps, there are also no additional discomfort. In this case, only a few drops of blood are released, it bleeds for a short time.

Abundant bleeding, similar to menstruation, against the background of a general satisfactory condition, occurs with a deficiency of progesterone.

Bleeding with spontaneous interruption is accompanied by constant or periodic pain in the lumbar region, abdomen. Disturbed by nausea, bouts of dizziness, slightly increased body temperature. Bleeding can be weak or intense, and clots are often observed in the discharge.

When a fertilized egg is fixed outside the uterus, internal bleeding often occurs, and discharge from the genital tract may appear much later. Characteristic manifestations – acute pain in the abdomen radiates to the anal region, right or left side, blood pressure decreases, cold sweat appears, fainting is possible. Significant blood loss leads to the development of a state of shock with a high probability of death.

Implantation bleeding

Why does it bleed at the initial stages of gestation? Most often, the appearance of spotting during pregnancy is associated with the implantation of the embryo. They occur 6-12 days after conception and are often one of the first signs of conception.

Usually, the appearance of spotting at the beginning of pregnancy coincides with the time of the onset of menstruation, if the cycle is regular. But discharge in pregnant women is not as abundant as menstrual bleeding. Duration – from several hours to three, with the first pregnancy up to 5 days.

Photo: What is typical for implantation bleeding

How does implantation bleeding manifest?

• weak, pulling pain in the lower abdomen;
• headache, dizziness;
• sudden change of mood;
• bouts of nausea;
• increased sensitivity, swelling of the mammary glands;
• fatigue, drowsiness.

Important! When the embryo is implanted, little blood is released, usually these are small spots. The discharge may be pink, brown, orange, and there should be no clots.

Early dates

The first months of pregnancy are the most difficult and dangerous. It is in the early stages that various pathologies and complications often appear.

Why blood may appear in the early stages during pregnancy:

1. At the 4th week of pregnancy, discharge with an admixture of blood may appear – this is implantation bleeding. Heavy bleeding is a dangerous sign, most often indicates a miscarriage. Spontaneous abortion can be caused by exercise, fever, infections, drugs or alcohol. Such bleeding is profuse, painful, blood clots are present.
2. The appearance of sanious discharge at the 5th week of pregnancy may be a sign of a missed pregnancy. The reasons are overwork, Rh conflict, bad habits, bacterial and viral diseases of the reproductive system, genetic disorders in the embryo. Symptoms – causeless fever, severe pain in the lower back and lower abdomen, the disappearance of signs of toxicosis.
3. Blood in the discharge at the 6th week of pregnancy appears with an ectopic attachment of the fetal egg, fetal fading, Rhesus conflict. Discharge with blood at 6 weeks of pregnancy is a reason for an urgent visit to the gynecologist.
4. At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
5. From the 8th week of pregnancy, one of the most dangerous periods of pregnancy begins. The formation of the placenta begins, the hormonal background changes. Bloody discharge appears with the threat of miscarriage or spontaneous abortion. Pregnancy is often not saved.

Pay attention! Second trimester bleeding occurs in only 5-10% of women. Most often this is due to late spontaneous abortion, isthmic-cervical insufficiency. The appearance of blood in the third trimester mainly occurs with presentation, placental abruption.

ECO

The appearance of blood discharge during pregnancy on the 8-10th day after IVF is not considered a pathology, provided that the woman feels normal. After the introduction of the embryo into the uterine cavity, minor damage to the small uterine vessels often occurs. Brown, dark cream, pale pink, odorless discharge most often indicates a successful transplant, pregnancy.

If spotting after IVF is observed for 1-2 days, slight pulling pains in the lower abdomen are disturbing, this may be due to a progesterone deficiency. After the examination, the doctor will adjust the hormonal maintenance therapy.

Pink discharge on the 16th day after the transfer is a dangerous symptom. It may be a sign of detachment of the fetal egg, the threat of termination of pregnancy.

According to studies, uterine bleeding in the first trimester is a common occurrence in pregnancy after IVF. Discharge does not affect the incidence of adverse reproductive outcomes. The number of embryo rejections in women with and without uterine bleeding is approximately the same. Consult with our doctors by phone for more details.

Consult a gynecologist

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Diagnostics

If blood has gone from the genitals of a pregnant woman, the doctor conducts an external and gynecological examination.

Analyzes and examinations:

• general and biochemical blood test;
• general urine analysis;
• tests for hCG, other hormones;
• Ultrasound of the pelvic organs;
• CTG is performed to assess the vital activity of the fetus.

Read also
Is it possible to get pregnant after an abortion

Treatment

Methods of treatment depend on the results of the examination.

Bloody discharge in the first trimester – causes and therapeutic measures:

• In case of miscarriage, they resort to cleaning the uterus.
• An ectopic pregnancy is treated by diagnostic laparoscopy, the remnants of fetal tissues are removed, and antibiotic therapy is carried out.
• With the threat of miscarriage, hospitalization, bed rest, the appointment of drugs to maintain pregnancy, sedatives and tocolytics to reduce uterine tone are indicated.
• Bubble drift is eliminated by curettage of the uterine cavity.
• Surgery is necessary for cervical cancer.
• Damage to the polyp, erosion of the cervix requires expectant management, if the condition does not worsen, removal and cauterization is performed after childbirth.
• Hormone therapy is prescribed for a lack of progesterone.

Damage to the cervix of the uterus requires bed rest, and infectious pathologies are treated depending on the pathogen. In this case, antibiotics, antiviral, antifungal drugs can be prescribed.

Complications and consequences

It is impossible to ignore bloody impurities in vaginal discharge during pregnancy. Without proper and timely assistance, the following complications may occur:

• miscarriage;
• intrauterine fetal death;
• the development of an infectious process, sepsis due to the remainder of dead tissues in the uterine cavity;
• profuse blood loss can lead to death.

Important! Urgent medical attention is needed in case of heavy bleeding, discharge of bright scarlet blood, presence of blood clots in the discharge. In life-threatening and fetal conditions, severe pain in the abdomen, lower back, convulsions, profuse cold sweat, and loss of consciousness are disturbing.

Methods of prevention

If there is blood in the first trimester, it is important to remain calm. Stress and anxiety will only exacerbate the situation. But any health problem is easier to prevent than to treat.

How to avoid bleeding during childbearing – recommendations from a gynecologist:

• eat right and balanced, give up junk and junk food, eat more fresh vegetables and fruits;
• observe the drinking regime;
• in the absence of contraindications, moderate physical activity is indicated – yoga, swimming, special gymnastics for pregnant women;
• more time to walk in the fresh air;
• avoid stress, overwork, observe the daily routine, get enough sleep;
• give up bad habits, do not be in smoky rooms;
• timely visit a gynecologist;
• according to the doctor’s prescription, take vitamin complexes for pregnant women;
• do not self-medicate.

The prognosis for bleeding during gestation depends on the causes and timely visit to the doctor. Properly provided medical care can save the life of the fetus and the woman.

FAQ

Why is there blood from the genital tract during gestation?

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The causes of bleeding in early pregnancy are different. Most often, spotting appears when the fetal egg is fixed, progesterone deficiency, with erosion of the cervix and polyps. Dangerous causes – ectopic, molar, miscarriage, miscarriage.

What to do if there is bleeding during pregnancy?

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Much depends on the amount of blood released, general well-being. If the bleeding is not strong, not for long, the general condition is normal, it is enough to lie down and rest. Write down the date of the attack, inform the doctor at the next visit. But if even slight spotting during early pregnancy lasts more than 72 hours, is accompanied by cramping or acute pain, fever, you should immediately visit a gynecologist or call an ambulance.

How can you recognize a miscarriage?

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With the threat of interruption, spotting is scanty, pain in the lower abdomen is absent or may be dull, aching. The condition is considered reversible, with timely treatment, pregnancy can be saved. If a miscarriage has begun, bleeding intensifies, cramping pain appears. The general condition is satisfactory. Urgent hospitalization is required, the probability of maintaining pregnancy is decided on an individual basis.

Expert opinion

Bleeding during early pregnancy is a dangerous symptom. Sometimes spotting can be caused by physiological reasons. But often such a symptom appears in life-threatening conditions for the woman and the fetus. To clarify the diagnosis, ultrasound examinations are performed, the degree of blood loss is determined.

We publish only verified information

Article author

Menshikova Maria Viktorovna

obstetrician-gynecologist

Experience 38 years

Consultations 1816

Articles 95

Specialist with extensive practical experience. He has a certificate of a mammologist, a certificate of professional certification. Participates in foreign business trips and individual training programs (Los Angeles).

• 1982 – 1986 NPO MONIIAG – obstetrician-gynecologist
• 1987 – 1989 VNITs OZMIR – obstetrician-gynecologist
• 1989 – 1992 departmental polyclinic st. Moscow – Kurskaya – obstetrician-gynecologist
• 1992 – 2001 NPO MONIIAG – obstetrician-gynecologist
• 2007 – 2008 NP KMIKM – doctor administrator
• 2009 – 2013 Pereslavl CRH, women’s consultation – obstetrician-gynecologist
• 2020 to present Teledoctor24 LLC – doctor – consultant (gynecologist)

The question is asked by Anya, – a question-answer from the specialists of the clinic “Mother and Child”

10/23/2014

Hello! I have a second pregnancy (my son is 1 year 2 months), the term is 13-14 weeks. At the 11th week, heavy bleeding began (until that time, nothing bothered) and I was admitted to the hospital with a diagnosis of “beginning miscarriage. ” Heavy bleeding lasted from 13.00 to 16.00, then it bled a little all the next day, and on the third day the discharge began to darken and disappeared. The next morning after admission, I had an ultrasound scan (06/04/05), which showed:
The uterus in anteflexio, with clear, even contours, rounded, enlarged due to pregnancy and according to its duration. Meometrium of normal structure and echogenicity, without nodules and retrochorial hematomas, in which one live embryo is visualized. The placenta is formed on the right side with the transition to the anterior wall of the uterus, up to 1.2 m thick. The amount of water is normal. The internal os of the uterus is completely closed.
The results of the analyzes: Cl. blood test: Er – 4, 15; Hb – 124; Ht – 35, 8; L-9, 4; P – 6; C – 73; L – 18; M-3; E-0; ESR – 22. General analysis of urine: Specified weight -1010, PH – Neutral; Protein, Glucose, erythrocytes – neg; L – 1-2-1; epithelium singly. Biochem. blood test: Common. Protein – 65.0; Urea – 3, 2; Creatinine – 76; Bilirubin – 12-0-12; Alat – 23; AsAt – 59; Glucose – 3, 4.
Gr. Blood A (II) Rh – factor positive. RW, HIV, HBs Ag – negative, DHA – 1.88.
Treatment was prescribed: No-shpa 2, 0-3 times / m, papaverine 2 times, utrozhestan 1 t – 2 times, Vite 1-3 times, dicynone 2, 0 – 2 times / m, valerian 1 – 3 times, dexamethasone ½ tab. H night, magneB6 2-3 times, Materna 1. a day.
While I was in the hospital, I bled a little bit a couple of times, and every day there were periodically pulling pains and tingling in the lower abdomen. She was discharged after 2 weeks, the medications were the same (except for decinone). The next day after discharge, dark brown discharge appeared again, on the same day I did a new ultrasound (06/20/05) results: Pregnancy 14 weeks, One live embryo is determined in the uterine cavity, the size of the fetus is proportional and corresponds to a period of 12 weeks. Rhythmic heartbeat 10 beats/min. Motor activity is determined by malformations not identified. Chorion along the anterior wall of the uterus On the degree of maturity. The thickness of the placenta is 16 mm. The tone of the myometrium is slightly increased along the anterior wall. The cervix is ​​not shortened. The cervical canal is closed.
I have a few questions: How might such a threat affect a child’s development? What additional tests should be taken to clarify the cause of the threat? How long to take the prescribed medication in this amount? Could the short period between pregnancies be the cause of the threat?
Thank you for your advice

Clinic “Mother and Child” Kuntsevo:

01/27/2021

The presence of short-term bleeding during pregnancy with normal blood tests and ultrasound data (adequate fetal development, absence of detachment of the placenta) does not have a negative effect on the fetus. In such cases, it is necessary to exclude inflammation of the vagina, a decidual polyp of the cervical canal, when spotting does not occur from the uterus, but is external in nature and is not associated with problems of the fetal egg.