What’s Normal and What Isn’t? : New England Women’s Healthcare: OBGYNs

Bleeding During Pregnancy: What’s Normal and What Isn’t? : New England Women’s Healthcare: OBGYNs

Conveniently located in Woburn, MA and Wilmington, MA

Noticing blood in the toilet or on your underwear during pregnancy can certainly cause a scare. However, it doesn’t always mean that something has gone wrong with your pregnancy. 

The expert OB/GYNs at New England Women’s Healthcare in Woburn, Massachusetts, have helped many pregnant women navigate bleeding during pregnancy, and most go on to have a normal, healthy pregnancy. 

First, it’s important to know when to call your doctor and when to seek emergency care for bleeding during pregnancy. Bleeding is generally classified into two categories: spotting and heavy bleeding.

Light bleeding or spotting

Don’t freak out. Many women experience light bleeding, also called spotting, during pregnancy. Women experience spotting for a number of reasons, which we’ll cover below. Spotting is not always a cause for concern, but it’s still a good idea to call your doctor and explain your symptoms.

Heavy bleeding during pregnancy

Call your doctor right away or seek emergency medical care, such as at an urgent care center. Heavy bleeding at any point during pregnancy (heavy enough to need a pad or tampon to absorb it) can indicate pregnancy complications or health issues in mom. 

Spotting during the first trimester

Many women experience spotting during the first trimester — an estimated 25%, in fact. While spotting during the first trimester can indicate problems, that’s not always the case. Spotting that lasts just a day or two and isn’t accompanied by other symptoms usually isn’t anything to worry about.

Spotting during your first trimester may indicate:

• Implantation bleeding (a sign that the embryo is implanting into your uterus)
• Carrying multiples (which may increase the chances of implantation bleeding)
• Cervical polyps
• Cervical irritation, such as from a medical exam or sexual intercourse
• Infections, such as a urinary tract infection or yeast infection
• An ectopic pregnancy (this is a medical emergency)
• A molar pregnancy, which can lead to miscarriage

As you can see, some of those potential culprits require medical attention, so if you’re spotting during your first trimester, it’s a good idea to see your doctor.  

Definitely call your doctor if your spotting lasts more than two days or is accompanied by symptoms like dizziness, severe nausea, headaches, and abdominal pain. 

Spotting during the second and third trimester

Bleeding later in pregnancy is typically more serious than bleeding early in pregnancy. Again, heavy bleeding is more of a concern than spotting, but even light bleeding can indicate the following complications: 

• Cervix inflammation or growths, such as polyps 
• Placenta problems, including placental abruption, vasa previa, and placenta previa
• A missed miscarriage
• Early labor

To sum up, light bleeding during pregnancy — especially early pregnancy — is not always a cause for concern. Heavy bleeding at any point during pregnancy and any bleeding in your second or third trimester may indicate problems. 

Call your doctor any time you experience bleeding, even if just to rule out pregnancy complications. Seek emergency care if you experience heavy bleeding, especially if you’re passing clots of blood and have symptoms such as dizziness and cramping.  

Have questions about pregnancy? Come on in to our Woburn, Massachusetts, clinic. Make an appointment by calling 781-787-3003, requesting a time slot online, or sending a message to our team.

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Bleeding in Early Pregnancy | AAFP

What causes bleeding during early pregnancy?

About one in every four pregnant women will have vaginal bleeding in the first few months. Mild cramping and light spotting can be normal in early pregnancy. But vaginal bleeding may be a sign of something more serious. Some of the most common causes are:

• Threatened miscarriage. This is when there is bleeding from the uterus but the pregnancy is still healthy. Sometimes a blood clot forms in the uterus and increases the risk of miscarriage. But most women with threatened miscarriage will have a healthy baby.

• Ectopic pregnancy. This is when the pregnancy grows outside the uterus, usually in the fallopian tubes. Symptoms include heavy bleeding, dizziness, sharp pain in the stomach or shoulder, and cramps. Ectopic pregnancy is a medical emergency and can be life threatening.

• Early pregnancy loss (also called miscarriage). This is the unexpected loss of a pregnancy before 14 weeks. Most miscarriages happen because the pregnancy is not developing normally.

Other causes of bleeding in early pregnancy include infections, hemorrhoids (HEM-uh-roids, or swollen veins in your rectum or anus), cervical cancer, and rare pregnancy-related cancers.

What should I do if I am bleeding?

Call your doctor right away. If you have heavy bleeding or severe pain, go to the emergency room.

Your doctor can do tests to see why you are bleeding. You may need a pelvic exam, an ultrasound, blood tests, or urine tests. Sometimes an ultrasound is all that’s needed to make sure your pregnancy is healthy. If it is still early in the pregnancy, you may need more tests to find the cause of the bleeding.

How is it treated?

It depends on the cause of the bleeding. No treatment is needed for a threatened miscarriage. Ectopic pregnancies need to be treated with medicine or surgery. After a miscarriage, the tissue may pass on its own. If not, you may need medicine or a procedure called aspiration to remove the tissue. Women with Rh-negative blood types may need a shot to help prevent problems in future pregnancies.

What can I do to prevent early pregnancy loss?

There is no way to prevent an early pregnancy loss after it has been diagnosed. There is often no way of knowing exactly why it happens. If you have an early pregnancy loss it is important to remember that you did not do anything to cause it. Most women who have had an early pregnancy loss can have healthy pregnancies in the future. If you have had two or more early pregnancy losses, talk to your doctor about whether you need other tests or treatment.

Keeping your body healthy is the best way to have a healthy pregnancy and baby. Talk to your doctor about any health problems before getting pregnant. Taking a prenatal vitamin with folic acid before you get pregnant can lower the risk of brain and spinal cord problems in your baby. Talk to your doctor before taking any over-the-counter or prescription medicines. Using cigarettes, drugs, alcohol, and large amounts of caffeine may increase your risk of early pregnancy loss.

Where can I get more information?

Your doctor

American College of Obstetricians and Gynecologists

• https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy

Medline Plus

• https://medlineplus.gov/ency/patientinstructions/000614.htm

Reproductive Health Access Project

• https://www. reproductiveaccess.org/wp-content/uploads/2017/08/2017-08-factsheet-miscarriage-english.pdf

Complications of abortion

Any abortion, as a serious medical intervention, inevitably carries the risk of complications. Some negative consequences and complications after an abortion may be characteristic of a certain method of abortion. For example, with medical abortion, mild pain in the abdomen, nausea, vomiting, headaches, dizziness, chills, fever, uterine contractions. In 2.5% of cases with medical abortion, the pregnancy is not interrupted, up to 5% of cases an incomplete abortion occurs, in this case, curettage is additionally done.

The most dangerous type of abortion is curettage (surgical abortion). it is the most traumatic. During surgical abortion, damage to the uterus by surgical instruments is possible. The risk of complications is markedly reduced if the method of abortion is chosen taking into account its duration.

Complications arising after an abortion are divided into two groups: early and late.

Early consequences of abortion

Early complications develop during abortion or immediately after it. Discharge after abortion. Bloody discharge that appears after an abortion usually lasts up to a week and is somewhat more abundant than normal periods. In some cases, light bleeding lasts up to a month. It is necessary to pay attention to the presence of impurities in the discharge after an abortion, their color and smell. This will make it possible to suspect a developing complication in time and take action. It is also important to control the amount of blood loss. If, after an abortion, the discharge is too abundant (two “maxi” pads are consumed per hour), you should immediately see a doctor, because. this may indicate an incomplete abortion. The appearance of an odor may indicate an infection. The first day of the abortion is considered the first day of the cycle. Normally, menstruation begins 3 weeks after the abortion; for several months, some shift in the cycle (up to 10 days) is acceptable. Perforation of the uterus is one of the most serious complications of abortion.

During the operation, the uterine wall is ruptured by the inserted instruments. The risk of this complication increases with the length of pregnancy. Perforation of the uterus requires immediate surgical treatment, and in especially severe cases, surgical removal of the uterus is necessary. In addition, when the uterine wall is perforated, the intestines, bladder, or large vessels can be damaged. Sometimes a rupture or incision of the cervix occurs. These consequences can significantly reduce the likelihood of pregnancy after an abortion, or even lead to infertility. In subsequent pregnancies, bearing is difficult, there is a high risk of uterine rupture during childbirth. Severe bleeding occurs when large vessels are damaged, with uterine myoma or after numerous births. Requires urgent therapy, in severe cases, a blood transfusion is done. If it is impossible to stop bleeding, the uterus is removed, because. prolonged blood loss can lead to the death of a woman.

Incomplete abortion – sometimes during an abortion, the ovum is not completely removed. In this case, bleeding develops, abdominal pain appears, and chronic inflammation of the uterus, endometritis, may develop. With this complication, a second abortion is performed, the remnants of the fetal egg are removed.

Penetration of the infection into the uterine cavity during surgery can cause inflammatory processes and exacerbation of diseases of the pelvic organs – endometritis (inflammation of the uterus), parametritis (inflammation of the periuterine tissue), salpingitis (inflammation of the fallopian tubes). In especially severe cases, sepsis can develop – blood poisoning. This condition is very life-threatening and requires urgent antibiotic treatment.

Late effects

Late complications after an abortion can occur months or even years after the operation. These are chronic inflammatory diseases, adhesive processes, hormonal disorders and dysfunctions of the organs of the reproductive system. During pregnancy, large-scale hormonal and physiological changes occur in a woman’s body, which ensure gestation, prepare the body for birth, and feeding. Abortion is a severe stress for the body, in which the hormonal system suffers first of all.

Menstrual disorders

– when menstruation becomes irregular after an abortion, with frequent delays – a very common problem, it occurs in more than 12% of patients. surface of the uterus (endometrium). In this case, deeper layers are often damaged, which leads to the formation of adhesions and scars. Subsequently, the growth of the endometrium occurs unevenly. Because of this, menstruation after an abortion becomes very scarce, or vice versa, abundant and painful. Unlike surgical curettage, after medical abortion, periods usually return immediately, because. mechanical damage to the endometrium does not occur. Secondly, a strong hormonal failure leads to disruption of the ovaries. Dysfunction develops, which contributes to the occurrence of other complications. Here are some of them:

• uterine fibroids,
• endometriosis (growing of the uterine mucosa into the muscle layer),
• pathological growth of the endometrium (hyperplasia),
• endometrial polyps,
• intrauterine adhesions (synechial)
• polycystic ovaries,
• adenomyosis (modification of endometrial tissue due to inflammation of the uterine glands), etc.

Serious hormonal disorders can lead to the formation of benign and malignant tumors.

Endocrine disorders

– caused by hormonal failure, include disorders of the thyroid gland and adrenal glands, termination of pregnancy significantly increases the risk of breast cancer.

Inflammatory diseases

Directly affect the possibility of carrying a pregnancy after an abortion, can cause pain during sex, as a result, sexual desire decreases, a woman experiences less orgasm. Inflammatory diseases, which very often accompany abortions, can negatively affect the blood supply to the fetus – his food and breath. The risk of pregnancy fading, stillbirth, fetal growth retardation, neonatal diseases increases. With severe complications, the likelihood of infertility is high.

Ectopic pregnancy

More common among women who have had an abortion, because adhesions that form in the fallopian tubes make it very difficult to pass them.

Impact of abortion on subsequent pregnancies

Abortion has a clear negative effect on reproductive function. Forced expansion of the cervix during an abortion leads to its weakening, which can later provoke a miscarriage. The risk of miscarriage during a subsequent pregnancy after one abortion is 26%, after two abortions – 32%, and after three or more – increases to 41%. Adhesions and damage to the uterus prevent the fetus from fixing in the uterus, its incorrect location, and perforation can provoke its rupture during childbirth.

Female infertility

– the impossibility of fertilization and bearing, may occur as a result of a violation of the function of the genital organs, if they are damaged or removed. According to doctors, up to 50% of all cases of female infertility are due to previous abortions.

Remember that there is no safe abortion. Abortion is a serious blow to a woman’s health and a price to pay for a careless attitude towards contraception and the prevention of unwanted pregnancies.

when to call an ambulance? Encyclopedia of IVF Clinics

Discharge from the genital tract of a woman can be both normal and with various diseases, injuries, tumors. Usually, discharges that do not contain blood, as well as menstrual ones, do not require urgent medical attention. However, every woman should carefully monitor her condition in order to suspect such violations as, for example, bleeding outside the period of menstruation.

Based on the condition and symptoms, a woman or her relatives must decide whether to call an ambulance, endure until an independent visit to the gynecologist, or generally manage on their own.

BLEEDING from the genital tract

If it does not occur during menstruation, it is possible that this is the result of ovarian dysfunction and improper production of necessary hormones. The reason for calling an ambulance may be a large amount of blood released, a sharp decrease in blood pressure, a fainting state. However, more often a woman is able to visit a gynecologist on her own.

BLEEDING during pregnancy

BLEEDING during pregnancy is a dangerous sign. Most often, it indicates a miscarriage or premature birth (depending on the gestational age). Call an ambulance IMMEDIATELY, as every minute of delay in providing specialized assistance can be fatal for saving the fetus and even the life of the mother.

BLEEDING during menopause

BLEEDING during menopause (in menopause) is a formidable manifestation of the possible presence of a tumor of the uterus or ovaries. Even if the bleeding looks like normal menstruation, but occurs a year or several years after the complete cessation of menstruation, you need to visit a gynecologist IMMEDIATELY! After the cessation of menstruation, their resumption is normally impossible. BLEEDING in adolescence is most often a manifestation of juvenile ovarian dysfunction.

Despite the fact that most girls go through a period of regularization of menstruation, juvenile dysfunction sometimes leads to massive life-threatening bleeding. Therefore, realistically assess blood loss and call an ambulance if you think that it exceeds 500 ml (remember that the body contains about 4 liters of blood in total).

BLEEDING after intercourse

BLEEDING after intercourse, as a rule, does not require emergency care, but signals some kind of malfunction in the vagina or cervix: the presence of cervical erosion, inflammation that led to a change in the mucosa, and even cervical cancer uterus! It is advisable to visit a gynecologist as soon as possible.

IF bleeding is accompanied by severe pain that occurred during intercourse, then it is quite possible that it was caused by trauma and rupture of the wall or fornix of the vagina, violation of the cervical mucosa or its erosion, etc. Calling an ambulance is REQUIRED, just as with any other injury accompanied by bleeding.

PAIN in the lower abdomen, inguinal folds, genitals, perineum, lower back may be a sign of some disorders in the reproductive system, from inflammation of the appendages to a malignant tumor. Therefore, despite the fact that for the most part, pains are dull, tolerable and rarely require emergency medical care, they signal a clear ill-being and serve as the reason for a mandatory visit to the doctor.

ACUTE PAIN in these areas may be a sign of life-threatening conditions: ovarian rupture, ovarian cyst rupture, ectopic pregnancy disorder, termination of normal pregnancy, etc. ALWAYS, when pain is accompanied by a strong heartbeat, a sharp drop in blood pressure, a weak pulse, pale skin, profuse sweat, urge to urinate, and especially BLEEDING, an ambulance call is MANDATORY!

But even if bleeding is not visible, this does not mean that it does not exist: often blood is abundantly secreted from the vessels, but accumulates in the abdominal cavity and is not released outside, creating the illusion of relative well-being. CRYING PAIN in the lower abdomen with a sensation of a foreign body in the vagina (and even more so, probing something foreign in the depths of the vagina) is often a sign of the onset of a uterine fibroid node (of course, if this does not happen during pregnancy).

IMMEDIATELY call an ambulance: possible heavy bleeding, pain shock, threat to the woman’s life. SHARP PAIN in the lower abdomen on the left or right without bleeding or with small spotting may be a sign of torsion or rupture of an ovarian cyst, a violation of an ectopic pregnancy. IMMEDIATELY call an ambulance, even if the pain is localized on the right, giving the impression of an exacerbation of chronic appendicitis.

Internal bleeding can be profuse and fulminant, leading to dangerous blood loss in just half an hour or an hour.

GENERAL RULE for women: ANY acute condition in the genital area (bleeding without pain, pain without bleeding, pain with bleeding) can be a sign of a disorder in which specialized medical attention is MANDATORY, and the number can go by minutes.