Pregnancy – bleeding problems – Better Health Channel

Bleeding from the vagina in early pregnancy is very common. In fact, it is thought to happen in almost one in four pregnancies – many of which will result in a healthy baby. About a third to half of all women who have bleeding will go on to miscarry.

Bleeding later in your pregnancy is less common and can be a sign of a serious problem, such as placenta previa (when the placenta covers the cervix) or placental abruption (separation of the placenta).

You should go to your nearest hospital emergency department if you are experiencing:

• heavy bleeding, for instance soaking two pads per hour or passing golf ball sized clots
• severe abdominal pain or shoulder pain
• fever or chills
• dizziness or fainting
• unusual smelling vaginal discharge
• bleeding in the second half of your pregnancy.

Causes of bleeding problems during pregnancy

It is not always possible to pinpoint why a woman is bleeding during pregnancy. Some of the many reasons may include:

• Miscarriage
• Ectopic pregnancy
• Implantation bleeding
• Placenta previa
• Placental abruption.

Miscarriage

A miscarriage is the loss of a pregnancy before the fetus (unborn baby) can survive outside the uterus (womb).

Miscarriage usually occurs in the first 12 weeks of a pregnancy (the first trimester), and most miscarriages occur without a clear cause.

Vaginal bleeding is the most common sign of miscarriage. Some women may experience period-like cramping pain in the lower pelvis. Others may experience no symptoms at all.

Ectopic pregnancy

During the first trimester, vaginal bleeding can be a sign of ectopic pregnancy. This is when the fetus starts to grow outside of the uterus, often in one of the fallopian tubes.

Symptoms of ectopic pregnancy can include cramping, vaginal bleeding and abdominal pain. Pain might be caused by a ruptured fallopian tube. This is a medical emergency and needs immediate surgery.

Implantation bleeding

One cause for bleeding in early pregnancy is ‘implantation bleeding’. This usually occurs as light bleeding or ‘spotting’ and happens when the fetus implants (buries) itself into the lining of your womb (around the time that your first period after conception would have been due). This bleeding will often last a few days then stop.

Placenta previa

Placenta previa occurs where the placenta is (either wholly or in part) inserted into the lower part of the uterus and covering the cervix. One of the signs of placenta previa is bleeding after 28 weeks.

Diagnosis of placenta previa is by ultrasound. If you are diagnosed with placenta previa, your baby will usually be born by caesarean section.

Placental abruption

This is when part or all of the placenta separates from the wall of the uterus before the birth of your baby. The amount of bleeding varies, as does the impact on your baby. Treatment may involve monitoring you and your baby, bed rest, or, in more serious cases, the early birth of your baby.

Tests for bleeding problems during early pregnancy

It can take some time for your doctor to be sure of what the bleeding means. You may need a number of tests, which could include:

• Vaginal examination – to check the size of your uterus and the amount of bleeding. This examination lasts a few minutes and may be a bit uncomfortable.
• Blood tests – to check your blood type and, sometimes, the levels of pregnancy hormones in your blood.
• Ultrasound scan – gel is rubbed on your abdomen. A hand-held scanner uses sound waves to provide pictures of the pregnancy. In very early pregnancy, more information is gained by placing a small, slender scanner in the vagina. You will need to have a full bladder before the scan. An ultrasound scan takes around 15 to 20 minutes. If an ultrasound is needed, it can be arranged through the emergency department of your nearest hospital or your local doctor.

Tests for bleeding problems during later pregnancy

Both placenta previa and placental abruption can cause heavy bleeding of bright red blood from the vagina.

A vaginal examination is often used to help diagnose placental abruption, but could trigger heavier bleeding in the case of placenta previa. Therefore, an ultrasound scan should always be taken first, and digital (finger) vaginal examinations should be strictly avoided in the case of placenta previa.

Tests used to diagnose placenta previa include:

• medical history
• ultrasound scan
• feeling the mother’s belly to establish the baby’s position (the baby is sideways or presenting bottom-first in around one in three cases of placenta previa)
• very gentle speculum vaginal examination (to make sure the bleeding is not coming from the cervix or vagina).

Having ruled out placenta previa using the tests above, a digital vaginal examination may be used to identify placental abruption.

Treatment of bleeding problems during early pregnancy

The bleeding may be light and stop in a day or two. Many people go on to have a healthy baby at full term after such a bleed.

However, sometimes the bleeding becomes heavy and a miscarriage is likely to happen. While you still need to see a doctor, in such circumstances there is no emergency care that will save your pregnancy.

Sometimes, during a miscarriage, some of the pregnancy tissue may remain inside the uterus. This can lead to very heavy bleeding if it is not treated. Your doctor will tell you if you need further treatment.

If you are Rhesus (Rh) negative (if you have a negative blood type), you may require an injection of anti-D immunoglobulin to prevent problems related to possible blood incompatibility in future pregnancies.

Bleeding during early pregnancy and taking care of yourself at home

You may feel a range of emotions over this time. Guilt is a normal feeling, but don’t blame yourself, as you have done nothing wrong. Your body will be going through changes in hormone levels and this can make you feel very emotional. It may help to talk to family or friends.

While there is no specific treatment to prevent a miscarriage, things you can do that may help include:

• Getting plenty of rest.
• Using pads rather than tampons while you are bleeding.
• Avoiding sex while you are bleeding. Sex can resume once the bleeding has stopped.
• Taking mild pain relief medication, such as paracetamol, if needed.
• Reporting any changes in your condition to your doctor.

If you are finding your mood remains low for an extended period of time, you may be experiencing depression and require the assistance of a professional.

Where to get help

• Your GP (doctor)
• Obstetrician
• Midwife
• Sexual Health Victoria (SHV)External Link. To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Post and Antenatal Depression Association (PANDA) Helpline Tel. 1300 726 306

Vaginal bleeding in pregnancy: MedlinePlus Medical Encyclopedia

URL of this page: //medlineplus.gov/ency/article/003264. htm

To use the sharing features on this page, please enable JavaScript.

Vaginal bleeding in pregnancy is any discharge of blood from the vagina during pregnancy.

Up to 1 in 4 women have vaginal bleeding at some time during their pregnancy. Bleeding is more common in the first 3 months (first trimester), especially with twins.

A small amount of light spotting or bleeding may be noted 10 to 14 days after conception. This spotting results from the fertilized egg attaching itself to the lining of the uterus. Assuming it is light and does not last very long, this finding is most often nothing to be concerned about.

During the first 3 months, vaginal bleeding may be a sign of a miscarriage or ectopic pregnancy. Contact the health care provider right away.

During months 4 to 9, bleeding may be a sign of:

• The placenta separating from the inner wall of the uterus before the baby is born (abruptio placentae)
• Miscarriage
• The placenta covering all or part of the opening to the cervix (placenta previa)
• Vasa previa (baby’s blood vessels exposed across or near the internal opening of the uterus)

Other possible causes of vaginal bleeding during pregnancy:

• Cervical polyp or growth
• Early labor (bloody show)
• Ectopic pregnancy
• Infection of the cervix
• Trauma to the cervix from intercourse (small amount of bleeding) or recent pelvic exam

Avoid sexual intercourse until your provider tells you that it is safe to start having intercourse again.

Consume only fluids if the bleeding and cramping are severe.

You may need to cut down your activity or be put on bed rest at home. Your provider will talk to you about the specific kinds of activity changes you may need to make.

Medicine is not needed in most cases. DO NOT take any medicine without talking with your provider.

Also, talk to your provider about what to look for, such as the amount of bleeding and color of the blood.

Contact your provider if:

• You have any vaginal bleeding during pregnancy. Treat this as a potential emergency.
• You have vaginal bleeding and have placenta previa (get to the hospital right away).
• You have cramps or labor pains.

Your provider will take a medical history and perform a physical exam.

You will probably have a pelvic exam, or ultrasound as well.

Tests that may be done include:

• Blood tests
• Pregnancy ultrasound
• Ultrasound of the pelvis

You may be referred to a high risk specialist for the duration of the pregnancy.

Pregnancy – vaginal bleeding; Maternal blood loss – vaginal

• Ultrasound in pregnancy
• Female reproductive anatomy
• Anatomy of a normal placenta
• Placenta previa
• Vaginal bleeding during pregnancy

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.

Salhi BA, Nagrani S. Acute complications in pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.

Turocy J, Williams Z. Early and recurrent pregnancy loss: etiology, diagnosis, treatment. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 16.

Updated by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Medical termination of pregnancy in Bor

Termination of pregnancy is a serious and difficult decision in a woman’s life. Folk wisdom says: measure seven times, cut once. You need to seriously consider everything before deciding to have an abortion, and if such a decision is made, choose a clinic that has a license for this type of activity, and a doctor who has received special training in medical abortion, received the appropriate permission and has experience in such work.

In our country, at her own request, a woman can have an abortion for up to 12 weeks. There are also various medical indications for termination of pregnancy, when pregnancy poses a serious threat to a woman’s life. In this case, an abortion is done at any stage of pregnancy after determining the indications for it by a gynecologist and related specialists. The reason for termination of pregnancy for medical reasons can be both a serious pathology on the part of the woman and on the part of the fetus. Only an experienced and competent gynecologist can decide on the choice of abortion method.

• Surgical (8-12 weeks of pregnancy, counting from the first day of the last menstruation).

• Mini-abortion (42-56 days from the first day of the last menstruation).

• Medical termination of pregnancy (up to 42 days from the first day of the last menstruation).

Perhaps the most modern and safest way to terminate a pregnancy, which can be used in the early stages – medical abortion . In the department of gynecology of the Medical Center “Guarantee”, experienced gynecologists who have a special permit to conduct pharmacist perform only this option of terminating a pregnancy. Due to the absence of surgical intervention, we avoid a number of complications and possible consequences, such as: mechanical damage to the uterus and cervical canal, inflammation, infection, bleeding, and most importantly, possible infertility in the future.

Medical termination of pregnancy: advantages of the method

1. Minimal hormonal stress for the body (since abortion can be carried out at very early stages of pregnancy, when hormonal changes are not yet significant, and the fetal egg is weakly attached to the uterus).
2. The possibility of using immediately on the day of treatment in case of ultrasound confirmation of the gestational age and the exclusion of an ectopic location of the fetal egg.
3. Absence of surgical intervention and the use of anesthesia, which eliminates the risk of the following complications: infection, adhesions, trauma to the uterine cavity, inflammation.
4. After medical termination of pregnancy there is no risk of developing secondary infertility.
5. It is easier to tolerate, that is, almost like a natural process, since it proceeds almost the same as normal menstruation, possibly with more abundant discharge.
6. For women at a young age who are forced to terminate an unwanted pregnancy, this is the best way out.

Medical termination of pregnancy price depends on the drug used in the clinic.

Medical termination of pregnancy – how does it work?

In accordance with the current legislation , Farmabort at the Garantiya Medical Center provides for at least three visits to the doctor.

Visit 1

On the day of treatment, the doctor examines the patient, conducts an ultrasound examination. The survey is carried out in order to:

• Exclude ectopic pregnancy.

• Determine the gestational age. Medical termination of pregnancy terms is limited! (for medical abortion no more than 6 weeks or 42 days from the first day of the last menstrual period).

During the examination, you may be asked to take a blood test for the hormone confirming the presence of pregnancy (hCG), if you can not visualize the fetal egg in the uterine cavity. This appointment is justified.

In many centers, it is practiced at the first consultation to take a smear from the patient for flora, a blood test for syphilis, AIDS, and hepatitis. Formally, these are optional components. However, if suddenly you have a situation that requires surgical intervention, then these tests will be required. Therefore, by passing a blood test and a smear in advance, you insure yourself.

If the presence of a uterine pregnancy is confirmed, then the doctor must give you an informed consent form for termination of pregnancy before the procedure, which you must sign.

If you are firmly convinced of your decision, the doctor will tell you what the medical method of abortion is, what are the contraindications, the order of return visits, what symptoms may be, how you should behave. The doctor will tell you that in a small percentage of cases (2 – 5%) the method may not work and you will have to terminate the pregnancy surgically. You must be prepared for this, and the occurrence of such a situation should not be taken tragically. It must be remembered that the alternative, in any case, is only surgical intervention. But you have a real chance to avoid it by resorting to the method of medical termination of pregnancy.

After discussion, the doctor will give you 3 mifepristone tablets, which you must drink in his presence.

Some women experience bleeding on the first day after taking mifepristone, and 5% of women may have a complete abortion.

Visit 2

(36 – 48 hours after the first visit)

Under the action of Mifepristone, the fetal egg exfoliates from the walls of the uterine cavity. The next step is to expel it from the uterine cavity. For this purpose, the clinic will give you a drug that contracts the uterus (misoprostol). Usually, 2 misoprostol tablets are given first, followed by 2 more tablets 3 hours later. During these 3 hours, it is advisable that you stay at the clinic (although staying at home is also possible). It is at this time that most women experience bleeding from the genital tract. That is, it should be understood that it was not menses after medical termination of pregnancy . Taking the drug misoprostol can also be accompanied by some symptoms that are predictable and manageable.

• Pain. Complaints about pain and the need for pain relief varies greatly in different women, depending on the emotional type of personality and pain threshold. Comfortable sitting or lying down is recommended; support for medical personnel or accompanying loved ones; distracting music or TV. With severe pain, you can use antispasmodics (no-shpa) or analgesics such as paracetamol, baralgin, etc. It is not recommended to use drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs), because. they reduce the effect of misoprostol.
• Fever and chills. Misoprostol sometimes causes fever. Such an increase in temperature does not exceed 38 ° C and lasts no more than 2 hours. The use of paracetamol eliminates these symptoms. If the temperature rise is more than 38 ° C and lasts more than 4 hours or appears every other day, then this is not associated with taking medication, but signals an infection. It is necessary to inform the doctor about this. You may be prescribed antimicrobials.
• Nausea and vomiting. In a patient who came for a pharmacological abortion, nausea may be associated with the pregnancy itself. However, abortion drugs can also cause nausea, rarely vomiting. These symptoms usually go away on their own; antiemetics may be used.
• Diarrhea. The occurrence of diarrhea is associated with the use of misoprostol. It does not occur often, is of a short-term nature, passes on its own. The need for treatment is rare.
• Bleeding. Termination of pregnancy (emptying of the uterine cavity) is accompanied by bleeding, usually similar to menstruation, but more abundant. However, such bleeding rarely leads to a decrease in hemoglobin and / or requires any treatment. Doctors will assure that discharge after medical termination of pregnancy is the norm.

Excessive bleeding is extremely rare, it can be in patients with a violation of the blood coagulation system. You need to know that heavy bleeding is considered if two sanitary pads of the maximum size are completely saturated with blood within an hour, and this continues for two hours in a row or more. In this case, you need to contact your doctor. The doctor may additionally use drugs that reduce the uterus or, with continued bleeding, scraping the walls of the uterine cavity is suggested.

In 80% of women, by the 7th day after taking Mifepristone, a complete abortion occurs, and the bleeding stops. By the 14th day after taking Mifepristone, 96.6% of women have a complete miscarriage. However, the doctor is still monitoring the woman’s condition in order to exclude the consequences of medical termination of pregnancy .

Visit 3

(10 – 14 days after the first visit)

A third visit to the clinic is necessary to evaluate the effectiveness of medical abortion: complete abortion, incomplete abortion, ongoing pregnancy.

As already mentioned, the efficiency of the method is 95 – 96%.

In case of ineffectiveness of the method, evaluated on the 14th day after taking Mifepristone, at the Garantiya Medical Center, the gynecologist completes the termination of pregnancy surgically by aspiration of the uterine cavity with vacuum suction, while dilating the cervical canal is not required. The procedure is free.

During medical termination of pregnancy, it is recommended:

• do not leave the locality where you are located so that you always have the opportunity to contact your doctor;
• avoid strenuous exercise;
• do not go to the bath, sauna, swimming pool;
• not to live sexually.

Already in the first cycle after a pharmacological abortion, the woman’s fertility is restored, i.e. she can get pregnant again. Therefore, you should definitely discuss the issue of contraception with the doctor during the third visit.

The total cost of medical termination of pregnancy is discussed with the doctor during the first examination.

Medical termination of pregnancy: contraindications

The method has contraindications:

• idiosyncrasy
• pregnancy greater than 42 days after cessation of menstruation
• pregnancy not confirmed by ultrasound
• ectopic pregnancy
• uterine fibroids
• adrenal, renal and/or hepatic insufficiency
• inflammatory diseases of the female genital organs
• bronchial asthma

If there is a scar on the uterus, the issue is resolved individually.

Download consent for pharmacist (available at the clinic).

Think again: is this pregnancy really unwanted? Is your decision driven by momentary emotional impulses? Contact the Centers for Helping Women in Difficult Life Situations. Share with your loved ones, they may be able to help you.

Addresses and phone numbers of shelters for pregnant women and women with children in Russia

The list of crisis centers for pregnant women and mothers with children currently includes 28 shelters under the auspices of the Russian Orthodox Church, and thirteen new ones will be added soon.

Nizhny Novgorod Women’s Crisis Center http://www.woman-nnov.ru/

Specialists of the Nizhny Novgorod Women’s Crisis Center are consultants of the All-Russian telephone for women victims of domestic violence 8-800-700-06-00, which is supported by the Anna National Center for the Prevention of Violence.

Center for Comprehensive Care for Pregnant Women and Women with Babies in Difficult Life Situations “HOPE” http://centrmama.ru/

Miscarriage – Appotek

A miscarriage occurs if the fetus dies before the 20th week of pregnancy. Typical symptoms include severe abdominal pain and bleeding from the vagina. In some cases, no medical treatment is needed, but sometimes, if tissue is still left in the uterus, it should be removed.

General information

Up to half of all pregnancies end spontaneously. Often, miscarriage occurs due to chromosomal aberrations or other developmental disorders. Sometimes it can be caused by an infection, but in many cases there is no clear cause. Most miscarriages occur before 12 weeks. It’s not that painful physically, but it can be emotionally difficult.

The medical definition of miscarriage is the termination of a pregnancy before 22 weeks of gestation. After this, the fetus is usually so developed that it has a minimal chance of survival. After this period, miscarriage is called preterm labor and requires treatment to allow the fetus to continue to develop.

Symptoms

If you have a miscarriage, you may experience severe abdominal pain. The pain is usually localized in the lower abdomen and can be perceived as severe menstrual pain. Vaginal bleeding is also a common symptom – blood may be mixed with tissues. Some women also experience back pain.

Most people first experience heavy bleeding as the uterus rejects the remnants of the fetus, and then there is a slight bleeding for several days. If the uterus does not reject the remaining tissues, bleeding continues – then help will be needed to complete the miscarriage. In the case of a so-called delayed miscarriage or “missed abortion”, only a brownish discharge may be observed, and then help is also required to complete the miscarriage.

Be aware that bleeding and abdominal pain during pregnancy are not always signs of a miscarriage. Bleeding is a common symptom and may be caused by something else. For example, it may be bloody discharge, which is a natural sign of a developing pregnancy. The uterus may also bleed in connection with sexual intercourse. Sometimes cervical polyps, infections, or hemorrhoids can cause a little bleeding.

In more rare cases, this may indicate a serious illness requiring emergency care. An ectopic pregnancy means that the embryo develops outside the uterus, this condition usually causes severe pain in the lower abdomen, often combined with bleeding.

In the last stages of pregnancy, sometimes problems with the placenta can cause heavy bleeding. In some cases, bleeding may be associated with neoplasms, but this happens rarely and is usually detected during initial consultations.

Causes

A miscarriage is usually unaffected and sometimes has no specific cause. Studies show that it can often be caused by chromosomal abnormalities or fetal malformations. Sometimes the problem occurs due to defects in sperm or eggs, or during cell division. Then the embryo cannot develop normally, and the pregnancy is terminated.

Miscarriage can also be caused by infections or improper attachment of a fertilized egg to the uterus. Late miscarriages may be related to cervical problems. In some cases, placental defects can also cause miscarriage. Serious external damage can also cause miscarriage, although this is a rarer occurrence.

An ectopic pregnancy, which means that the embryo does not develop in the uterus, but, for example, in the fallopian tube or abdomen, always causes a miscarriage, because it is impossible to carry the pregnancy in this way.

Risk factors associated with miscarriage:

• alcohol, smoking and drugs
• age
• injuries
• overweight
• hormonal disorders (such as thyroid problems or lack of progesterone)
• chronic diseases (e. g. diabetes)
• infections
• ectopic pregnancy

Prevention and Protection

To increase your chances of getting pregnant and avoid miscarriage, there are a few things to keep in mind:

• take prenatal vitamins
• do not forget about regular medical supervision during pregnancy
• avoid caffeine, alcohol, smoking and drugs
• try to lose weight before getting pregnant if you are overweight
• avoid drugs if possible (many drugs can have an adverse effect on pregnancy – read the instructions carefully or ask your doctor or pharmacist)
• eat a healthy diet

If you have a chronic condition such as diabetes, it is advisable to check with your doctor before and during pregnancy as you may be at increased risk of miscarriage.

Treatment

A gynecological examination using transvaginal ultrasound is often used to diagnose miscarriage. An early miscarriage sometimes does not require treatment at all, but in some cases, assistance may also be needed to remove residual tissue from the uterus. For this, either drug treatment is prescribed, or the remaining tissue can be removed surgically.

Women who have had multiple miscarriages with the same partner should undergo a medical examination to find the cause. In the case of miscarriages that occur in the later stages, the cause is often looked for in the cervix, and in the case of a new pregnancy, a suture is sometimes necessary.

When to seek help

If you are pregnant and have prolonged bleeding, you may have had a miscarriage. If you only have abdominal pain and the bleeding stops on its own after about a week, you usually don’t need to seek medical attention. It is also normal to continue to bleed, but to a lesser extent, for a few more weeks. If the bleeding gets worse, you should seek medical attention. This also applies to bleeding that is accompanied by an unpleasant odor.

If you are not sure if it is a miscarriage, you should also seek medical help. In the first half of pregnancy, you can get help in the gynecological department.