Vaginal bleeding in pregnancy

Bleeding during pregnancy is relatively common and doesn’t always mean there’s a problem – but it can be a dangerous sign.
Urgent advice:Call your midwife or GP immediately if:
• you have any bleeding from your vagina

Implantation bleeding
In early pregnancy, you might get some harmless light bleeding, called “spotting”. This is when the developing embryo plants itself in the wall of your womb. This type of bleeding often happens around the time your period would have been due.
Cervical changes
Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding – after sex, for example.
Miscarriage or ectopic pregnancy
During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy.
However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.
If a pregnancy ends before the 24th week, it’s called a miscarriage. Around 1 in 5 pregnancies ends this way.
Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can also be other causes of miscarriage, such as hormone or blood clotting problems.
Most miscarriages occur during the first 12 weeks (3 months) of pregnancy and, sadly, most cannot be prevented. Other symptoms of miscarriage include:
• cramping and pain in your lower abdomen
• a discharge or fluid from your vagina
• a discharge of tissue from your vagina
• no longer experiencing the symptoms of pregnancy, such as breast tenderness and feeling sick
If you have bleeding or any of the symptoms above, contact your midwife or GP straightaway.
Ectopic pregnancy
An ectopic pregnancy is when a fertilised egg implants outside the womb – for example, in the fallopian tube.
It can cause bleeding and is dangerous because the fertilised egg can’t develop properly outside the womb. The egg has to be removed, which can be done through an operation or with medicines.
Symptoms of an ectopic pregnancy tend to develop between 4 and 12 weeks of pregnancy but can happen later.
Other signs of ectopic pregnancy can include:
• tummy pain low down on one side
• vaginal bleeding or a brown, watery discharge
• pain in the tip of your shoulder
• discomfort when peeing or pooing
However, these symptoms aren’t necessarily a sign of a serious problem. They can sometimes be caused by other things, such as a stomach bug, but they need to be checked out by your midwife or doctor.
Causes of bleeding in later pregnancy
Cervical changes
These can lead to bleeding, particularly after sex.
Vaginal infections
Your midwife or doctor can discuss tests and treatment with you.
A ‘show’
This is when the plug of mucus that has been in the cervix during pregnancy comes away, signalling that the cervix is getting ready for labour to start. It may happen a few days before contractions start or during labour itself.
Find out about the signs of labour and what happens in labour.
Placental abruption
This is a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.
Low-lying placenta (placenta praevia)
This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy, and put you and your baby at risk.
You may be advised to go into hospital for emergency treatment, and a caesarean section will usually be recommended. Read more information on placenta praevia.
Vasa praevia
This is a rare condition where the baby’s blood vessels run through the membranes covering the cervix.
When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a life-threatening amount of blood.
Finding out the cause of bleeding in pregnancy
To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels.
Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes it might not be possible to find out what caused the bleeding.
If your symptoms are not severe and your baby is not due for a while, you’ll be monitored and, in some cases, kept in hospital for observation.
How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are.
Being in hospital allows staff to keep an eye on you and your baby, so they can act quickly if there are further problems.

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