Pregnancy - bleeding problems

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

Bleeding later in pregnancy is less common and can be a sign of a serious problem, such as placenta praevia (when the placenta covers the cervix) or placental abruption (when the placenta separates from the wall of the uterus). If you have any bleeding in the second half of your pregnancy, go to your nearest hospital emergency department.

It is not always possible to pinpoint why a woman is bleeding during pregnancy.

Causes of bleeding in pregnancy#

There are many possible reasons for bleeding, including the following.

Miscarriage#

A miscarriage is the loss of a pregnancy before the fetus (unborn baby) can survive outside the uterus (womb). Miscarriage usually happens in the first 12 weeks of pregnancy (the first trimester), and most miscarriages occur without a clear cause.

Vaginal bleeding is the most common sign of miscarriage. Some women also have period-like cramping pain in the lower pelvis, while others have no symptoms at all.

Ectopic pregnancy#

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

Pain may be caused by a ruptured fallopian tube. This is a medical emergency and needs immediate surgery.

Implantation bleeding#

One cause of bleeding in early pregnancy is implantation bleeding. This usually appears as light bleeding or spotting and happens when the fetus implants (buries) itself into the lining of the womb, around the time the first period after conception would have been due. This bleeding often lasts a few days and then stops.

Placenta praevia#

Placenta praevia is when the placenta is inserted, wholly or in part, into the lower part of the uterus and covers the cervix. One of the signs is bleeding after 28 weeks. Placenta praevia is diagnosed by ultrasound. If you are diagnosed with it, your baby will usually be born by caesarean section.

Placental abruption#

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

Tests for bleeding problems#

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 the following.

• Vaginal examination to check the size of your uterus and the amount of bleeding. This examination lasts a few minutes and may be a little 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 and 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 may need 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 your doctor or the emergency department of your nearest hospital.

Distinguishing placenta praevia and placental abruption#

Both placenta praevia 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 it could trigger heavier bleeding if placenta praevia is present.

For this reason, an ultrasound scan should always be done first, and digital (finger) vaginal examinations should be strictly avoided if placenta praevia is suspected. Tests used to check for placenta praevia include:

• 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 praevia)
• a very gentle speculum vaginal examination, to make sure the bleeding is not coming from the cervix or vagina

Once placenta praevia has been ruled out, a digital vaginal examination may be used to help identify placental abruption.

If you have bleeding in early pregnancy#

The bleeding may be light and stop within a day or two. Many people go on to have a healthy baby at full term after such a bleed. Sometimes, however, the bleeding becomes heavy and a miscarriage is likely to happen. While you still need to see a doctor, in these circumstances there is no emergency care that can save the pregnancy.

Sometimes, during a miscarriage, some of the pregnancy tissue remains 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 have a negative blood type, you may need an injection of anti-D immunoglobulin to prevent problems related to possible blood incompatibility in future pregnancies.

Taking care of yourself#

You may feel a range of emotions during this time. Guilt is a common feeling, but try not to 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 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 such as paracetamol if needed
• reporting any changes in your condition to your doctor

If your mood remains low for an extended period of time, you may be experiencing depression and could benefit from the support of a health professional.

Key points#

• Bleeding from the vagina in early pregnancy is very common, and many pregnancies still result in a healthy baby.
• Vaginal bleeding is the most common sign of miscarriage, though some women have no symptoms at all.
• Symptoms of ectopic pregnancy can include cramping, vaginal bleeding and abdominal pain; pain may be caused by a ruptured fallopian tube, which is a medical emergency.
• Bleeding in the second half of pregnancy needs urgent assessment at a hospital emergency department.

Where to get help#