Bleeding During Pregnancy

Bleeding during pregnancy can be common. As many as 20% of women will have some sort of bleeding, especially during early pregnancy. This can range from a few brown spots to bright red blood loss and even large clots.

It is important for women to remember that bleeding while pregnant is not necessarily a sign of problems. However, bleeding in the second and third trimesters can indicate a pregnancy complication. Any bleeding, at any stage still needs to be investigated.

Bleeding in first trimester

Bleeding during the first three months of pregnancy can be a sign of miscarriage. Around 1 in 5 pregnancies results in miscarriage. Around half the women who experience bleeding do not miscarry.

Sometimes bleeding in early pregnancy is caused by an implantation bleed. This happens when the thick, bloody lining of the uterus is disturbed by the embryo nestling its way into the uterus. An implantation bleed generally only lasts for a day or two.

Signs of miscarriage

• Vaginal bleeding. Often starts with spotting, but can increase to heavy bleeding.
• Uterine cramping, similar to period pain.
• A sense that something is not right.
• Loss of pregnancy symptoms such as nausea and breast tenderness.

In cases of threatened miscarriage and bleeding, women may progress to the stage where miscarriage is inevitable. The majority of miscarriages are thought to happen because of problems with embryo's development.

A threatened miscarriage is when the embryo is still inside the uterus. A complete miscarriage is when the uterus is empty and the embryo has been passed. Often, a D & C - (dilation and curettage) of the uterus is necessary. Retaining products of conception can lead to infection and ongoing bleeding.

Ectopic pregnancy

Occurs when the embryo implants outside of the uterus, most commonly the fallopian tube. An ectopic pregnancy happens once in around sixty pregnancies. It is more common in women who have had surgery to their fallopian tubes, a previous ectopic pregnancy, or a history of pelvic infections.

Molar pregnancy

Though rare, a molar pregnancy can cause bleeding while pregnant. Instead of an embryo forming clusters of abnormal tissue, a mole grows. Bleeding, pain and a lack of fetal signs are symptoms. An ultrasound can diagnose a molar pregnancy.

Uterine infection

Occasionally infection can cause bleeding in pregnancy. Antibiotics are commonly prescribed.

Urinary tract infection

A U.T.I. can cause bleeding during pregnancy. Treatment with antibiotics is usually effective. Untreated urinary tract infection can lead to premature labour and kidney damage.

Post coital bleeding

Many women experience light vaginal bleeding after intercourse. Commonly, this is because the cervix is engorged with blood. Pregnant women are often advised to stop having sex for as long they are bleeding.

Bleeding in the Second and Third Trimesters

Placenta praevia

This is a condition where the placenta lies over or partially over, the cervix. Because there is not a firm seal between the uterine wall and the placenta, blood escapes. There are different degrees of placenta praevia. If cervical coverage is complete, the baby can only be born by caesarian section.

Placental abruption

This is an obstetric emergency, threatening the mother's and baby's lives. In placental abruption, the placenta separates from the wall of the uterus and causes bleeding and abdominal pain. In most cases, caesarean section delivery is necessary.

Premature labour

Bleeding while pregnant can happen when in premature labour e.g. before the 37th week of pregnancy. Blood loss may be more watery and tinged with mucous. This is because the membranes may have also ruptured and amniotic fluid is mixing with blood.

Uterine rupture

Can be a cause for bleeding while pregnant, most commonly in the later stages of pregnancy. A uterine rupture is an obstetric emergency.

Varicose veins

Occasionally, varicose veins of the vagina or lesions on the cervix can cause bleeding in pregnancy. Women who've had vaginal trauma or varicosities are generally aware they could have bleeding while pregnant.

Fetal bleeding

Fetal cells can be identified as present in the mother's vaginal blood, rather than maternal cells.

If you are bleeding while pregnant

• Make an appointment with your healthcare professional.
• Monitor your blood loss and keep a count of how often you change your pads.
• Don't use tampons and avoid sexual intercourse.
• Don't assume you are going to lose the baby or miscarry. Many women bleed during pregnancy and progress to having a healthy baby.

Get medical help if you

Have any bleeding during pregnancy. Although it is more common to have bleeding in early pregnancy, it is still important to seek the advice of a health care professional. Check here for more information.

• Feel any cramping or pain.
• Do not feel your baby moving or there is a change in the pattern of their movements.
• Have an elevated temperature. A normal temperature range is 36.1-37.3 degrees Celsius.
• Bleed heavily, pass blood clots or obvious pieces of tissue.
• Feel dizzy or faint.
• Are breathless or have pain in your shoulder tip/s.

What will my healthcare professional do?

• Check your medical and obstetric history.
• A vaginal examination.
• Order blood tests. A pregnancy test, full blood count, and blood type assessment including Rh factor are common.
• Urine tests which including culture and sensitivity to check for infection.
• An ultrasound. If you are bleeding during early pregnancy, you may need to have a full bladder so the uterus can be more clearly seen by the sonographer.

Written and reviewed by Jane Barry, midwife and child health nurse on 1/01/20.