Bleeding in Pregnancy – What Could the Bleeding Be?

Bleeding during pregnancy can be a very scary time for a pregnant woman, however blood loss doesn’t always mean you could be experiencing a miscarriage.

Bleeding during pregnancy is more common than you might think – around 30% of women experience bleeding during pregnancy. Around half of those women will continue on to have a healthy baby and the other half will have a miscarriage. The most likely time bleeding can occur is in the first trimester.

Some women have a once-off bleed, others may bleed throughout their whole pregnancy. This may be in the form of spotting, streaking, period-like blood loss or more.

Those women who need to see a doctor within 72 hours of every bleed are those who have rhesus negative blood groups (e.g. O-, A-). See our article, Rhesus Negative Blood Groups In Pregnancy for more information.

All bleeding should be reported to your doctor or midwife. Any passage of blood from the vagina of a pregnant women before 24 weeks will be termed a ‘threatened miscarriage’ or ‘threatened abortion’. After 24 weeks its termed an ‘ante-partum haemorrhage’.

Below is an explanation of some of the more common reasons for bleeding during pregnancy, and as you will read, its not always sinister.

Implantation Bleeding or Streaking

When a fertilised egg attaches to the uterine lining, this can result in light spotting or streaking (streaks of blood). Usually this only lasts a day or two, however do mention it to your carer for safe measure. Implantation bleeding is usually bright fresh blood like that which you would expect to see if you cut your finger. It can also be in the form of a pink mucous stain.

Breakthrough Bleeding

Some women experience what is known as ‘breakthrough bleeding’ at the times when your period would have normally been due. So this would be at 4, 8 and 12 weeks of pregnancy. It is often accompanied by the feeling that you would normally associate with your period being imminent i.e. back ache, cramps, a heavy sensation in your pelvis, feeling bloated and ‘off’. Of course the period doesn’t arrive (even though you feel like it will) because you are actually pregnant! During pregnancy, hormones prevent your period from occurring. Sometimes the hormone levels are not yet high enough to stop your period and therefore you have this breakthrough bleeding. It can last for around three months – after this time the placenta begins to take over hormone production from your ovaries. Some women may experience breakthrough bleeding throughout the whole pregnancy and have healthy babies, under the close watch of their carer.

Threatened or Actual Miscarriage

Studies indicate that around one third of pregnancies end in miscarriage (the medical term is spontaneous abortion) but don’t despair – these figures refer to the first 12 weeks of pregnancy, including very early miscarriages that occur before you even realise that you are pregnant. Often this is a result of a damaged or imperfect fetus – your body may reject a pregnancy that it knows will not be normal.

Once you have reached the 14-16 week mark you can be fairly sure that your pregnancy is safe. It’s probably not such a bad idea to refrain from telling the world you are pregnant until you get to the 12 week mark for this reason. Although you might be busting to share your wonderful news, it can be very distressing to have to tell the world again if you lose the pregnancy. Sometimes sympathy is comforting but sometimes it can be overwhelming when you are grieving for lost dreams.

Common signs of miscarriage include bleeding (being most common), cramping, backache and stomach pains. Women commonly say that they no longer ‘feel pregnant’ when they have miscarried and are bleeding. The signs of pregnancy disappear, no more nausea, sore breasts of bloated tummy. If you are bleeding and feel like this then chances are that you have lost the fetus. If you are bleeding but still feel pregnant then the chances are very good that the bleeding is just a scare and the little one is hanging on in there. An ultrasound will usually be reassuringly normal.

It is possible to miscarry without any bleeding, which is known as a ‘missed abortion’. The fetus dies but is retained by your body. The signs of pregnancy would definitely have disappeared if this happens but the absence of a heartbeat would only be detected on ultrasound. You may need a curette to clear out the uterus.

For more information, see our article, Miscarriages – Saying Goodbye Before You’ve Said Hello.

Bleeding After Sex

‘Post-coital bleeding’ is one of the most common causes of vaginal blood loss. This is completely harmless and is caused by increased blood supply and softening of the cervix. Although this form of bleeding is not serious, you should always report this to your carer. Be prepared when you phone the maternity ward for the very personal question, “Have you just made love?” It’s a bit embarrassing but a common reason for bleeding, so it’s the first question midwives ask women who phone with vaginal bleeding. You do not need to cease love-making but you may need to reassure your partner!

Ectopic Pregnancy

An ectopic pregnancy occurs when your fertilised egg implants itself outside of the uterus, usually in a fallopian tube. You may experience severe pain down one side of your abdomen, or generalised pain which doubles you over, you may feel faint and nauseous. The pain may suddenly disappear if the tube ruptures but it will return within hours/days and you will feel really unwell.

This is an emergency situation as an ectopic pregnancy can rupture the fallopian tube causing internal bleeding, damage to the tube and maternal collapse. Your fallopian tube may need to be removed along with the pregnancy but this does not mean you will have trouble conceiving in future provided your other ovary and fallopian tube are healthy.

For more information, read our article on Ectopic Pregnancy

The next question you will be asked if you phone to report a ‘bleed’ is “Have you had a scan, and was the placenta situated nomally?”

Bleeding From The Placenta

Painless vaginal bleeding can be from an abnormally placed placenta. Sometimes the placenta implants itself very low down on the uterine wall, occasionally right over the cervical canal. This is called placenta praevia and it occurs in about two percent of women. Placenta praevia will inevitably result in a bleed at some point in your pregnancy, usually after the 20 week period. There are differing degrees of severity of this condition but all will require repeat ultrasounds to accurately diagnose it. This condition may require bed rest, an induction or a Caesarean if it remains over the cervix in the remaining weeks of pregnancy to prevent your baby being put at risk.

Another cause of bleeding later in pregnancy is placental abruption (which occurs in approximately one in 200 pregnancies) where the placenta partially or completely separates from the wall of the uterus. Symptoms can include generalised severe pain and heavy bleeding. The blood may be seen by you or concealed in the uterus which will be tense, tight, hard to touch and very painful. If you smoke, have high blood pressure, kidney problems or pre-eclampsia, you are more at risk. It requires urgent admission to hospital and depending on the severity of the bleeding, you may either be put on bed rest, be induced or have a Caesarean. To find out more about low-lying placenta and placenta praevia read our article HERE.

What should I do if I experience bleeding during pregnancy?

If you are over 20 weeks of pregnancy, seek medical advice immediately.

Do not use tampons if you are bleeding or anytime during pregnancy, always use pads. If the bleeding is light and you have no pain, in the first instance, contact your doctor or Obstetrician to discuss the next step.

However if the bleeding is heavy (i.e. running out and you are passing clots) and the bleeding is accompanied with stomach cramps, backache and period type pains, contact your hospital immediately. While this is understandably an upsetting time, try to remain as calm as you can – remind yourself that bleeding can occur in pregnancy. That it is your blood, not the babies blood that you are seeing and that it is quite possible to continue on with a healthy pregnancy.

Don’t be surprised if the advice you receive for early bleeding (before 12 weeks) is to just watch and wait. Nothing will prevent an ‘inevitable abortion’ from occurring. Trust that your body has probably rejected the pregnancy for a very good reason and whilst it is very disappointing and upsetting, there is nothing you can do to prevent it happening. Likewise you are not responsible for this happening, you will not have done anything to cause it.

These things will make you feel better but cannot prevent it happening:

• Bedrest
• Panadol/Panadiene/Naprogesic for the cramps
• Hot water bottle for your tummy
• Tea and sympathy from your partner

You may pass the fetus and tissue whereby the bleeding will then cease. Should you continue to bleed you will need an anaesthetic and a curette to ‘clean out’ your uterus.

Remember that the majority of bleeding in early pregnancy settles spontaneously and the pregnancy continues unharmed.

Bleeding in Pregnancy Stories

To read real-life stories of bleeding in pregnancy, you might like to read our forum discussion on Bleeding in Pregnancy where women are invited to share their stories of bleeding with varying outcomes.

Kelly Zantey is a birth attendant (aka doula) the creator of BellyBelly, mum to two beautiful children and has just opened the BellyBelly Pregnancy Centre in Canterbury, VIC.

Article proof-read and edited by BellyBelly Midwife, Brenda Manning.

To read more pregnancy articles, please click here.