Bleeding During Pregnancy
It can be a very scary time if you start bleeding during pregnancy. However it’s important to know that blood loss doesn’t always mean you could be experiencing a miscarriage.
Bleeding during pregnancy, especially during the first trimester, is more common than you might think. According to the study patterns and predictors of vaginal bleeding in the first trimester of pregnancy, around one-fourth of study participants reported bleeding during pregnancy, with 8% of women reporting heavy bleeding. Most incidences occurred between weeks 5″8, and in most cases, lasted no more that than 3 days.
Of the women who experienced bleeding during pregnancy, 12% percent of women experienced a miscarriage compared to 13% of women who did not bleed. They cited fibroids and prior miscarriage as maternal characteristics associated with bleeding.
While most women will have a once-off bleed, a small percent may bleed throughout their whole pregnancy. This may be in the form of spotting, streaking, or period-like blood loss.
Do I Need To Tell My Doctor Or Midwife?
All bleeding during pregnancy 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’.
You especially need to see a doctor or midwife within 72 hours of any bleeding if you have a rhesus negative blood group (e.g. O-, A-), to see if there has been a possible mixing of yours and your baby’s blood. This results in the rhesus negative body producing antibodies against positive blood (which is the more dominant, likely blood group that your baby will inherit – but of course it’s unknown until birth). It doesn’t have any bearing on your first pregnancy, but in subsequent pregnancies, antibodies will attack what it thinks is foreign matter. See our article, Rhesus Negative Blood Groups In Pregnancy for more information.
Below is an explanation of some of the more common reasons for bleeding during pregnancy, and as you will read, its not always sinister. If the bleeding is accompanied by strong cramping, speak to your doctor or midwife asap. Some mild cramping/stretching sensations can be experienced in a healthy pregnancy though.
Possible Cause #1: 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 and occurs during the time between implantation no longer than when your period was due (some women mistakenly think they have just had a light period). 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 mucus stain. However do mention it to your carer for safe measure.
Possible Cause #2: 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.
Possible Cause #3: 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 fetus – your body may reject a pregnancy that is unable to survive its complications.
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 baby. 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.
Possible Cause #4: Bleeding After Sex
Bleeding after sex is one of the most common causes of bleeding during pregnancy. 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 recently had sex?” 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 that he’s not hurt the baby, who is safely protected in your uterus, well above the vagina.
Also see our article on Bleeding After Sex During Pregnancy.
Possible Cause #5: 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 normally?”
Possible Cause #6: 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 In 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 midwife or obstetrician to discuss the next step.
Once you’ve had it checked out by a medical professional, you could also seek out an experienced acupuncturist who is a specialist in fertility/pre-natal care, as there are some points they can work on to help you with bleeding and energy in that area. Acupuncturists work with patients who have had recurrent or threatened miscarriage – so might be worth a try – it is a safe, natural and healthy option.
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. Know 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.
What If I’m Experiencing A Miscarriage?
If you are experiencing a miscarriage, unfortunately nothing can prevent it from occurring. Whilst it is very disappointing and upsetting, there is nothing you can do but to take care of yourself emotionally and physically. Know that you are not responsible for a miscarriage happening, and you would not have done anything to cause it. These things can help you to feel more comfortable physically (but cannot prevent a miscarriage from happening) are:
- Panadol/Panadiene/Naprogesic for the cramps
- Hot water bottle for your tummy
- Tea and support from your partner
You may pass the developing 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.
However, remember that the majority of bleeding in early pregnancy settles spontaneously and the pregnancy continues unharmed.
Have you experienced bleeding during pregnancy?
Share your stories and experiences below in the comments section.