Bleeding at any stage of pregnancy can be frightening for a woman. Many cases of bleeding are explained by minor issues like implantation of the fertilized egg into the uterus, vaginal irritation from intercourse, or a minor infection. Other more serious conditions can cause bleeding that is considered to be abnormal. All bleeding should be reported to a medical professional.
Causes
Abnormal bleeding is usually caused by a problem with the pregnancy or a moderate to severe vaginal or uterine infection. During the first half of the pregnancy, a miscarriage is a common cause of bleeding. The American Pregnancy Association explains that when a woman is have an early miscarriage, in addition to bleeding, she will likely have cramping that is low in the uterus and pass tissues from the vagina. An ectopic pregnancy can also occur in the early part of pregnancy. This occurs when the fertilized egg attaches somewhere that it shouldn't, such as in the fallopian tubes. Symptoms of this include bleeding, sharp abdominal pain and a reduced level of the pregnancy hormone, human chorionic gonadotrophin, or hCG.
Placental abruption can occur any time in the second half of the pregnancy and even during labor. Abruption takes place when the placenta separates from the uterus. It occurs in about 1 percent of pregnancies, explains the American Pregnancy Association. In addition to bleeding, the woman will have stomach pain. Placenta previa is a very rare cause of bleeding that has no other symptoms. It occurs when the placenta completely or partially covers the cervix.
Preterm labor can be a cause of abnormal bleeding in the second half of the pregnancy. In addition to bleeding, the woman will have regular contractions, a low backache and her water may even break.
Identification
It is difficult and usually impossible for a woman to identify the cause of abnormal bleeding during pregnancy. This is why all bleeding, no matter how minor, should be reported to a health care provider. The provider can do a number of assessments to identify the cause of the bleeding. In very early pregnancy, an ultrasound may be done to view the embryo. An ectopic pregnancy can sometimes be seen in an ultrasound, but is best diagnosed by drawing a woman's blood and analyzing her hCG levels. Placental abruption is more easily identified by the symptoms because bleeding is quite significant. A blood test can also help identify or rule out infection. Preterm labor is identified by tracking contractions and performing an internal exam of the cervix to see if it has opened in preparation for delivering the baby.
Treatment
A procedure called a dilation and curettage (D&C) may be performed after an early miscarriage, according to MedlinePlus. The D&C allows a medical care provider to dilate the uterus and withdraw any remnants of the pregnancy to prevent infection. An ectopic pregnancy is terminated either using medications or performing a surgical abortion. This procedure is done as soon as the ectopic pregnancy is discovered to prevent rupture and significant blood loss that could potentially harm the mother. Placental abruption is a very serious condition and when it occurs, every attempt is made to deliver the baby, which is usually via cesarean section. Preterm labor may be slowed or stopped using medications and bed rest.
Risk Factors
There isn't anything a woman can do to prevent the main causes of abnormal bleeding in pregnancy. FamilyDoctor.org suggests that women who smoke, drink alcohol, eat poorly, or participate in recreational drugs are likely to have more problems in pregnancy, including abnormal bleeding. The American Pregnancy Association suggests women who have had a miscarriage before may be at a greater risk of having one again. Ectopic pregnancies may be more likely in women who have had a previous infection of the fallopian tubes, a previous ectopic pregnancy, or a previous pelvic surgery. Risks of placental abruption go up if a woman has already delivered a baby in the past, is over 35, has previously had an abruption, suffers from sickle cell anemia, has high blood pressure, uses cocaine or has experienced an injury to the stomach.
Considerations
The cervix is very spongy and full of blood during pregnancy. A routine vaginal exam, or even intercourse can brush the cervix enough to cause bleeding. This type of blood is usually spotty and bright red. Sometimes a woman may bleed a greater amount, but only for a short while. Blood may also appear a day or two following an exam or intercourse, and may be brown instead of red. This suggests the blood had time to dry slightly before it was passed from the vagina. Pink-tinged discharge during pregnancy can indicate a vaginal or uterine infection, such as yeast or bacteria that require medication for treatment, according to MedlinePlus.
