Bleeding during pregnancy is a sign that can occur regardless of the period of embryogenesis and indicates changes in the woman’s body. It can be observed with spontaneous miscarriage, ectopic pregnancy, Rh conflict, placenta previa and other conditions. This manifestation can develop against the background of general well-being or be accompanied by painful sensations in the lower abdomen, lower back, sacrum. Diagnosis is carried out on the basis of gynecological examination data, ultrasound assessment of the patient and fetus. Treatment of this pathological sign is determined by its cause and is prescribed exclusively by a specialist.
General information
Bleeding during pregnancy is an obstetric symptom, indicating the possible development of a number of disorders, the cause of which can be both physiological changes in a woman’s body after conception and pathological conditions. Only an obstetrician-gynecologist can finally find out the etiology of such a manifestation after a full examination. Bleeding during pregnancy is observed in about one in five patients. In 50%, they indicate pathological changes and end in spontaneous miscarriage. In half of the patients, the sign is of a physiological nature. Bleeding occurs more often in the first and third trimester of embryogenesis.
The danger of bleeding during pregnancy lies in the fact that they can be provoked by a wide variety of factors, including those that pose a threat to the mother and fetus. In some situations, there are no other pathological signs. Any bleeding during pregnancy should be a reason for immediate medical attention. Only a specialist is able to assess the danger to the health of a woman and a fetus, as well as decide on further tactics. Timely assistance provided even in the abnormal course of pregnancy allows you to continue its management and save the life of the child.
Causes
Bleeding during pregnancy can occur at any stage of embryogenesis, develops both against the background of physiological changes in the woman’s body, and due to the formation of a certain obstetric pathology. In the early stages, half of the women have a slight separation of blood due to implantation of the fetal egg in the uterine cavity. Such bleeding during pregnancy is often regarded by the patient as menstrual, so she does not seek medical help, which in the future may make it difficult to determine the period of embryogenesis. A similar symptom is also possible with insufficient progesterone production in the early stages of gestation.
The most common cause of pathological bleeding during pregnancy in the first trimester is spontaneous miscarriage. This sign appears both with a newly started and with a complete abortion. Approximately 6 weeks after conception, the symptom occurs with ectopic attachment of the fetal egg. Also, bleeding during pregnancy at this time may indicate rhesus conflict, fetal fading. Similar manifestations are typical for women suffering from varicose veins that feed the uterus. In this case, bleeding during pregnancy is caused by increased blood supply to tissues.
Bleeding during pregnancy in the second trimester is diagnosed much less often, about 5-10% of all cases of gestation. As a rule, the symptom is caused by pathological changes and in most cases indicates spontaneous late abortion or cervical insufficiency. Sometimes the separation of blood from the genital tract is observed with stillbirth. Bleeding during pregnancy in the third trimester also always indicates the development of gestation pathology. The most common cause is placenta previa. In this case, the embryonic organ completely or partially overlaps the uterine pharynx, while due to the high load on the lower segment, micro-tears of the placenta occur, which causes a similar sign.
Less often, bleeding during pregnancy in the third trimester is caused by premature detachment of the normally located placenta. In this situation, there is a high threat to the life of the fetus. The danger also lies in the fact that initially internal bleeding develops during pregnancy or the formation of a hematoma, and only then the blood pours out. The rarest, but most dangerous for the life of the mother and child, the cause of the development of this symptom is a rupture of the uterus. Such a complication is diagnosed in the presence of a scar on the myometrium and tissue overgrowth provoked by polyhydramnios, a large fetus or multiple pregnancy. Extremely rarely, bleeding during pregnancy occurs due to a violation of the integrity of the fetal membranes or vessels of the umbilical cord.
Also, bleeding during pregnancy can be triggered by causes that manifest themselves at any stage of embryogenesis. Such causes include benign neoplasms – fibroids, polypous growths in the cervical canal and uterine cavity. Bleeding during pregnancy is often observed in women with cervical erosion. Sometimes the sign occurs due to increased blood circulation in the pelvic organs. The risk of developing the symptom is also present with violent sexual contacts, significant physical exertion, concomitant cardiovascular diseases associated with weakening of the endothelium.
Classification and symptoms
Depending on the origin of bleeding, two groups can be distinguished:
- Physiological bleeding during pregnancy – occurs due to the restructuring of the body, does not pose a threat to the health and life of the fetus or mother.
- Pathological bleeding during pregnancy – indicates its abnormal course, may be accompanied by a risk to the life and health of the woman and baby, require immediate medical attention.
The clinic of bleeding during pregnancy directly depends on the cause of such a sign. The release of blood from the genital tract in the early stages of embryogenesis, provoked by physiological changes, proceeds against the background of general well-being. Bleeding during pregnancy, developed due to the presence of polyps, erosion, fibroids in most cases also do not cause well-being disorders. At the same time, there is a slight release of biological fluid – only a few drops, the symptom is of a short-term nature. Bleeding during pregnancy associated with progesterone deficiency will be more abundant, similar to menstrual bleeding.
In the case of bleeding during pregnancy associated with its spontaneous termination, the patient is concerned about constant or cramping pain in the lumbosacral region, abdomen. Additionally, nausea, dizziness, malaise, and a slight increase in body temperature may occur. Bleeding during pregnancy in this case can be of varying intensity, often there are pieces of tissue in the secretions. With ectopic attachment of the fetal egg, as well as with rupture of the uterus, there is a serious threat to the life of a woman. In such a situation, internal bleeding initially develops during pregnancy, and only then pathological discharge from the external genital tract appears. There is acute abdominal pain with irradiation to the anal region, the lateral parts of the trunk. With significant blood loss, a state of shock occurs with the threat of death.
Pathology in the late stages is also not always accompanied by a detailed clinical picture. In the case of placenta previa, this is the only symptom that should cause alertness in a woman and become a reason for contacting an obstetrician–gynecologist. As for the premature detachment of the properly attached placenta, in this case, bleeding during pregnancy develops against the background of uterine hypertonicity, abdominal pain, deterioration of general well-being is noted. During cardiac monitoring of the fetus, there is a violation of the heart rate, motor activity.
Diagnosis and treatment
To identify the cause of bleeding during pregnancy, a gynecological examination of a woman is performed. With changes of physiological origin, it is not possible to detect any deviations from the norm. With pathological bleeding during pregnancy against the background of spontaneous abortion, the opening of the cervix is observed. An increase in the tone of the myometrium may indicate the onset of placental abruption. From laboratory diagnostic methods, an analysis is used to determine the concentration of hCG (human chorionic gonadotropin). With ectopic pregnancy and bleeding, this indicator will be reduced. Instrumental diagnosis of bleeding during pregnancy consists in ultrasound. Using this method, it is possible to assess the condition of the myometrium and embryo, the level of blood flow in the vessels, the exact localization of the placenta and (possibly) its incipient detachment. Using CTG, the diagnostician can make a conclusion about the vital activity of the fetus.
The treatment also depends on the cause of the symptom. If there are no pathological changes or the manifestation is provoked by damage to the polyp, medical assistance is not required. In rare cases, the doctor recommends its removal. A wait-and-see tactic is also used in the case of cervical erosion. Her cauterization is carried out after childbirth. Bleeding during pregnancy against the background of the threat of miscarriage and placenta previa requires immediate hospitalization in an obstetric hospital with subsequent prescription of medication. Sedatives and tocolytics are used to reduce uterine tone. Pregnancy management at the same time requires careful supervision by a specialist.
Bleeding during pregnancy caused by ectopic attachment of the fetal egg, rupture of the scar or completed spontaneous abortion require hospitalization and surgical treatment. After removal of fetal tissue residues or emergency delivery, antibacterial therapy is prescribed. In this case, stopping bleeding during pregnancy is carried out in different ways, depending on its intensity, often ligation of the uterine arteries is carried out. In case of premature placental abruption, an emergency caesarean section is indicated.
Prognosis and prevention
Bleeding during pregnancy is usually accompanied by a favorable prognosis. Timely medical care can save the life of the fetus and the woman. Fatal outcome is extremely rare. Prevention of bleeding during pregnancy consists in early detection of benign neoplasms and their treatment even before conception. To prevent the development of a pathological sign, you should register as early as possible, take all the necessary tests and, if any violations occur, immediately seek advice from an obstetrician-gynecologist. Prevention also consists in avoiding stress, physical exertion, violent sexual contacts.