About 30% of pregnant women suffer some type of bleeding. It is normal for these losses to alarm the future mother and should be urgently assessed by a gynecologist, but they do not have to mean that the pregnancy is not going well.
Hemorrhages in pregnancy
According to Raquel Ferrer, gynecologist at Vall d’Hebrón Hospital in Barcelona, in half of the cases there is some pathology, but the most frequent cause is a small trauma caused by an intense effort. During pregnancy, the mucous membranes in the cervix are more irrigated and the tissues are more likely to bleed.
In any case, to determine the cause you will have abdominal and vaginal ultrasound, pelvic exams and bleeding analysis. But what will determine the diagnosis will be the quarter in which you are.
Losses in the first trimester of pregnancy
One in four pregnant women has vaginal bleeding at the beginning of pregnancy. If stains during the first weeks, it may be due to these causes:
- Implantation: It occurs six to twelve days after ovulation, when the egg implants in the uterus and breaks some blood vessels. Many women confuse it with menstruation, although this bleeding is milder and dark red or brown. It can last several days, but not more than five. It is not serious, unless it forms a large hematoma, in which case the doctor will recommend relative rest so that it does not continue to grow.
- Threat of abortion:It happens in the first twelve weeks and is sometimes accompanied by abdominal pain similar to menstrual. If the pregnancy occurs at an early stage and the embryo’s heartbeat is not yet appreciated, the doctor will follow up for a week to see if the pregnancy continues (in which case it will recommend rest to the pregnant woman) or if there has been an abortion In this case the ultrasound will determine if the gestational sac has been expelled or if it is a deferred abortion (which has not been spontaneously expelled). If there are remains in the uterus, a curettage should be practiced. Spontaneous abortions cannot be prevented: 50% are due to genetic diseases, 25% due to implantation, coagulation or immunological problems and 25% due to unknown causes.
- Ectopic pregnancy:It is a pregnancy that is developing outside the uterus (in the fallopian tubes, in the cervix or in the ovary). Losses are accompanied by strong pain located in the place where the ovule has been implanted and nausea and weakness. Generally, an aspiration should be performed to remove the embryo.
- Mola or trophoblastic disease: It is characterized by a degeneration of the cells that form the sac and placenta. It causes heavy bleeding and pain. It is treated with chemotherapy.
Hemorrhages in the second and third trimesters
From the 15th week of pregnancy blood losses usually occur due to these causes:
- Placenta previa: It is the one that has been implanted very close to the opening of the cervix. There are partial ones, if they partially cover the exit, and occlusive ones (they cover it entirely). The problem arises when the placenta bleeds, sometimes due to small contractions of the womb produced by the development of pregnancy. The bleeding is intense red and very liquid, sometimes intermittent, and may be accompanied by pain. Normally the treatment is hospital admission to control the pregnant woman and absolute rest until the end of pregnancy. If you bleed a lot and the placenta is occlusive, you will have to perform an urgent C-section.
- Premature detachment of the placenta:The placenta detaches from the uterine wall before term, and in doing so, it bleeds. “This hemorrhage differs from that caused by the placenta previa because it is darker, with clots and persistent, and is accompanied by contractions with pain,” explains Ferrer. In most cases, the pregnancy must be terminated urgently.
- Prior vasa: It is rare and is characterized by an alteration in the formation of the vessels of the placenta. The bleeding is light red and very abundant, without pain. It is a cause of caesarean section.
- Polyps: They can cause bleeding, but unless it is very intense, nothing will be necessary.
- Labor:If you have already spent week 37 and you see dark blood with mucus accompanied by contractions, it is that you are starting labor. Hemorrhage corresponds to what is known as “loss of the mucous plug.” This means that the plug that covers the opening of the uterus during pregnancy has come off. In this case, bleeding is a good sign: your baby is about to be born.
So can blood losses in pregnancy be
If during your pregnancy a hemorrhage occurs, think that it may be due to different causes. And there are different types, according to their characteristics.
- Quantity: If the losses are intermittent and small, they usually indicate a wound; the abundant indicate other pathologies, although they are not always more serious.
- Duration: Bleeding can last a few days, such as implantation, or more than five, as in the placental abruption.
- Color: If the color of the blood is clear it means that there is active bleeding at that time. If it is dark, brown, it is “old blood” that has been produced days ago and that indicates a self-limited process.
- Symptoms: Hemorrhage may be accompanied by other symptoms, such as abdominal pain, nausea, vomiting, weakness … Before any of these symptoms, go immediately to the emergency room to have you examined.