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vaginal bleeding in pregnancy Alternative Names
pregnancy-vaginal bleeding, maternal blood loss, maternal haemorrhage, antepartum haemorrhage
Definition
Vaginal bleeding in pregnancy generally refers to bleeding that happens at any time during pregnancy before the delivery of the baby.
What is going on in the body?
There are many causes of vaginal bleeding in pregnancy. Some of these causes are normal, whereas others may be life-threatening to mother or child. Bleeding may occur at any time during pregnancy. A doctor should evaluate any vaginal bleeding during pregnancy.
What are the signs and symptoms of the condition?
Women may experience vaginal bleeding or spotting, with or without cramping, backache or labour pains. The bleeding can range from bright red and heavy to small amounts of dark blood clots.
What are the causes and risks of the condition?
There are many causes of vaginal bleeding in pregnancy. These include: - normal implantation of the fertilised egg into the wall of the uterus. This usually occurs in the very early days of pregnancy.
- trauma to the cervix, which may occur after sex or an injury.
- inflammation of the cervix.
- miscarriage, or loss of the baby in the first half of pregnancy.
- ectopic pregnancy. This is when the foetus grows outside the uterus, where it is supposed to be. This is a medical emergency that may cause heavy internal bleeding, shock and even death.
- a tumour or cancer. Rarely, the foetal tissue itself can actually become a tumour. This unusual condition is called a molar pregnancy.
Common causes of bleeding in late pregnancy include: - the placenta detaching from the wall of the uterus before or during labour. This can cause severe abdominal pain, heavy vaginal bleeding and possible death of the mother and child. This condition occurs in 1% of pregnancies. It is associated with maternal smoking, cocaine use, high blood pressure and trauma to the abdomen.
- a placenta abnormally located over the cervix, blocking the birth canal. This can cause heavy vaginal bleeding as the cervix opens. Serious maternal and foetal problems may occur if normal delivery is attempted in this setting. bleeding is painless
- labour. Late in pregnancy, bleeding may be a normal sign of labour as the cervix opens. This spotting or bleeding is usually mixed with mucous and is known as the "bloody show."
- premature labour. If labour begins before the 37th week of pregnancy, vaginal bleeding may occur. Other warning signs may include vaginal discharge, pelvic or lower abdominal pressure, tightening of the uterus, abdominal cramps, and diarrhoea.
What can be done to prevent the condition?
Prevention depends upon the cause. Early antenatal care will allow the doctor to screen for risk factors of miscarriage, premature labour, and other problems. Eating a balanced diet rich in folate may prevent miscarriages due to genetic problems. Avoiding cigarettes, cocaine and trauma may decrease the risk of the placenta detaching. Practicing safer sex methods can help prevent sexually transmitted diseases. These are a common cause of ectopic pregnancy.
How is the condition diagnosed?
The cause of vaginal bleeding may be discovered using: - pelvic examination. This will determine how much bleeding has occurred, if the cervix is opened, and whether or not foetal tissue is present in the vagina during a miscarriage
- ultrasound, uses sound waves. This allows a doctor to see a possible ectopic pregnancy, foetal death, and molar pregnancy. It also helps to determine the location of the placenta or if the placental is detaching too early.
- repeated testing of HCG levels, or pregnancy hormone levels, in early pregnancy.
- blood tests to determine the amount of blood loss.
What are the long-term effects of the condition?
The psychological effects of a miscarriage can be devastating. The risks and long-term effects of vaginal bleeding in pregnancy depend upon the cause, duration and quantity of blood loss. Potential effects include: - shock
- Rh sensitisation if Rh(0)(D)Immunoglobulin is not given, which can lead to health problems for the foetus in future pregnancies
- the need for blood transfusions
- the need for surgery
- death of the mother and child
- premature delivery and the consequences of early delivery
- problems related to any cancer, such as the need for chemotherapy
What are the risks to others?
This condition is not contagious and poses no risks to anyone except the mother and child.
What are the treatments for the condition?
Not all vaginal bleeding in pregnancy requires treatment. If bleeding occurs, but a miscarriage or early delivery does not occur, observation is all that is needed. Treatment for other causes include: - scraping of the lining of the uterus, also called a "D&C." This is done to remove the dead foetus or placenta after a miscarriage or molar pregnancy.
- surgery to remove a foetus that implants outside the uterus.
- methotrexate to cause an abortion of a foetus that implants outside the uterus. This drug may be used to avoid surgery.
- caesarean delivery, or c-section. This may need to performed in the event of heavy bleeding that threatens the health of the mother or child.
- medications designed to relax the uterus , such as ritodrine. These are often used in the event of premature labour.
- transfusions, which may be life-saving for the mother and foetus in the event of severe blood loss.
What are the side effects of the treatments?
All surgery is associated with a risk of bleeding, infection, and reactions to analgesia. Death may even occur in rare cases. Recovery from surgery may require 6 to 8 weeks of limited activity. Transfusions carry the risk of infection and allergic reactions. All medications have side effects, such as allergic reactions and stomach upset. Specific side effects depend on the drugs used.
What happens after treatment for the condition?
Most cases of bleeding will end up turning into pregnancies that continue without further problems. In the event of a miscarriage, a woman should wait 1-2 months before attempting another pregnancy. Significant blood loss may occur in some cases. This may require treatment with iron and vitamin pills to increase the blood counts. If premature labour stops, medications to relax the uterus may be given to extend the pregnancy beyond the 36th week.
The mother's blood type is determined. If a mother has what is called an Rh negative blood type, a drug called Rh{0} (D) Immunoglobulin may be needed. This helps prevent a type of blood incompatibility problem between mother and foetus that can harm the baby in future pregnancies.
How is the condition monitored?
Monitoring depends on the cause of bleeding. It may consist of a "wait and see" approach. Repeat ultrasound examinations or blood tests may be used. Any additional episodes of vaginal bleeding should be promptly evaluated by a doctor.
Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
