Bleeding in pregnancy: what are they and what to do?

Red leaks

Bright red blood loss during   pregnancy  is usually  the most worrying .  The red color in fact means that  the blood is “fresh” .

Again,  the leaks could be harmless or signal the presence of complications , which require  immediate evaluation  by your doctor.

In the event of bright red blood loss, it is therefore important to go immediately to the nearest emergency room for an obstetric visit.

In addition to the color of the discharge, your doctor will evaluate:

• the gestational age  at which the bleeding occurred;
• whether the losses are  abundant or not  (stains on the briefs or real bleeding);
• whether it is a single episode or  continuous ;
• if you have  pelvic pain  or other symptoms.

If necessary, she will then proceed to a midwifery examination and/or an ultrasound to ensure that the baby is well.

Bleeding in the first trimester: what can it depend on?

Bleeding during pregnancy is quite common in the first trimester. The causes can be different: sometimes they do not require any intervention, while in some cases they must be treated promptly. Let’s see together the most frequent ones.

System losses

Implantation losses are   quite common and appear very early in pregnancy, often even  before the positive test . Usually, in fact, they occur around  10-14 days after conception ,  when the fertilized egg implants itself in the uterine lining .

They can be recognized because  they are light, clot-free and pink or brown in colour . They have no pathological significance and simply represent a sort of “warning of early pregnancy”.

Cervical ectropion (cervical sore)

It is a small lesion of the uterine cervix which forms a  “little sore” . It can be present before or appear during pregnancy due to hormones.

Ectropion is an absolutely harmless manifestation, but it can cause bleeding if prompted by sexual intercourse or small traumas (for example the use of the speculum).

Cervical polyps

These are  growths  that form in the neck of the uterus, often caused by increased estrogen levels, inflammation or blocked blood vessels in the cervix.

They are usually completely  harmless , although they can cause bleeding episodes following mechanical stimulation, such as in the case of sexual intercourse.

They are typically not treated during pregnancy. However,  if you bleed frequently , your doctor may suggest that  they be removed  as an outpatient procedure.

Miscarriage

The presence of bleeding could signal a  miscarriage  or a  threatened miscarriage . In the first case, it means that the pregnancy has ended, while in the second case it could still have a favorable outcome.

Unfortunately it is often not possible to distinguish these two conditions on the basis of the extent of the losses (scarce or more abundant) and a visit accompanied by an ultrasound is necessary to make the diagnosis.

If the pregnancy is terminated very early (4-5 weeks) it is referred to as  a biochemical pregnancy . It often goes unnoticed and is confused with a period that arrives late and is a little heavier than normal, because the woman is still unaware that she is pregnant. Some women, however, recognize it by a first positive pregnancy test followed by a negative result at the end  . second test or beta assay .

The most common cause of miscarriages in the first trimester is  fetal chromosomal abnormalities  that are not compatible with life. Unfortunately, there is no way to predict a miscarriage, but it is important to remember that miscarriage does not affect fertility or the ability to carry a subsequent pregnancy to term.

When bleeding signals a threatened miscarriage, doctors usually recommend  complete rest .

Extrauterine or ectopic pregnancy

An  ectopic pregnancy  occurs when the embryo implants itself outside the uterus, usually in one of the fallopian tubes. It is rarer than miscarriage, but can be dangerous if not diagnosed early. If the embryo continues to grow, it can cause a rupture of the tube itself.

Generally,   women who have had the following are most at risk of developing an ectopic pregnancy:

•  tubal infection or surgery
• a previous  ectopic pregnancy

Treatment can be pharmacological or surgical.

Molar pregnancy

It is a very rare condition.  It is a pathological pregnancy with cystic degeneration of the chorionic villi and formation of a hydatidiform mole. It can be accompanied by the normal pregnancy symptoms, even if the embryo is not viable.

Molar pregnancy is diagnosed by  ultrasound  and usually requires a  surgical approach (curettage) .

Bleeding in the second and third trimester: what can it depend on?

Even in the second and third trimester, bleeding can occur due to minor causes, such as  cervical polyps  or  ruptured capillaries  at the level of the uterine cervix.

However,  when bleeding is profuse , problems with the placenta are generally suspected: among these, the most frequent are  low placenta or placenta previa  and  placental abruption .

Low placenta and placenta previa

It occurs when the placenta is located in the lower part of the uterus less than 2 centimeters from the internal orifice (low placenta) or even in correspondence with it , obstructing it completely or partially (placenta previa). The diagnosis is made by ultrasound.

Low placenta and placenta previa are among the most common causes of bleeding in the third trimester.  The bleeding is usually bright red and not associated with pain .

In the case of placenta previa, rest (sometimes even absolute) is generally recommended and sexual intercourse and strenuous activities are not recommended.

If the placenta remains previa until the end of the pregnancy, a cesarean section is usually scheduled. Often, however, the placenta  tends to migrate upwards  thanks to the enlargement of the uterus and therefore to move to positions compatible with a natural birth (lateral, anterior or posterior placenta). In the event of severe bleeding that cannot be controlled by doctors, an emergency caesarean section may be performed.

Placental abruption

It occurs when the placenta “breaks” from the wall of the uterus before the baby is born, causing  dark or bright red bloody discharge often preceded by abdominal pain . Known causes include:

• smoking  and  drug use
• high pressure
• abdominal trauma  or  injury

Although placental abruption is a rather rare complication, it can be very dangerous:  if not diagnosed in time, in fact, it can lead to the loss of the fetus (due to lack of oxygen supply) and a high risk of hemorrhage also for the mother .

The prognosis depends on the extent of the detachment (marginal or massive):  in the mildest cases the tissue can heal and allow the gestation to continue, while in the most serious cases it requires emergency surgery.

Premature or preterm birth

We speak of premature or preterm birth when labor begins before the pregnancy has reached full term (usually after 23 weeks of pregnancy or in any case before 3 weeks from the expected date of delivery ).

The bleeding that heralds a premature birth can be very variable and have a  pinkish, bright red or brown color .

In the event of a preterm birth, doctors usually intervene pharmacologically to stop labor from starting. When this is not possible, they at least try to slow it down, in order to have time to administer drugs to the mother to speed up the lung maturation of the fetus.

There has been tremendous progress on the survival rate of babies born prematurely. The survival rate rose considerably as early as 26 weeks of gestation.

Bleeding in pregnancy: other causes

Hemorrhagic cystitis

Bleeding after urinating  during pregnancy can indicate the presence of hemorrhagic cystitis, a urinary tract infection that causes light vaginal bleeding (spotting).

Sometimes the bleeding can be confused with implant losses, however it is sufficient to dab the urethral opening with toilet paper or a cotton ball to realize that  the spotting does not have vaginal origin .

In case of cystitis it is important  to consult the gynecologist  to start effective and safe treatment for the child as soon as possible.

Sexually transmitted infections

Some infections such as genital herpes  can cause bleeding. Even in these cases, it is important to receive a diagnosis: in this way, at the time of delivery, all precautions will be taken to avoid infecting the baby.

Bleeding in pregnancy: when to go to the emergency room?

• If you have noticed that you are bleeding, first of all  try to stay calm : the presence of bleeding does not necessarily indicate an ongoing complication.
• The second thing you need to do is contact your gynecologist or midwife right away . Remember to report any other symptoms or activities that preceded the losses (e.g., sexual intercourse or exercise). If you are unable to get an answer, go immediately to the nearest obstetric emergency room for the appropriate evaluations.
• Avoid having sex  while waiting for instructions from your pregnancy professional or emergency room medical staff.
• Do not apply drugs, tampons or other devices  into the vagina (cups, menstrual rings), but if necessary use a  sanitary pad  to contain the bleeding.