Bleeding in Early Pregnancy
At least 1 in 4 women will have some bleeding in pregnancy. It is always alarming but most of the time the pregnancy will continue normally, ending with a healthy mother and baby. Most of the time the bleeding is coming from inside the uterus but occasionally it can be due to problems on the cervix or elsewhere in the genital tract.
Bleeding in early pregnancy can occur for variety of reasons. Sometimes at approximately 10-14 days after conception there can be a small amount of blood which coincides with the embryo embedding in wall of uterus. This is called an implantation bleed. This diagnosis can only be made in retrospect after a scan confirms the pregnancy is alive and well.
Bleeding later in pregnancy can be an early warning of a miscarriage especially if there is cramping or period type pains. An early scan performed through the vagina can usually reveal if the pregnancy is going well or not.
Most commonly, early pregnancy problems are dealt with urgently in a designated Early Pregnancy Unit (EPU) which will be staffed by skilled nurses, doctors and sonographers. Occasionally however, the scans are inconclusive and need to be repeated, sometimes with serial blood tests to measure levels of the pregnancy hormone hCG.
In 1 in 100 pregnancies the embryo implants outside of the womb, usually in fallopian tube. This is called an Ectopic Pregnancy. This is usually characterized by lower abdominal pain followed by bleeding and will be suspected if no pregnancy is visible in the uterus on scanning. Occasionally the diagnosis is made before the woman knows she is pregnant, which can be very dramatic. Sometimes the diagnosis can be difficult and require repeated scans and blood tests. If diagnosis is suspected then eventually keyhole surgery (laparoscopy) may be needed to diagnose and treat this potentially life-threatening condition.
Bleeding in Later Pregnancy
Any bleeding in pregnancy requires immediate attention at hospital where your midwife or doctor will listen to story, examine you, listen to the baby’s heartbeat, and arrange a scan and blood tests
Occasionally women experience bleeding from neck of womb which is not so serious but still needs careful examination and assessment, so, again, at the signs of any bleeding, call your midwife or doctor immediately. At some stage your cervix may need to be inspected (using a speculum, like during a smear test) to see if there are any abnormalities on your cervix such as a polyp or local problem.
Most of the time the bleeding is mild and settles quickly. The blood is maternal blood not fetal (except in very rare circumstances) so will not effect the growth or development of the baby.
However, recurrent bleeding can sometimes affect the growth of the baby and therefore requires extra monitoring and can sometimes requite early delivery of baby. This is because the bleeding may interfere with the function of the placenta and possibly restrict the baby’s growth.
Painless bright red bleeding after 12 weeks could indicate that the placenta is low lying, known as Placenta Praevia. Between 16-20 weeks 10 percent of women are affected by low lying placenta but in all but 1 percent of cases, the placenta will move up and out of the way as the pregnancy progresses. If it does not move then delivery will always be by Caesarean Section. For more information see Complications During Pregnancy
Cord prolapse is a dramatic event which can rarely complicate late pregnancy and labour. It occurs when the membranes rupture and the baby is not in suitable position, and therefore not fitting snugly into the pelvis. It can be quite dramatic and result in the umbilical cord coming out of vagina. This is a great risk to baby as the cord may get compressed. This occurs more commonly when the baby’s head is very high or the baby is in a breech or transverse position of if you have extra amniotic fluid. It most commonly occurs in hospital and is recognised by a dramatic change in baby’s heart rate and results in lots of emergency bells ringing and several doctors and midwives arriving in room. The treatment is to turn the woman on to her side or into a knee-elbow position on all fours and try and relieve any pressure on the cord. It then requires the emergency delivery of the baby usually by Caesarean Section unless the neck of womb already open. If the baby is a good size and there is a nice fat cord then usually baby is born in good condition without any damage.
Fortunately in this country rupture of uterus is a rare condition. It can occur in any labour where it become obstructed or if the baby is lying in a poor position without making progress. It most commonly occurs in women who are labouring after having had a previous a Caesarean Section or some other operation on the uterus. It is usually diagnosed by sudden pains which do not go away between contractions and a sudden change in the baby’s heart rate and the uterine contractions. There may or may not be significant bleeding from vagina and a dramatic change to the baby’s position. Fortunately most babies do not die after this complication and emergency surgery and can save both the mother and baby’s life. The mother will need careful surgery to repair the uterine rupture and in some cases will need an emergency hysterectomy. The chances of this happening when you labour after previous c section are approximately 1 in 200 and more commonly when drugs are used to induce or speed labour. The risk is also slightly higher after repeated Caesarean Sections.
Placental Abruption (acute separation of the placenta)
This is a dramatic and often totally unexpected event, which can seriously affect health of both mother and baby. It’s a rare event and can occur in late pregnancy or labour. It is characterised by severe and continuous pain over the uterus and bleeding. Sometimes bleeding can be excessive. This condition constitutes real risk to mother and baby if not treated quickly and carefully. In minor cases it may not interfere with outcome of the pregnancy at all. But when it is dramatic it can cause the death of the baby and significant problems with the mother’s clotting and kidney function. Once diagnosis is made and if baby is mature, delivery is often done as an emergency and most of time there is a good outcome for mother and baby. Fortunately this condition is rarely recurrent.
In these unusual cases where blood loss is excessive a blood transfusion will be essential to save the woman’s life. Occasionally extra blood products such as clotting factors may be required. Fortunately blood transfusions in UK are very safe, with the risk of contracting HIV less than one in a million.