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Vaginal Bleeding In Pregnancy

Definition

Vaginal bleeding in pregnancy means 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. It occurs in as many as 20% of pregnant women during the first trimester, or first three months of pregnancy. Bleeding can also take place later in pregnancy.
A healthcare provider should check into any vaginal bleeding during pregnancy.
Some causes of bleeding are not of concern. However, others may be life-threatening to the mother and baby.
Bleeding may be related to conditions other than the pregnancy itself. For example, minor vaginal tears or infections may lead to vaginal bleeding.

Risks

What are the causes and risks of the condition?

Following are some causes of vaginal bleeding during pregnancy:
  • ectopic pregnancy, which occurs when the embryo implants outside the uterus
  • inflammation of the cervix
  • injury to the cervix, which may occur after intercourse
  • miscarriage, or loss of the baby in the first half of pregnancy
  • a molar pregnancy, in which the fetal tissue becomes a tumor
  • normal implantation of the embryo into the wall of the uterus
  • a tumor or cancer
Common causes of bleeding in late pregnancy are as follows:
  • normal labor, which may be preceded by blood and mucus from the vagina
  • placenta abruptio, a condition in which the placenta detaches from the wall of the uterus before or during labor
  • placenta previa, a condition in which the placenta is abnormally located over the cervix, blocking the birth canal
  • premature labor

Prevention

What can be done to prevent the condition?

Early prenatal care will allow the healthcare provider to screen for pregnancy risk factors. Eating a balanced diet rich in folate may prevent miscarriages caused by 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 which are a common cause of ectopic pregnancy.

Diagnosed

How is the condition diagnosed?

Diagnosis of vaginal bleeding during pregnancy begins with a medical history and physical exam. The healthcare provider may perform a pelvic examination. This will determine how much bleeding there has been, whether the cervix has opened, and whether tissue from the baby is present in the vagina.
The healthcare provider may order these tests:
  • blood tests to determine the amount of blood loss
  • pregnancy ultrasound
  • progesterone level blood test
  • repeated testing of beta HCG levels, or pregnancy hormone levels

Long Term Effects

What are the long-term effects of the condition?

The long-term effects of vaginal bleeding in pregnancy depend on the cause and severity. Potential effects are as follows:
  • abdominal cramping or pain
  • death of the mother and unborn child
  • the need for blood transfusions
  • the need for surgery
  • premature delivery and the consequences of early delivery
  • problems related to any cancer, such as the need for chemotherapy
  • psychological and emotional problems related to miscarriage
  • Rh sensitization if RhoGAM is not given to a woman who is Rh-negative, which can lead to health problems for the fetus in future pregnancies
  • shock

Other Risks

What are the risks to others?

Vaginal bleeding is not contagious. It poses no risk to anyone except the mother and child.

Treatments

What are the treatments for the condition?

Not all vaginal bleeding in pregnancy needs treatment. If bleeding occurs but a miscarriage or early delivery does not take place, observation is all that is needed.
Treatment for other causes is as follows:
  • blood transfusions in the event of severe blood loss
  • Cesarean birth of the baby
  • D&C to remove retained tissue in the uterus after a miscarriage or molar pregnancy
  • medicines, such as ritodrine (i.e., Yutopar), to stop premature labor
  • methotrexate to treat very small ectopic pregnancies
  • surgery to remove tissue growing in abnormal locations.

Side Effects

What are the side effects of the treatments?

Surgery may cause bleeding, infection, and a reaction to anesthesia. Blood transfusions carry the risk of infection and allergic reactions. All medicines have side effects, such as allergic reactions and stomach upset.

After Treatment

What happens after treatment for the condition?

The aftereffects of vaginal bleeding depend on the underlying cause. Women with bleeding often have pregnancies that continue without further problems. In the event of a miscarriage, a woman may be advised by her healthcare provider to wait 3 to 4 months before attempting another pregnancy.
If premature labor is halted, medicines to relax the uterus may be needed to extend the pregnancy beyond the 36th week. If significant blood loss has occurred, iron and vitamin pills may be recommended to help regain health. Counseling or other supportive therapy might be helpful to relieve distress related to conditions such as miscarriage.

Monitor

How is the condition monitored?

Monitoring depends on the cause of bleeding. In some cases, it may consist of a wait-and-see approach. Repeat pregnancy ultrasounds or blood tests may be used.
Women with molar pregnancies need careful monitoring, as molar pregnancies can recur. When a molar pregnancy comes back, small cells from the placenta can spread to other organs like cancer. Chemotherapy may be needed for a person with recurrent molar pregnancy.
Any additional episodes of vaginal bleeding should be promptly evaluated by the healthcare provider. New or worsening symptoms should be reported to the healthcare provider.

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