Bleeding in Pregnancy

Any bleeding during pregnancy can cause anxiety or fear if you are expecting, however early bleeding doesn’t always mean you could be experiencing a miscarriage. Bleeding is more common than you may think. Some literature state the overall incidence of bleeding as 19%. While you should report all bleeding to your LMC, below is an explanation of some of the more common reasons for bleeding during pregnancy. The most likely time bleeding can occur is in the first trimester.

Implantation Bleeding

When your fertilised egg attaches to your uterus lining, this can cause light spotting or streaking (streaks of blood) at about 6-7 days. Usually this will last a day or two and you may think this is normal but short menstruation, however do mention it to your LMC. Implantation bleeding is usually brighter coloured blood and may be pink in colour.

Breakthrough Bleeding

Some women experience what is known as “breakthrough” bleeding around the time when your period would have normally been due. When pregnant, hormones prevent your period from occurring. Sometimes the hormone levels are not yet high enough to stop your period and therefore you have breakthrough bleeding. The break through bleeding can last for around three months – after this time the placenta begins to take over hormone production from your ovaries. Some women may experience breakthrough bleeding right through their pregnancy and have healthy babies, however will be closely monitored by their LMC. The LMC may discuss with you the need for consultation if bleeding persists.

Bleeding From The Placenta

This is a common cause of early bleeding. If the bleeding occurs for more than 1-2 days, is heavy or happens more than once, it should be checked out by your LMC.

Threatened or Actual Miscarriage

Literature on miscarriage indicate that around one third of pregnancies end in miscarriage - this figures also include very early miscarriages that occur before you even realise that you are pregnant. Common signs of miscarriage include:

• bleeding (being most common)
• abdominal cramps
• stomach pains.

"Missed miscarriage" is when you miscarry without any bleeding. This is often picked up during ultrasound.

Ectopic Pregnancy

An ectopic pregnancy occurs when your fertilised egg implants outside of the uterus. In 95% of cases the site of implantation is the fallopian tube. You may experience severe pain down one side of your abdomen and you may feel faint. This is an emergency situation as an ectopic pregnancy can rupture the fallopian tube and cause internal bleeding. Your fallopian tube may need to be removed along with the pregnancy but this does not mean you will have trouble conceiving in future as you will still have your other ovary and fallopian tube.

Actions to take if you experience bleeding during pregnancy

• Do not use tampons if you are bleeding or anytime during pregnancy, always use pads.
• If the bleeding is light and you have no pain, in the first instance, contact your LMC to discuss the next step. If you do not have an LMC contact your GP.
• If the bleeding is heavy and is accompanied with stomach cramps / pains, contact your LMC immediately. If you do not have an LMC contact your GP or go to an emergency department of your local hospital. Though this is understandably an upsetting time, try to remain as calm as you can.

If you are over 20 weeks of pregnancy seek advice from your LMC immediately. Some common causes of bleeding in mid to late pregnancy include:

• placenta praevia occurs in about 0.5% to 1% of pregnancies at full term. This is caused from the placenta implanting itself at the bottom of your uterus and can partially or completely block the cervix. This condition requires a Caesarean Section if it remains over the cervix in the remaining weeks of pregnancy to prevent your baby being put at risk.
• placental abruption occurs in approximately 1% of all deliveries. In placental abruption the placenta is normally situated but partially or completely separates from the uterus. Symptoms can include severe pain and heavy bleeding. If you have high blood pressure or pre-eclampsia, you are more at risk of placental abruption. It requires admission to hospital and depending on the severity of the bleeding, you may either be advised to rest, be induced or have a Caesarian Section.