Pregnancy BLEEDING - an overview

Roughly 1 out of 4 women will experience vaginal bleeding during their pregnancies; it is particularly common but doesn't necessarily mean that there is a problem. Many blood vessels are being formed with the growth of the placenta that an occasional tiny vessel breaks and you start to spot or bleed a little. While bleeding should not be trivialized, 90% of such pregnancies go on to become a success. A good way to tell if the pregnancy is safe is by the amount of pain associated with the bleeding. A small amount of painless vaginal bleeding during pregnancy doesn't amount to much but should the bleeding be heavy, accompanied with cramps and backache you should contact your doctor right away. That is to say slight bleeding in early pregnancy which is painless, brief and the blood is red or pinkish with no fragments of tissue is nonworrisome.

Vaginal Bleeding in the first 12 weeks.

• Having said that, any amount of bleeding should not be taken lightly.
• Your doctor will carry out various examinations to determine the cause of the bleeding. These tests include a pelvic examination, an ultrasound or a blood test to measure the level of the pregnancy hormone, HCG.
• In the case of a 'safe' pregnancy, bleeding ceases and the woman goes on to have a pregnancy without any problems.
• However, a small number of women go on to experience slight bleeding on and off throughout the pregnancy duration for no apparent reason.

Implantation Bleed This is when a small amount of vaginal bleeding occurs for 1-2 days as the fertilized egg implants itself into the uterine wall 2-4 weeks after conception. Some women experience this mild bleeding which is a natural process and nothing to be too worried about. Women with irregular periods can mistake this bleeding for their periods

Hormonal Bleed This is a light period-like bleed which happens around a month or two of pregnancy just when your next period is due. This is one reason why women don't even know they are pregnant. The developing placenta produces hormones that suppresses periods. The hormone levels are not high enough in the initial weeks to completely prevent the onset of a period. What happens next is slight and brief bleeding.

Intercourse Bleed Spotting can also occur after intercourse but it is harmless. This is happens due to the increased blood supply to the cervix causing it to become softer and more delicate. This may cause the occasional bleeding or spotting. Known as cervical ectropion, this condition is not a concern unless an infection is suspected. The blood vessels at the tip of the cervix breaks, a harmless but scary sight. Deep penetration should be avoided to prevent the incidence. To allay your fears your doctor will check to see if the bleeding is coming from the congested vessels lining the vagina/cervix or the uterus (which is a cause of concern).

Bleeding after 12 Weeks

• As pregnancy progresses, the level of HCG or human
• Vaginal Bleeding after 12 Weeks
• As pregnancy progresses, the level of HCG or human chorionic gonadotropin increases so much so that more tests need to be arranged.
• Bleeding between weeks 12 and 24 is much less common than in the first trimester. Later miscarriages - after week 20 are largely due to placental problems or some abnormality in the uterus.
• Bleeding after week 24 should always be taken seriously.
• In some instances when the bleeding is light especially after intercourse or an internal examination, the cause for concern lowers unless there is some pain.
• A woman with rhesus negative blood needs to be dosed with anti-D immunoglobulin to protect against the formation of antibodies against the fetal blood in case of bleeding.

Marginal Placental Bleed The bleeding is usually painless and happens because of a rupture in one of the small blood vessels at the edge of the placenta. Usually the bleeding subsides quickly but in some cases it can form a clot near the cervix and lead to a small brownish vaginal discharge for a few days. This can be painful because of the mild contractions that results. Bed rest and care prescribed by the doctor takes of things.

Placenta Previa Low lying placenta which either fully or partially covers the cervix causes some bleeding to occur. The placenta which is not attached to the uterus is more likely to bleed from one or more of the blood vessels across the placental surface. It is usually discovered during the routine 20 week scan; in most instances the placenta tends to move up so that it no longer blocks the cervix. However in about 1 percent cases it doesn't shift. Placenta previa is more common with women who have had more than one child, who have had c-sections and who are having multiple pregnancies. The bleeding though painless can be quite heavy.

Placental Accreta This is a rare complication in which the placenta grows into the deeper layers of the uterus and firmly attaches itself. Of the three variations, accreta is the most common. Once again the condition is more probable in women who have had previous c-sections or have scarring from uterine surgery. Acrreta remains symptomless until the final stage of labor when the placenta is not able to dislodge from the uterine wall. Treatment involves surgical removal of the placenta.

Placenta Abruption This is when the placenta separates itself from the uterus. Bleeding here is painful but the cramps are not extreme if only a small portion of the placenta gets dislodged. Bleeding can be heavy with clots. Concealed abruption is especially dangerous but fortunately rare. Here the middle portion of the placenta separates with a large blood clot developing between the placental surface and the uterine wall. Feeling faint and severe pain is experienced. The blood lost collects behind the back of the placenta and remains there and therefore doesn't drain out. Medical treatment is essential and immediate delivery of baby is imminent.

Uterine Rupture Sometimes the uterus can tear or rupture during pregnancy and labor. Scarring from a previous cesarean or uterine surgery can weaken the uterine wall. Abnormalities to the placenta such as previa or accreta can also increase the chances of uterine rupture. What usually follows is a sharp pain accompanied by the feeling of something tearing inside and then some vaginal bleeding. When a rupture occurs, c-section should be immediately performed and the uterus should be surgically repaired.