BLEEDING during PREGNANCY – Causes

Bleeding during early pregnancy

About 20% of pregnant women could have bleeding during early pregnancy – during first 12 weeks of pregnancy. Possible causes of first trimester bleeding include:

Implantation Bleeding
Some pregnant women could have implantation bleeding during early pregnancy. Pregnant woman can experience some spotting within 6-12 days after conception as the fertilized egg implants itself in the lining of the uterus. Implantation bleeding or spotting is light bleeding and lasts from a few hours to a few days. Some women don't realize they are pregnant because they mistake this bleeding for a light period - because of that timing, implantation bleeding can sometimes be confused with a menstrual period.
In case of implantation bleeding often doctors will check HCG levels to see how far along you are in pregnancy. HCG levels should double approximately every two days. Your doctor may check your levels more than once to see that they are rising appropriately. Low HCG levels can indicate a miscarriage or ectopic pregnancy. It is important to let your doctor know if you have any spotting or bleeding no matter how light it might be.

Decidual Bleeding
Decidual bleeding is a type of light bleeding that can occur at intervals in early pregnancy around the times that a woman would have expected her menstrual period. Decidual bleeding is not a true menstrual period, but it is the most common reason why some women who report having had "periods" during pregnancy.

Cervical bleeding - Increased Cervical Sensitivity
From first days of pregnancy dramatic hormonal changes are happening in women body. Blood flow to the cervix increases as a result of the hormonal changes of pregnancy and this can trigger bleeding or lead to brief spotting after sex or after vaginal examinations and pap smears. This type of bleeding isn't cause for concern.

Ectopic pregnancy.
Light bleeding in early pregnancy can be a warning sign of ectopic pregnancy, even though you might not have other ectopic pregnancy symptoms yet. Ectopic pregnancy is pretty rare – about 1% of all pregnancies. Ectopic pregnancy occurs when the fertilized egg attaches somewhere outside the uterus - usually in the fallopian tube. The symptoms of ectopic pregnancy are spotting, strong cramps and/or pain in the lower abdominal area, usually on one side. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life-threatening to the mother.
In these cases your doctor would perform an ultrasound or order HCG testing to check for an ectopic pregnancy. HCG levels may rise during an ectopic pregnancy but not rise appropriately.

Miscarriage.
Unfortunately the miscarriage is common and frequent explanation for early pregnancy bleeding - it tends to be one of the biggest concerns with first trimester bleeding. Miscarriage is the loss of a pregnancy before the twentieth week of pregnancy. About half of women who bleed in pregnancy eventually miscarry, but that doesn't necessarily mean that if you're bleeding you've lost the baby, especially if you don't have any other symptoms. In general, about 20% of all pregnancies end in miscarriage. There are many causes for miscarriage including chromosomal abnormalities, uterine anomalies, infection or placental circulation. Miscarriage symptoms include spotting or bleeding (tissue passing through the vagina) and strong cramps in the lower abdomen.
Threatened miscarriage is a nonspecific term for when you have bleeding during pregnancy, but your cervix is still closed and there is no clear evidence that you are having a miscarriage (such as falling hCG levels). A threatened miscarriage can ultimately go on to be a viable pregnancy or may end in miscarriage.
If you are concerned that you are miscarrying call your doctor right away. Your doctor will perform an ultrasound - if during the ultrasound the doctor sees a heartbeat, your chances of miscarriage are not high. If you have an ultrasound between seven and eleven weeks of pregnancy and a heartbeat is seen, your chances of miscarrying are less than 10%.

Infections
Bleeding or spotting can sometimes be a symptom of bacterial infections of the vagina or cervix. Any infection of the cervix, vagina and/or any of sexually transmitted diseases/infections (such as Chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester of pregnancy. Usually all possible vaginal and/or cervical infections should be treated before getting pregnant. If it was not done before pregnancy, it is very important to treat these infections during early stages of pregnancy, since there's evidence that some infections might increase the risk of second-trimester miscarriage or premature delivery.

Molar pregnancy (also called Gestational Trophoblastic Disease).
This is a very rare and dangerous condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue can be cancerous and can spread to other parts of the body. Other symptoms of molar pregnancy are:

• morning sickness,
•  severe nausea and vomiting,
•  rapid enlargement of the uterus- uterus that is larger than normal,
• vaginal discharge of tissue that is shaped like grapes (typical for molar pregnancy),
• increased level of Human Chorionic Gonadotrophin (hCG) – even higher than expected.

Bleeding during late pregnancy

There are several causes for bleeding during late pregnancy. Bleeding during late pregnancy can be a sign of problems with the placenta such as placenta previa or placental abruption. It could also be a sign of a late miscarriage if you are in your second trimester or preterm labor.
Abnormal bleeding during late pregnancy could be pretty serious – it could be the alarm for problems for mother and/or baby. Possible causes of late pregnancy bleeding include:

Placenta previa.
Placenta previa occurs when the placenta lies low in the uterus. This condition occurs when the placenta sits low in the uterus and partially or completely covers cervix - the opening of the birth canal. Placenta previa is diagnosed by ultrasound. A low-lying placenta will often correct itself during pregnancy. As the pregnancy progresses the attachment site may rise away from the cervix. Placenta previa is one of the most common causes for bleeding in the third trimester of pregnancy. Bleeding from placenta previa can often occur without any pain.
Although placenta previa is very rare, occurring in only one in 200 pregnancies, it is an emergency requiring immediate medical attention. If bleeding is severe an immediate cesarean could be required to stop the bleeding and to save the mother's life.

Placental abruption.
In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labor and blood pools between the placenta and uterus. Placental abruption is when the placenta separates from the uterus. Sometimes a partial separation occurs and sometimes it will separate completely. Placental abruption can be very dangerous to both the mother and baby - this is an emergency situation and can result in the death of the baby or the mother. Symptoms include vaginal bleeding (clots from the vagina), abdominal pain and tenderness, continuous uterine contraction and back pain.

Uterine rupture.
In very rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section. In most cases women have internal abdominal bleeding. Other symptoms of uterine rupture are pain and tenderness in the abdomen.

Vasa previa.
In this very rare condition, the developing baby's blood vessels in the umbilical cord or placenta cross the opening to the birth canal. Vasa previa can be very dangerous to the baby because the blood vessels can tear open, causing the baby to bleed severely and lose oxygen.
Other symptoms of vasa previa include abnormal fetal heart rate and excessive bleeding.

Subchorionic Hematoma
A subchorionic hematoma is bleeding under the placenta. Subchorionic hematoma can sometimes end in miscarriage, but most often the bleeding goes away over time.

Vanishing Twin
Pregnant women could have bleeding during pregnancy because of so called “Vanishing twin” – it is the term for a twin pregnancy in which one of the two babies is miscarried while the other remains viable.

Premature labor.
Vaginal bleeding late in pregnancy may just be a sign that your body is getting ready to deliver. A few days or weeks before labor begins, the mucus plug that covers the opening of the uterus will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as "bloody show"). If bleeding and symptoms of labor begin before the 37th week of pregnancy, contact your doctor right away because you might be in preterm labor.
Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and ache in the lower back.

Normal Labor.
Bleeding can also occur due to labor.  If you are approaching your due date and notice a small amount of bleeding, this could be an indication that you are going into labor. Contact your doctor as soon as possible and be ready for happy delivery.

Additional causes of bleeding in late pregnancy are:

• Injury to the cervix or vagina
• Polyps
• Cancer

Bleeding During Pregnancy – What to Do?

Vaginal bleeding during pregnancy at any trimester can be a sign of a problem. Your doctor should be immediately informed. While you are expecting your doctor or emergency services, wear a pad so that you can keep track of how much you're bleeding, and record the type of blood (for example, pink, brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for testing. Don't use a tampon or have sex while you are still bleeding.

Emergency medical; services would be needed if you are experiencing any of the following symptoms, which could be signs of a miscarriage or other serious problem:

• Severe pain or intense cramps low in the abdomen,
• Severe bleeding, whether or not there is pain,
• Discharge from the vagina that contains tissue,
• Dizziness or fainting,

A fever of more than 100.5 degrees Fahrenheit and/or chills.