It can be frightening if you start bleeding during pregnancy. However, blood loss doesn’t always mean you could be experiencing a miscarriage. Bleeding during pregnancy, especially during the first trimester, is more common than you might think.
According to a study, around 25% of participants reported bleeding during pregnancy, and 8% of women reported heavy bleeding. Most incidences occurred between weeks five and eight, and in most cases, lasted no more that than three days. Of the women who experienced bleeding, 12% had a miscarriage, compared with 13% of women who did not bleed. While most women will have one incidence of bleeding, a small number of women will bleed throughout their pregnancy. It can take the form of spotting, streaking, or period-like blood loss. Bleeding During Pregnancy Here is everything you need to know about bleeding during pregnancy. Do I Need To Tell My Doctor Or Midwife About Any Blood Loss? Yes.
All bleeding during pregnancy should be reported to your doctor or midwife. Any passage of blood from the vagina before 24 weeks of pregnancy is termed a threatened miscarriage or threatened abortion. After 24 weeks it’s termed as an ante-partum haemorrhage. You especially need to see a doctor or midwife within 72 hours of any bleeding if you have a rhesus negative blood group (e.g. O-, A-). The reason for this is to check whether there has been a possible mixing of your baby’s blood with yours. If the blood has been mixed, it may cause your body to produce antibodies against positive blood. A positive blood group is more dominant than a negative blood group. It’s most likely your baby will inherit a positive blood group, although you won’t know this before the birth.
The blood mixing doesn’t have any bearing on your first pregnancy. But for subsequent pregnancies, if you have another baby with positive blood, your antibodies would attack what it thinks is foreign matter. See our article on rhesus negative blood groups during pregnancy for more information. Below is an explanation of some of the more common reasons for bleeding during pregnancy. As you will read, it’s not always sinister. It’s possible to experience mild cramping or stretching sensations during a healthy pregnancy. But if there is bleeding accompanied by strong cramping, speak to your doctor or midwife as soon as possible.
#1: Implantation Bleeding or Streaking When a fertilised egg attaches to the uterine lining, it can result in light spotting or streaking (streaks of blood). Usually it lasts only a day or two and occurs around the time of implantation or when your period would have been due. Some women mistakenly think they have simply had a light period and don’t realise they are pregnant.
#2: Breakthrough Bleeding Some women experience what is known as ‘breakthrough bleeding’, during the times when a period would have normally been due. Therefore bleeding would appear at around 4, 8 and 12 weeks of pregnancy. It’s often accompanied by the feeling you would normally associate with your period being imminent, i.e. backache, cramps, a heavy sensation in the pelvis, feeling bloated and ‘off’. Of course, because you are actually pregnant, your period doesn’t arrive (even though you feel like it will). During pregnancy, hormones prevent your period from occurring. Sometimes, if the hormone levels are not yet high enough to stop your period, the result is breakthrough bleeding. It can last for about three months; after this time the placenta begins to take over hormone production from the ovaries. Some women experience breakthrough bleeding throughout the pregnancy, and under the close watch of their carer, have healthy babies.
#3: Threatened or Actual Miscarriage Studies indicate that around one third of pregnancies end in miscarriage (the medical term is spontaneous abortion). That sounds like a huge number, but don’t despair. It refers to the first 12 weeks of pregnancy, and includes very early miscarriages which occur before a woman even realises she is pregnant. A miscarriage of this kind is often a result of a damaged fetus; it means a woman’s body is rejecting a pregnancy that is unable to survive its complications. Once you have reached the 14-16 week mark, you can be fairly sure your pregnancy is safe. It’s probably not such a bad idea to refrain from telling the world you are pregnant until you reach the 12 week mark. Although you might be bursting to share your wonderful news, it can be very distressing to have to break the news that you have lost the pregnancy. Sympathy is often comforting, but sometimes it can be overwhelming when you are grieving for lost dreams. Common signs of miscarriage include bleeding (most common), cramping, backache and stomach pains. Women commonly say that they no longer ‘feel pregnant’ when they have miscarried and are bleeding. The signs of pregnancy disappear – no more nausea, sore breasts or bloated tummy. If you are bleeding and feel this way, then chances are you have lost the baby. If you’re bleeding but still feel pregnant, the chances are very good that the bleeding is just a scare and your baby is fine. An ultrasound will usually be reassuringly normal. It is possible to miscarry without any bleeding. This is known as a ‘missed abortion’, where the fetus dies but is retained by your body. The signs of pregnancy would definitely have disappeared if that happened, but the absence of a heartbeat would only be detected using ultrasound. You might need a curette to clear out the uterus. For more information, see our article, Miscarriages – Saying Goodbye Before You’ve Said Hello.
#4: Bleeding After Sex Bleeding after sex is one of the most common causes of bleeding during pregnancy. It’s completely harmless and is caused by increased blood supply and softening of the cervix. Although this form of bleeding is not serious, you should always report it to your carer. When you phone the maternity ward, be prepared for the very personal question, “Have you recently had sex?” You don’t need to stop having sex, but you might need to reassure your partner that he hasn’t hurt the baby, who is safely protected in your uterus, well above the vagina. Also see our article on Bleeding After Sex During Pregnancy.
#5: Ectopic Pregnancy An ectopic pregnancy occurs when your fertilised egg implants itself outside the uterus, usually in a fallopian tube. You might experience severe pain down one side of your abdomen, or generalised pain which doubles you over, and you might feel faint and nauseous. The pain can disappear suddenly if the tube ruptures but it will return within hours or days and you will feel really unwell. This is an emergency situation. An ectopic pregnancy can rupture the fallopian tube and cause internal bleeding, damage to the tube and maternal collapse. Your fallopian tube might have to be removed, along with the pregnancy, but it does not mean you will have trouble conceiving in future, provided your other ovary and fallopian tube are healthy. For more information, read our article on Ectopic Pregnancy.
#6: Bleeding From The Placenta Another question you may be asked if you phone your healthcare provider is: “Have you had a scan, and was the placenta situated normally?” Painless vaginal bleeding can result from an abnormally placed placenta. Sometimes the placenta implants itself very low down on the uterine wall, and occasionally right over the cervix. This is called placenta praevia and it occurs in about 0.5% of pregnancies. Placenta praevia will inevitably result in bleeding at some point in your pregnancy – usually after the 20 week mark. There are differing degrees of severity of this condition, but they all require repeat ultrasounds for an accurate diagnosis. To prevent risk to your baby, the condition might require bed rest, an induction or c-section if the placenta remains over the cervix in the remaining weeks of pregnancy. Another cause of bleeding later in pregnancy is placental abruption, where the placenta partially or completely separates from the wall of the uterus. It occurs in approximately 1 in 200 pregnancies. Symptoms include generalised severe pain and heavy bleeding. The blood might be visible or concealed in the uterus, which will be tense, tight, hard to the touch and very painful. If you smoke, or have high blood pressure, kidney problems or pre-eclampsia, you are more at risk. The condition requires urgent admission to hospital, and depending on the severity of the bleeding, you might be prescribed bed rest, an induction or a c-section. Find out more about low-lying placenta and placenta praevia.
#7: Uterine Fibroids Uterine fibroids are masses of compacted muscle and fibrous tissue, which can be found inside or outside the uterine wall. They can be either problematic or unproblematic during pregnancy — it mainly depends on the location of the fibroids and if they grow or not. Experts aren’t sure why, but pregnancy hormones can cause fibroids to either shrink or grow. Fibroids are best removed prior to a pregnancy, because worst case, they can cause ectopic pregnancy, heavy bleeding and pregnancy loss. However, many women are able to give birth without any problems too. If you have fibroids, it’s important to see a specialist to manage your individual case and suggest what to do next. Avoid cures found on the internet – you really need to see a specialist to receive a proper assessment of the situation. Read more about fibroids during pregnancy.
Remember, in most cases, bleeding in early pregnancy settles spontaneously and the pregnancy continues unharmed. Have you experienced bleeding during pregnancy?