All About Bleeding in Early Pregnancy

Pregnancy is a time when lots of changes happen in the body presenting with symptoms hitherto not experienced. While some of these are normal, others may be indicative of a problem that needs medical attention to prevent complications and ensure that the pregnancy carries on till term, and ends with a healthy baby and mother. One of the signs that are seen during pregnancy is bleeding. Bleeding during pregnancy or “Antenatal Bleeding” can be classified either as early pregnancy bleeding or late pregnancy bleeding. Bleeding during pregnancy is the passage of blood from the vagina from the time of conception up until childbirth. In the first trimester, early pregnancy or more specifically up until 12 weeks of pregnancy, bleeding may occur in some but not all women as a normal part of the process of a healthy pregnancy, and this bleeding is mostly seen as spotting or light bleeding. Bleeding in the second trimester, i.e. 12-24 weeks, and in the third trimester i.e. from the 24^th week onwards till childbirth is not normal, and is indicative of an underlying condition that requires medical attention.

What causes bleeding during early pregnancy?

According to the doctors for pregnancy, early pregnancy antenatal bleeding can be caused by a number of factors. The most common causes among them include

• Implantation bleeding – this is considered normal, and it occurs when the fertilized egg implants into the wall of the uterus. It is usually seen as light bleeding or spotting in some women, about 9-14 days after conception. The blood is either light red or pinkish and can be accompanied by mild cramping, and even the flow is light, unlike a normal menstrual period.
• Infections of the genitourinary system – can also cause bleeding in the early antenatal period.
• Problems with the cervix and cervical cancer – the presence of erosions of the cervix or cervical cancer that was not previously diagnosed may also result in bleeding during the early part of pregnancy as the uterus begins to grow in size.
• Polyps – uterine polyps can also be the cause of bleeding during early pregnancy, as the growing uterus with increasing estrogen levels and increased number of blood vessels can result in hemorrhage

There are other more serious causes of bleeding in early pregnancy, and these are usually associated with heavy blood flow, the passage of tissue along with blood, blood clots, severe pain and cramps in the pelvic and abdominal region, fever, chills, dizziness, or fainting.

Conditions that require immediate medical attention and care that can potentially threaten the pregnancy and also cause grave complications in the mother include

• Miscarriage – is the spontaneous loss of pregnancy before 20 weeks of pregnancy and can have a number of causes. It presents with moderate to severe bleeding, passage of tissues and fluid, severe pain and cramping in the pelvic and abdominal region.
• Ectopic pregnancy – a condition in which the fertilized egg does not implant within the uterus, but does so outside the uterus usually in the fallopian tubes. An ectopic pregnancy is not a viable pregnancy, as the growing fetus cannot be accommodated within the fallopian tubes which are not designed to carry a pregnancy to term.
• Molar pregnancy – is a result of an abnormal fertilization of the egg, and a condition in which the cells that grow into the placenta develop in an abnormal fashion resulting in a unviable pregnancy. A molar pregnancy can either be a complete molar pregnancy in which the placental tissue is swollen and with fluid-filled cysts and without the development of fetal tissues, or a partial molar pregnancy in which there is a mix or normal and abnormal placental tissue along with some fetal tissues which cannot survive up until term. This condition can lead to serious complications for the mother and needs immediate treatment. This condition presents with moderate to severe pain, accompanied by brown or red bleeding and the passage of cysts.
• Sub-Chorionic Haemorrhage– a condition in which there is a collection of blood between the wall of the uterus and the outermost layer of the protective covering of the embryo known as the chorion. The blood can leak through the cervix and result in bleeding through the vagina in the first trimester. The condition usually resolves without any intervention if it is small to moderate, but large collections of blood can result in the separation of the attachment between the membrane and the wall of the uterus leading to a condition known as premature rupture of membranes, and loss of pregnancy.

Factors that increase the risk of bleeding in early pregnancy include a history of C-section in the past as well as a history of miscarriages in previous pregnancies.

What are the investigations done when there is bleeding in early pregnancy?

When one consults a gynecologist nearby for bleeding during pregnancy, investigations that are advised would include blood tests such as Complete Blood Picture (CBP) and Erythrocyte Sedimentation Rate (ESR), bleeding time, clotting, time, and prothrombin time to evaluate any problems with clotting or bleeding, Serial Serum HCG and Progesterone levels to assess the overall status of the pregnancy-related hormones as a variation in these can be indicative of an underlying problem or future complications, and Rh Factor testing to exclude RH incompatibility. Imaging tests that are advised include Abdominal and Pelvic Ultrasound tests, and Doppler Sonography to monitor fetal hear sounds. All these tests can help the doctor for pregnancy, diagnose the exact underlying cause for the early antenatal bleeding, and take appropriate measures to address them.

How is bleeding during early pregnancy managed?

The management of early pregnancy bleeding depends on the underlying cause and its severity. Implantation bleeding is considered normal in some women and does not require any specific treatment. Infections if present are treated with antibiotics that do not cross the blood placenta barrier and are therefore safe for the baby as well. Polyps are usually not removed during pregnancy unless cancer is suspected. Other conditions such as a molar pregnancy or an ectopic pregnancy are unviable and will have to be surgically removed to prevent potentially life-threatening complications that may lead to for the mother. Miscarriages in most cases cannot be prevented, and the management of the mother after a miscarriage is extremely important to prevent future complications either immediately afterward or especially related to future pregnancies.

What should be done when there is bleeding during pregnancy?

It is important to consult a gynecologist near you either by booking an appointment with a doctor near you or getting an online consultation with a gynecologist if there is bleeding during early pregnancy while making a note of the type and severity of bleeding, and any other symptoms present.

Women who are pregnant will benefit by making small adjustments to their daily routines and habits. It is always important to eat a healthy diet that is nutritious and well-balanced so that the additional calories (about 350 extra) are addressed along with getting the required quantities of vitamins, minerals, and other essential nutrients. It is advisable to get regular exercise to prevent excessive weight gain, as permitted by the consulting gynecologist. It is important to avoid smoking, consumption of alcohol, and recreational drugs as these can have a bad impact on the pregnancy. It may also be advisable to reduce the intake of caffeine, although it doesn’t have to be totally avoided.

Getting regular antenatal check-ups, keeping any pre-existing medical conditions such as diabetes, and hypertension under control, and taking all the prescribed medications and prenatal vitamins will also ensure a trouble-free healthy pregnancy and a healthy mother and child.

While bleeding during early pregnancy especially if it is light or just seen as spotting may not be a cause for concern, it is nevertheless important to consult a gynecologist to ensure that there is nothing to worry about. Bleeding that happens after 20 weeks of pregnancy, however, is a cause for concern and is indicative of something that needs immediate medical attention and care.