Last updated: May 27, 2021
Candice Fraser M.D.
Obstetrics & Gynaecology
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Natalie had two normal pregnancies but was thrown for a loop when she experienced bleeding early in her third pregnancy. She knew bleeding in early pregnancy can be common, but she felt something was different.
“With two little kids at home the thought of making an appointment for a little bit of blood seemed overwhelming. I was exhauseted and worried. I found Your Doctors Online whille searching online and downloaded the app. I was able to speak to a doctor and explain what I was experiencing.”
While occaisional spotting during the first trimester is common, bright red blood can indicate a more serious problem. In Natalie’s case she was directed to her nearest hospital where she was ordered on bed rest for a tear in her placenta.
“Being on bedrest with small children is not an easy task. Having Your Doctors Online at my fingertips for any new symptom or worry was a godsend.”
While Natalie had the support of a doctor in her pocket, her pregnancy was high-risk and ended with an emergency c-section after a placental abruption.
“It was a very scary nine months,” she said.
What Causes Bleeding in Early Pregnancy?
While the sight of blood during pregnancy is a scary sight for any expecting mother, it is common. Bleeding during the first trimester can occur in up to 15 to 25% of pregnancies. Although vaginal bleeding is often not a sign of a serious issue, it is important to check-in with your healthcare provider if you experience any amount of vaginal bleeding when pregnant.
Implantation bleeding: Implantation bleeding can be mistaken for a light menstrual period. This is often because it occurs about 10 to 14 days after ovulation, which is when most women expect their menstrual period. Implantation bleeding is believed to be caused when the fertilized egg attaches itself to the lining of the uterus.
Changes to the Cervix: While sex does not increase the risk of miscarriage in a normal pregnancy, it can cause vaginal bleeding. This is due to the changes that the cervix undergoes during pregnancy. During pregnancy the cervix moves to a higher position in the vagina. Blood flow increases and causes the texture to soften and become more sensitive. This senstivity can cause the cervix to bleed after sex during pregnancy.
Infection: Experiencing vaginal bleeding during pregnancy can be a sign of an infection. Certain infections cause irritation to the cervix which can cause irritation or inflammation and bleeding. These infections include:
- Yeast infections
- Bacterial Vaginosis
An Ectopic Pregnancy: In a typical pregnancy, a fertilized egg will implant itself in the uterus. In an ectopic pregnancy, the egg will implant itself elsewhere, usually in the fallopean tube. If the egg is left to grow in the fallopean tube it can cause it to rupture, which can be fatal.
Placenta Previa: This condition occurs when the placenta (an organ that forms to provide oxygen and nutrients from the mother to her developing baby during pregnancy) implants at the bottom of the uterus and partially or completely covers the cervix.
Subchorionic hematoma: This condition occurs when blood forms between the placenta and the uterus. This condition, also known as subchorionic bleeding,may lead to light spotting or it may cause no symptoms. This condition often occurs during the first trimester and can be diagnosed during routine ultrasound. It typically resolves on its own without the need for any medical or surgical intervention.
What is Placental Abruption?
Placental abruption (abruptio placentae) is a serious condition that commonly occurs around 25 weeks of pregnancy in roughly 1% of pregnancies. It occurs when the placenta detaches partially or fully from the inner wall of the uterus before the time of delivery.
This is extremely dangerous as the placenta is responsible for providing oxygen and nutrients from the bloodstream of the pregnant mother to her developing baby. Placental abruption can cause heavy bleeding and is dangerous for both mother and baby if left untreated. .
Symptoms of Placental Abruption
Placental abruption commonly occurs in the last trimester of pregnancy, especially in those last few weeks before birth. The signs and symptoms to be aware of for this condition include:
- Pain in the back and abdomen
- Vaginal bleeding-although this will not always be present
- Uterine contractions coming one after the other
- Uterus feels tender or rigid
Many women report a quick onset of back and abdominal pain. While bleeding is often present, the amount can vary greatly. This is because in some cases the blood can become trapped inside the uterus. The amount of blood loss does not always coincide with the amount the uterus has seperated from the placenta.
While symptoms often have a quick onset, placental abruption can also develop slowly and cause light and intermittant bleeding. In these cases it can cause complications such as slow growth or low levels of amniotic fluid.
What Causes Placental Abruption?
The official cause of placental abruption is unknown, although trauma or injury to the abdomen or the rapid loss of amniotic fluid are cited as possible causes.
Factors that can increase the risk of placental abruption include:
- A trauma or injury to the abdomen
- Hypertension-related problems during pregnancy, including preeclampsia, HELLP syndrome or eclampsia
- A history of placental abruption in pregnancy that was not caused by an injury to the abdomen
- Chronic high blood pressure (hypertension)
- Premature rupture of the membranes during pregnancy
- Cocaine use during pregnancy
- Infection inside of the uterus during pregnancy (chorioamnionitis)
- Being older, especially older than 40
Placental abruption is a serious condition that can cause life-threatening problems for both mother and baby.
For the mother, placental abruption can lead to:
- Extreme blood loss requiring a transfusion Shock due to blood loss
- Blood clotting problems
- Failure of major organs such as the kidneys as a result of blood loss
- Rarely, the need for hysterectomy, if uterine bleeding can’t be controlled
For the baby, placental abruption can lead to:
- Lack of oxygen to baby
- Premature birth
- Restricted growth during pregnancy
The best prevention is to speak to your healthcare provider about the best practices to lower your risk. Some of these could include:
- Practice good self-care during pregnancy, such as wearing your seatbelt and avoiding activities that could put you at risk for trauma to your abdomen.
- Avoid smoking or using cocaine
- Monitor your blood pressure regularly as directed by your doctor.
Read next: Your Doctors Online helped me start my labor
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Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Candice Fraser M.D.
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