Medical

Vaginal Bleeding During Pregnancy

It can be normal to have bleeding at early pregnancy. But if bleeding persists into the 2nd and 3rd trimester, it can indicate underlying conditions. Let’s find out some hidden causes of vaginal bleeding during pregnancy.

By URLife Team

25 Jan 2024

During pregnancy, some women may encounter unexpected vaginal bleeding, an occurrence that can be unsettling. While an initial episode of bleeding might escalate to more severe instances, potentially leading to adverse outcomes, it's crucial to understand that not all instances of bleeding indicate a problem.

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Spotting vs. Bleeding During Pregnancy

Spotting during pregnancy is a common concern that many women face, particularly within the first 12 weeks. Spotting, characterised by the presence of light or trace amounts of pink, red, or dark brown blood, typically differs from a regular menstrual period. The flow is lighter, insufficient to saturate a panty liner. It's noteworthy that the majority of women who experience such spotting go on to have a healthy pregnancy and deliver a healthy baby. Therefore, while alarming, spotting doesn't always signify an underlying issue during pregnancy.

However, there are instances where vaginal bleeding during the 2nd and 3rd trimester can be a sign of complication. According to a 2022 report published in the National Library of Medicine, 1 in 10 women will experience vaginal bleeding during their third trimester of pregnancy. Bleeding is characterised by a more substantial flow of blood, requiring the use of a liner or pad to prevent the blood from staining your clothing.

Common Causes of Early Pregnancy Bleeding

Vaginal bleeding during pregnancy can have various causes, and it's important to note that not all instances indicate a serious problem. Some common reasons for vaginal bleeding during pregnancy include:

In the first trimester

1. Implantation bleeding: Spotting in the early stages of pregnancy is frequently attributed to implantation bleeding, a common occurrence. This phenomenon takes place when the fertilised egg attaches itself to the uterine lining, leading to a few days of light bleeding or spotting. It's important to note that this spotting often occurs before a woman is aware of her pregnancy and is sometimes mistaken for an impending menstrual period. It's crucial to differentiate this from bleeding that occurs after the expected period, as post-menstrual bleeding is more likely associated with early pregnancy in general, rather than implantation.

2. Miscarriage: While bleeding can be indicative of a miscarriage, it does not necessarily imply that a miscarriage may occur. A 2022 research issued in the journal StatPearl suggests that approximately 20-30 per cent of women experience some degree of bleeding in early pregnancy, and about half of these cases do not result in miscarriages. Miscarriages, which occur in about 15-20 per cent of all pregnancies, are most common within the first 12 weeks.

Most miscarriages cannot be prevented, as they often represent the body's natural response to an unhealthy pregnancy that wasn't developing properly. Experiencing a miscarriage does not necessarily indicate an inability to have a future healthy pregnancy, nor does it necessarily reflect on the overall health of the individual.

3. Ectopic pregnancy: Ectopic pregnancies occur when the fertilised egg implants outside the uterus, with the fallopian tube being the most common site for such pregnancies. A 2022 study issued in the Biomedicine Hub points out that while less frequent than miscarriages, ectopic pregnancies are reported in approximately 1 out of 60 pregnancies. Women are at a higher risk of ectopic pregnancies if they have a history of:

An infection in the fallopian tubes
A previous ectopic pregnancy
Previous pelvic surgery

Addressing the signs and risk factors associated with ectopic pregnancies is crucial for ensuring appropriate medical intervention and minimising potential complications.

4. Molar pregnancy: A molar pregnancy occurs when there is an abnormal fertilisation of an egg by sperm. Here, an empty egg is fertilised by a sperm, or a sperm fertilises an egg without any genetic material. As a result, there is no conceivable foetus or normal placental tissue. The abnormal tissue that forms looks like a cluster of grape-like structures. In another situation, two sperm fertilise a normal egg, leading to an abnormal chromosomal makeup. This may result in the presence of foetal tissue, but it is typically not viable.

In 2nd and 3rd trimester

1. Placental abruption: Vaginal bleeding during pregnancy can also be attributed to the placenta detaching from the uterine wall, a condition known as placental abruption. A 2021 report in the Cleveland Clinic shows that placenta abruption occurrence is relatively rare, affecting only 1 per cent of pregnant women, and it typically manifests during the last 12 weeks of pregnancy.
Women at higher risk for placental abruption include those who:

Have already had children
Are age 35 or older
Have a history of previous abruption
Have sickle cell anaemia
Have high blood pressure
Have experienced trauma or injuries to the stomach
Engage in cocaine use

2. Preterm labour: Vaginal bleeding can also serve as a potential indicator of impending labour. In the weeks leading up to labour, the mucus plug, composed of a small amount of mucus and blood, may be discharged. However, if this occurs prematurely, it could be a sign of preterm labour, necessitating immediate consultation with a physician.

3. Placenta previa: Placenta previa is a condition characterised by the placenta positioning itself low in the uterus, partially or completely covering the cervix. It occurs in approximately 1 in 200 pregnancies, and bleeding is a common symptom, usually occurring without associated pain. This is a serious condition that demands immediate medical attention.
Women at a higher risk of developing placenta previa include those who:

Have already had children
Have had a previous caesarean birth
Have undergone other surgeries on the uterus
Are expecting twins or triplets

4. Incompetent cervix: Incompetent cervix, also known as cervical insufficiency, is a condition where the cervix opens (dilates) too early during pregnancy, leading to the risk of premature labour. The cervix is the narrow, tubular structure that connects the uterus to the vagina. Normally, the cervix remains closed and firm throughout most of the pregnancy, providing support to the developing foetus. However, in cases of incompetent cervix, the cervix may start to open prematurely, often without contractions or pain.

Spotting During Pregnancy: Other Causes

There are several non-medical reasons why bleeding may occur during pregnancy:

Sexual Activity: Some women may experience light bleeding after sex. This is often attributed to the cervix being more tender during pregnancy, making it prone to minor bleeding.
Pelvic Exam or Ultrasound: Bleeding can occur after a pelvic exam or transvaginal ultrasound due to the increased sensitivity of the cervix, which is influenced by hormonal changes during pregnancy.
Infections: Certain infections, such as chlamydia, gonorrhoea, or other sexually transmitted infections (STIs), as well as urinary tract infections (UTIs), can lead to light bleeding. It is important to address these infections promptly, and treatment should be provided by a healthcare provider.
Injury or trauma: Trauma or injury to the vaginal area is a potential cause of bleeding during pregnancy. Any external force or injury to the vaginal region can lead to bleeding. This may include accidents, falls, or other forms of physical trauma.

Diagnosis of Bleeding During Early Pregnancy

When experiencing bleeding during pregnancy, your doctor may need some time to accurately determine its cause.

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To assess the situation, you may undergo a series of tests, which could include:

Vaginal examination: This involves checking the size of your uterus and the extent of bleeding. While the examination is brief, it may cause some discomfort.
Blood tests: These tests help determine your blood type and, in some cases, assess the levels of pregnancy hormones in your blood.
Ultrasound scan: A gel is applied to your abdomen, and a hand-held scanner, using sound waves, generates images of the pregnancy. In early pregnancy, a more detailed examination may involve placing a small, slender scanner in the vagina. A full bladder is typically necessary before the scan. The entire ultrasound process usually takes around 15 to 20 minutes.

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It is essential for pregnant women experiencing vaginal bleeding to seek prompt medical attention. Only a healthcare professional can accurately determine the cause and provide appropriate guidance and care based on the individual circumstances. While these reasons for bleeding may be less concerning than some medical conditions, it's crucial to seek guidance from a healthcare professional to rule out any underlying issues. Open communication with your healthcare provider ensures that any concerns are addressed, and appropriate care is provided, contributing to a healthy pregnancy outcome.