Wednesday, September 3, 2014

Causes of Vaginal Bleeding During Pregnancy



Is it possible to have periods during pregnancy...

 This may sound exceptional or surprising to you, but the answer is yes! When the body starts to produce human chorionic gonadotropin (HCG) during pregnancy, there is no question of menstrual bleeding. The terrifying problem for some women is period or unexpected bleeding during pregnancy.
Menstrual bleeding can be simply defined as the blood loss which occurs at the end of an ovulatory cycle, as a result of an egg not being fertilized by a sperm. During this cycle, your body discharges hormones that send signals to your reproductive organs to execute certain actions. If your body is still constant to have regular menstrual periods even in your pregnancy then it would be shedding the uterine lining, which is useful to nourish your baby every month.
Hence, the spotting or hemorrhage is experienced by 25-30 % of women during their pregnancy is nothing but vaginal bleeding. Implantation bleeding takes place during the first trimester, this happens because the embryo implants itself on the wall of the uterus or womb. Spotting or implantation bleeding is normal and a good sign to show that you are pregnant. However, if you have normal periods during pregnancy with lower abdominal pain it is a cause of concern.
Bleeding is particularly common in the first trimester. Although fewer women hemorrhage during the second and third trimesters, spotting can still occur. Even though this bleeding may look like menstruation but that’s not true.

Causes of Vaginal Bleeding or Periods During Pregnancy:

  Vaginal bleeding or spotting happens during the first 12 weeks of pregnancy. This is a sign of miscarriage and ectopic pregnancy. However, all pregnant women won’t face miscarriage because they had vaginal bleeding in the first few weeks of pregnancy.

Light bleeding during the first half of pregnancy is unlikely to harm your baby. The causes of light bleeding can be due to:
  • Breakthrough bleeding: This type of bleeding occurs when the female reproductive hormones like estrogen and progesterone covers the normal menstrual cycle. Breakthrough bleeding happens for a while and you will experience it more than once.
  • Implantation bleeding:This bleeding is common and it happens when the fertilized egg implants in the uterus or womb.
  • Vaginal or cervical infection:The area around the cervix becomes soft and injury can be caused by chafing or erosion during sex. The bleeding can be caused due to infection or a harmless growth of polyp.
Your doctor will advise you to visit an early pregnancy assessment unit (EPAU) in the hospital to find out the root cause behind the abnormal bleeding. The staff at EPAU will take a blood test to check the levels of pregnancy hormones. They will also do a physical examination to check whether the cervix is closed. The doctor will do an ultrasound scan and check the baby’s heartbeat via ultrasound.
Doctors treat early pregnancy bleeding as threatened miscarriage, but this doesn’t mean that you will miscarry. If you experience heavy bleeding, clots and period like cramps then it is a sure sign of miscarriage. Most women who suffer from bleeding during early pregnancy have complications during the later stages of pregnancy, but this is not applicable for all pregnant women who have bleeding during early pregnancy, but they go on to have healthy babies.
Should you inform your doctor about spotting? The answer is definitely yes. Though spotting is normal during early pregnancy, it is a good idea to visit your doctor. He will do an ultrasound scan to check whether your pregnancy is normal. Sometimes, spotting can be a sign of ectopic pregnancy, so it is better to do a thorough check. Since, untreated ectopic pregnancy can be life threatening for both mother and the baby.
It is most common to observe periods or spotting during first month of pregnancy. Here, are the most common reasons for first-trimester spotting or bleeding. If you are experiencing bleeding, please visit your gynecologist- he can help you with the best way to cure the problem.
Here we have prepared 22 causes of vaginal bleeding experienced during pregnancy for your help:

1. Decidual Bleeding:

This is one of the most common forms of period-like bleeding during pregnancy and is known as decidual bleeding. Occasionally, during pregnancy your body’s hormones can get out of their ‘normalcy’, causing you to misplace parts of the lining of your uterus. This is exclusively common in the initial stages of pregnancy, while the lining is totally closed to the placenta. But, it has been observed that normally it is not harmful to you or your baby as it is treatable.

2. Hormonal Changes:

You may experience slight bleeding throughout the entire pregnancy period just like a normal period; however, this is not a normal period. The bleeding that you are experiencing may be due to hormonal changes that take place when your body is getting used to the pregnancy.

3. Implantation Bleeding:

This bleeding occurs while the fertilized egg attaches itself to the wall of the uterus. This bleeding is very slight and only remains for about 5-10 days after conception. This type of pregnancy bleeding occurs 2-5 days after the conception and it is due to this timing that implantation bleeding can sometimes be confused with a menstrual period.

4. Increased Cervical Sensitivity:

Blood flow to the cervix rises due to the hormonal changes during pregnancy and this can lead to short-lived spotting after intercourse or after pap smears and vaginal examinations.

5. Ectopic Pregnancy:

Bleeding is also an indication of some pregnancy complications like ectopic pregnancy or a life threatening miscarriage. This may occur after a pap smear or a vaginal exam and usually happens due to an increase in the amount of blood which directly goes to the cervix.

6. Infections:

 

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An infection in the vagina or cervix may lead to bleeding or spotting. These are specifically essential to be diagnosed during pregnancy, because they may boost your risk of second-trimester preterm birth or miscarriages.
The infections can happen due to sexually transmitted disease like chlamydia, gonorrhea and herpes and can cause vaginal bleeding during the first trimester. Consult your doctor immediately if you have any of these infections and take the prescribed medications to resolve it.

7. Threatened Miscarriage:

When you have experience menstrual bleeding and your cervix is still closed, there are no chances of miscarriage or fall in the HCG level. Therefore, the threatening miscarriage is a nonspecific term. A threatened miscarriage can eventually go on to be a practical pregnancy or may end in miscarriage.

8. Vanishing Twin:

Due to period during pregnancy, you may experience vanishing twin syndrome, which is basically said to occur when in a twin pregnancy, one of the two babies is miscarried whereas the other remains viable.

9. Miscarriage:

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If a pregnancy ends before the 24th week it is commonly termed miscarriage. Miscarriages are quite common in the first three months of pregnancy and most pregnancies get terminated by spontaneous abortions which happen naturally.
Some miscarriages during early pregnancy can occur before 14 weeks. This shows that there is something wrong with the baby. The other cause of miscarriage can be hormone and other blood clotting problem. The miscarriages that take place in the first twelve weeks or three months of pregnancy can’t be prevented.
So how will you understand whether you are having a miscarriage? If the light spotting that you normally have during the first few weeks of pregnancy become bright red and is accompanied by brownish discharge you should immediately contact your doctor. Generally, during miscarriage the bleeding occurs for several days and it is different from the light pinkish discharge that you usually have during the first trimester.
Miscarriage is a quick explanation for early pregnancy bleeding, but it is not always right. The bleeding may be initiated by a miscarriage or some other condition. It is best to consult your doctor and be sure.

10. Sub Chorionic Hematoma:

The bleeding occurring in placenta is known as sub chorionic hematoma. Sub chorionic hematoma or sub chorionic hemorrhage. This is a common sonographic abnormality in the live embryo. The sonographic visualization of sub chorionic hematoma is important in a symptomatic woman. This is because a pregnant woman with a sub chorionic hematoma has a prognosis worse than a woman without the hematoma. However, small asymptomatic sub chorionic hematomas don’t affect the prognosis. However, most cases of sub chorionic hematomas ends in miscarriage, stillbirths, pre-term labour and abruption of placenta.
If the sonogram results show a sub chorionic hematoma then the outcome of the pregnancy depends on the size of the hematoma, the mother’s age and the fetus’ gestational age. The rate of miscarriage increases with the increasing age of the mother and the size of the hematoma. The late first and second trimester bleeding also worsens the prognosis.
Sometimes, sub chorionic hematoma occurs between the uterine wall and chorionic membrane and may leak through the cervical canal. Later during the first and second trimester may strip the developing placenta partially from the attachment site. Prognosis of the patient with this type of a hematoma is worse than the prognosis of the patients with hematoma early in the first trimester.
The subchorionic hematoma disappears gradually if it is small or moderate in size. However, large hematomas that strip nearly 30-40% of placenta from the endometrium may enlarge further. This kind of hematoma exerts pressure on the gestational sac and this leads to the premature rupture of membranes. This causes spontaneous abortion.

11. Premature Labor:

If your body initiates to get ready to deliver too early then you may enter a stage commonly known as pre-term labor. It occurs usually after 20th week or more than the 3 week before your due date.

12. Placenta Praevia:

Placenta Praevia or low lying placenta can put the fetus in risk. This mainly occurs during the third trimester. The complication starts when the placenta descends in lower part of the uterus that protects the cervical canal. The lowering of placenta blocks the mouth of the cervix. This condition triggers heavy bleeding and needs emergency treatment. Generally, caesarian is recommended by the doctor to save both the mother and the fetus.

13. Vasa Praevia:

Vasa Praevia is a rare condition and it happens when the baby’s blood vessels run through the membranes that cover the cervix. In normal circumstances, the blood vessels are protected by the umbilical cord and placenta. When the waters break, the blood vessels can tear and this cause vaginal bleeding. The baby can lose huge amounts of blood due to this condition and it is life threatening.
It is difficult to diagnose vasa praevia but it can be detected in the early stages by an ultrasound scan. Vasa praevia can also be detected if there is heavy bleeding and change in the heartbeat of the fetus after the blood vessels have ruptured.
This is really an uncommon condition in which the blood vessels of the developing baby in the umbilical cord or placenta crosses the birth canal. It’s hazardous and causes the baby to bleed and lose oxygen.

14. Molar Pregnancy:

Molar pregnancy is also called gestational trophoblastic disease. This is a very rare condition and it happens when abnormal tissue builds up inside the uterus instead of the baby. This tissue can spread to other parts of the body and it is cancerous. The symptoms of molar pregnancy are severe nausea and vomiting and rapid enlargement of the uterus.

15. Placental Abruption:

This is a very serious condition and it happens when the placenta comes off from the womb wall. Placental abruption cause stomach pain and it may occur even if there is no bleeding.

16. A ‘Show’:

This happens when a plug of mucus that was inside the cervix comes out. This signals that the cervix is ready for the labour to start. This mucus discharge or show can take place few days before the contractions start or during the actual labour.

17. Uterine Rupture:

This is a rare condition and happens if there is tearing in the scar caused during a previous caesarian surgery. This is life threatening and needs immediate attention.

18. Polyps:

Fibro epithelial polyps are benign lesions that occur in adult women and young girls. These polyps can be congenital slow growing lesions or lesions that develop due to chronic urothelial irritants like calculi or infections. Other benign lesions of the uterus include the endometriomas, fibromas, leiomyoma, neurofibromas, hemangiomas and lymphangiomas.
Fibro epithelial polyps can be normal hematomas, though sometimes you can see malignant forms of polyps. The common sign of polyps are renal obstruction and hematuria or presence of blood in urine.Fibro epithelial polyps can also block the uterine and pelvic junction.
The presence of polyps can be detected by intravenous urography or retrograde pyelography, especially if the affected area shows a radiolucent filling due to a defect originating from the proximal ureter. It becomes tough to detect the presence of a polyp if it happens to be extraordinarily long or if it protrudes into the bladder and is affected by calculus. If the patient is suffering from gross hematuria, a cystoscopy is usually done to check the presence of tumours especially with the presence of bladder mass.
If cystoscopy is diagnostic incase the polyp protruded the bladder then ureteroscopy is a more efficient way to detect fibro epithelial polyps. Diagnostic biopsies are not required, since the appearance and location of the lesions are pathognomonic. A complete excision and histologic evaluation can help to detect the areas of malignant transformation.
Can you prevent vaginal bleeding? How will you find out the root cause behind such bleeding? A vaginal or pelvic examination needs to be done by the doctor. An ultrasound scan can help detect the cause of bleeding and any abnormality in pregnancy. You have to undergo a series of blood tests. This blood test will help the doctor to detect the hormonal levels in the blood.The doctor can ask you about other symptoms like cramps, dizziness, nausea and pain. Answer all his questions accurately since this can help in the diagnosis though it is tough to find the real cause behind bleeding from the vagina during pregnancy.
You may have to stay under observation in a hospital. The duration of your hospital stay will depend on the cause of bleeding and how many months pregnant you are at that time. Being admitted in a hospital helps the staff to monitor the changes in your uterus and the health of the fetus. If there are any problems it is detected promptly and the treatment is provided accordingly.

19. Injury to Cervix and Vagina:

During pregnancy area around the cervix becomes delicate and raw. Sexual intercourse or an internal exam can cause bleeding from the cervix. It needs immediate medical attention to avoid the risk of any infections.Bleeding after a sexual intercourse can be termed as postcoital bleeding.

20. Uterine or Endometrial Cancer:

Any malignant growth of tissues in the uterus can cause cancer. The reasons for uterine cancer are not known. The abnormal growth of cells in the lining of the uterus causes this cancer and it can be diagnosed after menopause.
Women who have endometrial overgrowth or Hyperplasia, a family history of uterus cancer, who never had children, those who had menstrual cycle before 12 years and menopause after 50 are susceptible to uterine cancer. Even those who took tamoxifen radiation in their pelvis and has inherited a lynch syndrome (a type of colorectal cancer that comes through genes) can increase the risk of uterine cancer.
Common symptoms of uterine cancer are abnormal vaginal bleeding with discharge, pain during urination and sexual intercourse and severe pelvic pain. Uterine cancer can be detected by ultrasound, pelvic examination and biopsy. If the cancer is an advanced stage like stage IV then chest X ray, MRI, CT scans and biopsy are used to detect uterine cancer. Radiation, hormone and chemotherapy are generally used to treat uterine cancers. Treatment actually depends of the stage of cancer, if you are in the advanced stage of cancer and the damage done by the abnormal tissue is extensive then the kind of treatment will be very different compared to the treatment done if cancer is detected in the earlier stages.
Surgery is done to remove the uterus, ovaries, fallopian tube, adjacent lymph nodes and part of the vagina. Radiation or brachytherapy is done internally and externally to ameliorate the condition. In hormone therapy, the hormone progesterone is used on the cancer cells.
It is important to do a follow up if you are treated with uterine cancer or if you are undergoing treatment for uterine cancer.

21. Blighted Ovum:

Blighted ovum or embryonic failure can occur if there was any abnormality in the foetus. The ultrasound scan generally shows intrauterine pregnancy, this can either mean ectopic pregnancy or embryonic failure.

22. Intrauterine Fetal Demise:

You may have intrauterine fetal demise (IUFD) that can trigger missed abortion. This happens when the developing fetus dies inside the uterus. This can happen any time during pregnancy. Generally threatened miscarriage happens in the early stages of pregnancy but as you progress to the second and third trimesters the chances of miscarriages generally become nil. This is a rare condition.

Check With Your Doctor:

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If you’re unsure about the cause behind your unexpected menstrual bleeding, it is best to visit your doc and get yourself checked. Your doc may ask you some of these questions if you’ve been experiencing unexpected menstrual bleeding.
  • How far you are in pregnancy?
  • When did your bleeding begin?
  • Have you had vaginal bleeding during this or an earlier pregnancy?
  • Does the blood have an odor?
  • What is the color of the blood?
  • Do you have nausea, vomiting, or diarrhea?
  • Do you have any extra stress?
  • Have you changed your physical activity?
  • Does it stop and start, or is it a steady flow?
  • How much blood has been expelled?
  • Do you feel weak or tired?
  • Have you fainted or felt dizzy?
  • Do you have a fever?
  • Have you been injured, such as in a fall?
  • Did you undergo stress lately?
  • When did you last have intercourse?
In most cases, your doc may suggest an ultra-scope and ultrasonography which is very important when it comes to understanding the reason behind unexpected menstrual or heavy bleeding during pregnancy.
Generally those who undergo miscarriage due to any of the above mentioned abnormalities are in a stage of shock and depression. It is important to listen to the person without correcting her if she uses the word ‘baby’. It is true that you can’t reduce her pain but make her feel less alone. You can show your support and genuine concern for her. Make her feel positive with your healing words. Don’t ever let her feel isolated and always keep contact with a person who has suffered miscarriage. Miscarriages can cause an emotional vacuum, but that is not the end of the world. You can become pregnant even after a miscarriage. A counseling session with the obstetrician or gynecologist is the best way to deal with pregnancy. All you need is a positive mindset and courage!
Most of the time, a little spotting doesn’t pose any health risk to you and your little one, though, bleeding can sometimes specify a difficulty with your pregnancy.

 If you are pregnant, it is essential for you to be conscious about your bleeding. If you experience any irregular bleeding or period during pregnancy, contact your health care provider immediately.
Hope by now your doubts regarding is periods possible during pregnancy has been cleared. 

Happy Motherhood to You......