Light vaginal discharge during the first few weeks of pregnancy is considered normal and oftentimes harmless. It is a common occurrence that affects 20% of the population. Most women will see small drops of blood on their underwear, a condition called spotting. Although experts have not yet discovered the exact cause of this, bleeding while pregnant is said to be due to various hormonal changes. Estrogen and progesterone, hormones that regulate the menstrual cycle, may trigger light spotting during pregnancy.
In any case, it is still important to see a doctor to assess if it is indeed harmless spotting or a sign of a more severe condition. Bleeding while pregnant may be a point of concern and could be indicative of various conditions, depending on the trimester it had occurred.
The Three Trimesters
Pregnancy is divided into three parts called trimesters, each of which lasts for approximately 3 months. The first trimester involves the first 12 weeks of pregnancy. The second trimester starts from the 13th week of gestation to the 28th week of pregnancy. The third and last trimester occurs from the 29th week onwards.
First Trimester Bleeding
Bleeding that occurs during the first trimester is usually normal and may be due to the implantation of the fertilized egg at the lining of the uterus. This lasts for only a few hours to a few days. However, it could also indicate more severe conditions such as the possibility of a miscarriage or the contraction of a certain disease.
Also known as spontaneous abortion, this refers to the death of the fetus before the pregnancy has reached 20 weeks or 5 lunar months. Bleeding is usually accompanied by abdominal cramps, similar to that of dysmenorrhea and the passing of fetal tissue through the vagina.
Although the term abortion is used, this is entirely unintentional and the cause of which is unknown. Scientists believe that it may be related to chromosomal or uterine abnormalities that lead to abnormal fetal development.
To confirm this condition, physicians will examine the uterus through a pelvic exam and an abdominal ultrasound. If test results are positive, the woman is recommended to undergo D&C (dilation and curettage). This procedure is performed by dilating the cervix and removing any fetal or placental fragments from the womb. A noninvasive alternative to this procedure is the administration of certain medications that stimulate the body to expel the unwanted tissues from the uterus.
Another probable cause is the woman’s contraction of any of the following diseases: syphilis, rubella (German measles), poliomyelitis or tomegalovirus. These infections are capable of crossing the placenta (an organ that serves as protection and the source of nutrition of the fetus) and can potentially cause harm to the developing child.
Early diagnosis and treatment of these conditions can prevent injury to the baby or the development of abnormalities. That is why blood tests are conducted early on in pregnancy.
Second Trimester Bleeding
If vaginal bleeding occurs at any point during the second trimester, it may be due to either the presence of a hydatidiform mole (h. mole) or the occurrence of premature cervical dilatation.
Hydatidiform Mole (H.mole)
An h.mole, a condition that occurs during pregnancy, is the abnormal presence of a mass inside the uterus (womb). This is caused by the overproduction of tissue that is supposed to develop into the placenta. Additional symptoms of this condition include severe nausea and vomiting, and the speedy enlargement of the uterus. This occurs in1 out of every 1,500 pregnancies, more often in women who are 36 years or older and in those with blood type A who married men with blood type O. This disease causes the rapid expansion of the uterus, making it reach its landmarks (just over the symphisis brim at 12 weeks and at the umbilicus by week 20 to 24) before the usual time. The fetus is unable to survive under such circumstances and a suction curettage is advised.
Suction curettage is the insertion of a hollow, plastic tube into the uterus. It extracts the mole and the products of pregnancy through suction. It is the recommended medical management for women with h.mole.
A hysterectomy (removal of the ovaries) may be recommended for women wish to permanently prevent future pregnancies.
Premature Cervical Dilation
The cervix is a canal located just beneath the uterus. It serves as the passageway of the baby from the womb to the vagina. During the last trimester, once the baby has reached term, the cervix gradually opens (dilates) to allow the safe and efficient passage of the baby. In premature cervical dilation, the mother’s cervix is too weak to stay closed when the growing weight of the fetus presses upon it. This is usually indicated by vaginal bleeding. If no medical intervention is administered, it may result in premature rupture of membranes and consequently a premature birth.
To prevent this from happening, the woman is subjected to bed rest and tocolytic therapy. This aims to decrease or halt uterine contractions to prevent the birth of a preterm child. Additionally, a surgical procedure called cervical cerclage, which entails sewing the cervix close, will be performed to reinforce the cervical muscles and narrow the cervical canal. This is usually done between the 14th to 16th weeks of pregnancy and removed on the 36th to 38th week of pregnancy.
Third Trimester Bleeding
During the third trimester, if the woman experiences sudden vaginal bleeding, she may have a case of either placenta previa, abruptio placenta or preterm labor.
Placenta is normally situated at the upper part of the uterus and is usually delivered after the birth of the baby. However, in some cases, the placenta slips down to the bottom most part of the uterus, completely or partially blocking the passageway of the baby. Although this isn’t a problem during the first half of pregnancy, if it occurs during the third trimester, there is a big risk of severe bleeding, which is dangerous for both the mother and the unborn child.
An abdominal ultrasound will be performed to determine the exact location of the placenta. Women with this condition are recommended to deliver the baby through a cesarean section.
Placental abruption is the premature separation of the placenta from the uterus. That is, prior to birth of all the babies in the uterus. Aside from vaginal bleeding, this is usually accompanied by uterine contractions and fetal distress. The most common cause is injury to the abdominal area. In the case of multiple pregnancies (pregnancies with 2 or more fetuses), the delivery of the first baby may result in the rapid loss of amniotic fluid, causing abruptio placenta.
To confirm the presence of this condition, the doctor will perform an abdominal ultrasound for proper visualization of the uterus and the placenta. Management involves blood transfusion and the administration of IV fluids to prevent hypovolemia (deficient fluid volume). The health care team will also monitor the mother for symptoms of shock and for fetal wellbeing. The baby may be delivered via an emergency cesarean section. But if the fetus is fully developed and if physicians see it fit, the baby may be delivered through the vagina.
Labor involves regular, painful contractions that occur more frequently as time passes by. This usually lasts for several hours and is the body’s way for preparing for childbirth. Preterm labor occurs about three weeks before the baby has reached term, which may result in preterm birth. This is usually accompanied by backache, abdominal cramps, flu-like symptoms and vaginal bleeding.
Luckily enough, there are ways to prolong the incidence of labor and prevent premature birth. The mother will have to be hospitalized for the health care providers to monitor her condition. Corticosteroids will be administered via injection to speed up the baby’s lung maturity. The doctor may also administer tocolytics to relax the uterus and temporarily halt labor. Pain medications may be given to provide relief.
Whichever is the cause, excessive bleeding while pregnant is dangerous and may result to hypovolemia or deficit fluid volume. This is usually manifested by an increase in the pulse rate, a decrease in the blood pressure, an increased respiratory rate or fast breathing, cold, clammy skin, and deficient urine output (less than 500 ml per day). A dangerous level of depleted blood volume puts additional strain to the heart and may further develop to shock if left untreated. It is important to seek medical help immediately.