When an expectant mother experiences bleeding, it causes many to panic and not know what to do because they have never had this information before. We will get to know bleeding during pregnancy and what conditions it may be linked to. First of all, vaginal bleeding during pregnancy is something that must be taken seriously and with great caution because it is not normal.
Bleeding During Pregnancy
Vaginal bleeding during pregnancy is mostly found in two periods: the first half of pregnancy (gestational age not exceeding 20 weeks) and the second half of pregnancy. Vaginal bleeding during pregnancy is not normal and requires immediate medical consultation to determine whether the bleeding is dangerous, the risk of miscarriage, or the cause of the bleeding.
- Threatened miscarriage is vaginal bleeding that may vary in amount, with or without lower abdominal pain, but the cervix remains closed. It is found in pregnancies within the first 20 weeks. In early pregnancy, it may be a normal condition of bleeding from the implantation site of the embryo in the uterine lining, called implantation bleeding (Placental sign or Hartman’s sign). It usually occurs about 3 weeks after fertilization, counted from the first day of the last menstrual period, which can be mistaken for a miscarriage. Threatened miscarriage can occur for various reasons, such as congenital fetal abnormalities or chromosomal abnormalities of the fetus.
- Pregnancy without an embryo, also called Blighted Ovum, is an abnormal pregnancy where the egg and sperm fertilize and implant initially, but the embryo part degenerates, leaving only the gestational sac, which does not regress on its own. Therefore, it requires curettage. In some cases, if degeneration occurs early, the gestational sac is very small and may be naturally miscarried as a whole sac within the first 6 weeks or after 12 weeks. The sac can be completely expelled, but in the mid-period, from 7 weeks to before 12 weeks, miscarriage is often incomplete, which may cause complications such as bleeding.
- Uterine abnormalities
- Hormonal abnormalities affecting implantation
- Unknown exact cause
What Are the Risk Factors for Threatened Miscarriage?
- Age, history of previous miscarriage, smoking, alcohol consumption, drug use
- Inevitable miscarriage may occur after symptoms of threatened miscarriage or without any warning signs. Usually, there is heavier vaginal bleeding and severe lower abdominal cramping during miscarriage when the cervix opens.
- Incomplete miscarriage occurs when some pregnancy tissue remains in the uterus, causing continued vaginal bleeding and sometimes heavy bleeding, along with lower abdominal cramping as the uterus tries to expel the remaining tissue. Curettage is required to remove the retained pregnancy tissue.
- Complete miscarriage occurs when all pregnancy tissue is expelled from the uterus, with vaginal bleeding after miscarriage and severe pain.
- Missed miscarriage occurs when the fetus has died but remains in the uterus. There may be brownish vaginal discharge and some early pregnancy symptoms such as nausea and fatigue, which gradually disappear, and the uterus shrinks. The mother may not realize the loss of the fetus unless examined by a doctor.
Besides miscarriage, other causes of vaginal bleeding in pregnant women include ectopic pregnancy and molar pregnancy, both of which have symptoms similar to threatened miscarriage.
Ectopic Pregnancy
This is a condition where the embryo implants outside the uterine cavity, most commonly in the fallopian tube. It usually causes lower abdominal pain and vaginal bleeding. If the gestational sac ruptures, it causes internal bleeding in the abdomen. The patient may experience pallor, low blood pressure, and shock, which can be life-threatening.
Molar Pregnancy
This is an abnormal pregnancy that may cause spotting or heavy bleeding similar to menstruation. It is often accompanied by severe morning sickness, preeclampsia symptoms, swelling, and vaginal bleeding resembling miscarriage symptoms. When molar pregnancy is diagnosed, curettage must be performed to remove all molar tissue because it can develop into placental cancer.
Vaginal Bleeding in the Second Half of Pregnancy (Gestational Age Over 20 Weeks)
- Placenta previa: In normal pregnancy, the placenta attaches to the upper part of the uterus. If the placenta attaches to the lower part of the uterus or covers the internal opening of the cervix, it is called placenta previa.
- Placental abruption: This is the premature detachment of the placenta from the uterine wall, causing bleeding and blood clots under the placenta, which obstructs the transfer of nutrients and oxygen from the mother to the fetus. This results in abdominal pain, preterm labor, or severe cases leading to fetal death due to oxygen deprivation.
- Rupture of blood vessels in the placental membranes is rare.
From the above information, it is clear that bleeding in pregnant women is not normal and can be a health problem with various causes. Sometimes it can be dangerous and affect the safety of the fetus. Therefore, whenever there is vaginal bleeding or any abnormality, even if slight, the mother should immediately see a doctor, which is the best solution.
