Should you bleed in pregnancy?

There's nothing scarier, but before you panic, Dr Ginni Mansberg has some fail-safe words of advice

Practical Parenting Expert / July 03 2018

Going to the toilet and finding some blood on the toilet paper is a heart stopping moment. Bleeding in pregnancy is really common, but usually not a kiss goodbye to baby. Most women who bleed in the first trimester- and that is a whopping 25% of us, go on to deliver a healthy baby. Late term bleeding is much less common and the prognosis is not as good.

Let’s go through some of the causes;

You can always bleed from causes unrelated to your pregnancy- like a urinary tract infection or from some trauma to the vulva (from vigorous sex for example).

In the first trimester the main causes are

  1. An implantation bleed when the foetus embeds in your uterus- painless and harmless!
  2. An ectopic pregnancy- where the foetus implants in the tubes, not the uterus. It can come with cramps. The pregnancy cannot survive and an operation is needed to remove the foetus.
  3. A miscarriage. Often you have stopped ‘feeling pregnant’ and you might have cramps too.
  4. Subchorionic haematoma. This is the most common finding on an ultrasound done for first trimester bleeding. It is a small collection of blood between the placenta and the uterine wall. Stats show the prognosis for the pregnancy is worse if the hematoma is big, but not if it’s small and they usually are small. The bleeding can recur a few times during the pregnancy.
  5. A molar pregnancy- an uncommon condition where the embryo doesn’t develop into a foetus but instead becomes a cyst like benign tumour. It has to be removed.

In the second and third trimesters the main causes are

  1. Late miscarriage- really rare
  2. Placental abruption- where the placenta peels away (often partially) from the uterus wall. Comes packaged with pain. This is an emergency and requires immediate medical attention.
  3. Placenta previa- where the placenta grows low down in the uterus, partially covering the cervix so that as the cervix starts to open, the placenta starts to bleed. We usually have a heads up in the 18 week ultrasound that this is a possibility and it rarely comes as a surprise any more.

The amount of bleeding varies quite a lot depending on the cause. As a rough rule, less is better. If you are getting some blood on the toilet paper early on in your pregnancy, the prognosis is excellent. If there is a flood, whether early or late, you need to get to a doctor as soon as possible.

In my experience, most women who see blood of any description and in any amount are pretty distressed and don’t need to be convinced to see the doctor or midwife. They will arrange an ultrasound if they are worried and that will tell you what is going on. Usually it’s a sigh of relief!

For late bleeding, the situation is a bit more serious. You need to have an ultrasound as soon as possible and if there is an abruption, you need to be in hospital.

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