During pregnancy, spotting: in early and late stages

What is considered bleeding?

Bleeding is a discharge of blood from the genital tract of varying volumes. The color of the discharge depends on how much blood - small, medium or large - comes out. It can be red, brown or pink. The presence of bleeding indicates changes taking place in the body and can occur either without deterioration in health or be accompanied by pain in the lower abdomen and lower back.

All bleeding during pregnancy can be divided into two categories:

Physiological. Their cause is the restructuring of the female body. They do not pose a threat to the life and health of the mother and child.
Pathological. Observed during abnormal pregnancy, they threaten the life and health of the woman and the fetus and require immediate medical attention.

There are so many causes of bleeding that only a doctor can correctly diagnose the problem. Even with abnormal development of pregnancy, it is possible to save her and the baby, but only if you do not miss precious time.

What to do if you have nosebleeds during pregnancy

If you have a nosebleed that does not stop for a long time, you need to provide first aid to yourself:

sit down and tilt your head forward slightly;
take a napkin and soak it in cold water, place it on the bridge of your nose (you can use ice instead);
provide yourself with fresh air: unbutton, open the window;
if nosebleeds come from one nostril during pregnancy, press it against the septum for a few minutes;
if the bleeding is too heavy, take a cotton swab, moisten it with hydrogen peroxide and apply it to the bridge of the nose.

Please note that if you have nosebleeds, you are prohibited from performing certain actions. First of all, do not throw your head back, as you will cause a spike in blood pressure, which will only make the problem worse. Do not lie down, because you may swallow some of the blood, after which you will begin to feel very sick, possibly vomiting.

Why does bleeding occur in the early stages?

Bleeding most often appears in the 1st and 3rd trimesters. In the early stages they can be caused by the following reasons:

Gynecological examination or ultrasound. Often, minor discharge with blood appears after examination by a gynecologist or ultrasound using a transvaginal sensor. However, this is not a reason to panic. They are caused by trauma to the mucous membrane, which completely disappears in a couple of days.
The onset of menstruation. Some women, on the days when their periods were supposed to begin, experience mild, spotting discharge that lasts 3-4 days. This usually happens in the first three months after conception. It can be caused by both individual characteristics of the body and hormonal disorders.
Implantation. Blood may be slightly released at the time of implantation of the fertilized egg in the uterine cavity. However, a woman may mistake it for, albeit scanty, menstruation, and not guess about pregnancy. In the future, this may cause difficulties in determining the duration of pregnancy.
Infection. When pregnancy occurs, the immune system is significantly weakened. This can trigger the rapid development of sexually transmitted infections, and, as a result, severe inflammation, including bleeding.
Insufficient amount of progesterone. If the hormone is produced in insufficient quantities, it can threaten pregnancy. Based on the test results, the doctor prescribes treatment in the form of tablets, suppositories or progesterone injections.
Ectopic pregnancy. The cause of bleeding can be abnormal attachment of the fertilized egg in the abdominal cavity, ovary or, most often, the fallopian tube. In the early stages, such a pregnancy has all the signs of a normal pregnancy - toxicosis, lack of menstruation, breast enlargement, even two lines on the test. However, as the fetus grows, pain appears at the location of the embryo, as well as spotting, which then intensifies. In this case, it is impossible to save the pregnancy; at best, it is possible to leave the fallopian tube. However, if a woman suffers pain and does not see a doctor, a pipe rupture and severe bleeding may occur, which poses a threat to life.
Frozen pregnancy. Light bleeding may indicate fetal fading. For unknown reasons, it stops developing, which can manifest as pain in the lower abdomen. Also, most often, all signs of pregnancy disappear - the breasts become smaller, toxicosis stops, and the basal temperature drops. Sometimes the result is a miscarriage, but more often curettage is required. Delaying the procedure is dangerous for women's health.
Bubble drift. During fertilization, an error occurs and as a result, instead of an embryo, a benign tumor develops in the form of a cluster of small cysts. In this case, there is dark, thick blood with egg bubbles. There may be bleeding until the tumor is removed.
Spontaneous abortion or its threat. Accompanied by pain in the lower abdomen and lower back. As a rule, it begins with spotting, which, if you do not seek help, develops into massive bleeding, during which the embryo can be released. However, the outcome is not always disastrous. If you call an ambulance in a timely manner and go to the hospital, then if you follow all the doctor’s recommendations and drug therapy, there is a high chance of saving the baby. However, if the fetus has genetic abnormalities, or the bleeding is already profuse, with clots, accompanied by severe pain, then the process cannot be stopped and a miscarriage has occurred. It can be complete or incomplete, when curettage is required to remove the remnants of the membranes.

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Bleeding during early and late pregnancy. Bleeding during pregnancy is the most common pathology. And this is not just a pathology, but also a serious complication, which, unfortunately, not every pregnant woman is aware of. This is primarily due to the common misconception that you can have periods during pregnancy. But in fact, there should be no bleeding normally during pregnancy. Very rarely (in 3% of cases out of 100), some pregnant women experience slight spotting bleeding at the very beginning of pregnancy, when the woman does not yet know about her pregnancy. This occurs at the moment of attachment of the fertilized egg to the uterus, and, as a rule, corresponds to the expected period of menstruation. Only in this case is bleeding normal. In other cases, any bleeding is regarded as a pathology

Causes of bleeding during pregnancy

Bleeding can occur both early and late in pregnancy. Depending on how early or late the bleeding occurred, we can assume the pathology that caused the bleeding.

Bleeding in early pregnancy (before 12 weeks of pregnancy) may indicate:

- about the beginning of a miscarriage;

- about ectopic pregnancy;

- about a non-developing “frozen” pregnancy;

- about hydatidiform mole.

Bleeding in late pregnancy (after 12 weeks) may be due to abruption or placenta previa.

It should be noted that if bleeding

occurred during pregnancy, this does not mean that it is associated specifically with fetal pathology. The reason for this may also be exacerbation of gynecological diseases in the expectant mother - cervical erosion, uterine fibroids, cervical canal polyps, and so on. Bleeding can also be caused by a banal injury to the genital organs.

Bleeding during pregnancy can be of varying intensity - spotting, moderate or heavy with clots. Quite often, bleeding is accompanied by pain. The pain can be intense and sharp, spreading throughout the entire abdomen. Often they resemble contractions, as happens, for example, with a miscarriage. Or there may be a slightly noticeable nagging pain in the lower abdomen. In addition to pain and bleeding, a pregnant woman’s blood pressure decreases, her pulse quickens, and weakness appears. But it is impossible to make a diagnosis based on the nature and intensity of pain and bleeding, since with the same pathology these indicators differ in different women.

If the bleeding is insignificant, this does not mean that you need to lie at home and wait for it to pass. Any bleeding during pregnancy is a reason for an emergency visit to a gynecologist. Such conditions can be dangerous for both the life of the fetus and the mother.

Diagnosis of the cause of bleeding during pregnancy

In order to identify the exact cause of bleeding, an examination by a gynecologist and a series of diagnostic studies in a hospital or maternity hospital are necessary.

During the examination, the doctor takes a smear from the vagina. A pregnant woman undergoes a general and biochemical blood test, a coagulogram, a blood test for HIV, hepatitis, and syphilis; general urine analysis. Her blood type and Rh factor are determined. An ultrasound of the pelvic organs and fetus is required.

Further, depending on the identified pathology, additional studies may be prescribed. So, in case of a miscarriage or a non-developing pregnancy, the blood is additionally examined for hCG (human chorionic gonadotropin), hormones, and tests are taken for TORCH infections (herpes, rubella, cytomegalovirus, toxoplasmosis); smear for sexually transmitted infections. If an ectopic pregnancy is suspected, a diagnostic laparoscopy is performed. In cases of hydatidiform mole, the level of hCG is also examined.

To diagnose the cause of bleeding in late pregnancy, additional studies, as a rule, are not required, due to the high informativeness of ultrasound.

Treatment of bleeding during pregnancy

Treatment is prescribed depending on the pathology and stage of the disease. When a miscarriage begins, measures should be aimed at maintaining the pregnancy and stopping bleeding. If, according to the results of an ultrasound, the fetus is viable, in the early stages of pregnancy hemostatic drugs (Ditsinon), antispasmodics to reduce the tone of the uterus (No-spa, suppositories with papaverine), hormonal drugs - gestagens (Duphaston or Utrozhestan) are prescribed until the 16th week of pregnancy to maintain progesterone levels - “pregnancy hormone”, vitamins and microelements (vitamin E, Iodomarin, folic acid, MagneB6). If the effect is good, the bleeding stops and the pregnancy continues. If a miscarriage does occur and the discharge is profuse, the uterine cavity is curetted and the remnants of the fertilized egg are removed.

When the diagnosis of “frozen” pregnancy or hydatidiform mole is confirmed, as in the case of a miscarriage, curettage of the uterine cavity is indicated. After curettage, the hormone Oxytocin and hemostatic drugs are prescribed to contract the uterus. Bloody discharge after curettage stops after a week.

For ectopic pregnancy, treatment is surgical. A laparoscopy or laparotomy is performed and the affected fallopian tube is removed or the fertilized egg is squeezed out of the tube.

In case of placenta previa, if the discharge is insignificant, antispasmodics, magnesium drips, beta-adrenergic agonists (Ginipral), antiplatelet agents (Trental or Curantil) and vitamins are prescribed to maintain pregnancy. With placenta previa, bleeding may continue until delivery. All this time the woman is supposed to stay in the maternity hospital. When reaching full term (38 weeks of pregnancy), a cesarean section is performed. If the bleeding is heavy, a cesarean section is performed as an emergency, even if the fetus is premature. To compensate for blood loss, infusion therapy is performed (transfusion of fresh frozen plasma and red blood cells).

If placental abruption is suspected, an emergency cesarean section is performed, regardless of the gestational age and fetal viability. In parallel, infusion therapy is carried out.

All women with Rh-negative blood immediately after curettage, surgery for ectopic pregnancy and cesarean section are administered anti-Rhesus D-immunoglobulin to prevent Rh conflict between mother and fetus when fetal blood enters the mother's bloodstream.

All pregnant women who have experienced bleeding and managed to maintain pregnancy are advised to have sexual abstinence and emotional peace. Many drugs that are prescribed in the hospital must be used after discharge, even if there is no bleeding, in order to protect yourself from the repeated threat of miscarriage. If bleeding reappears, the pregnant woman should also immediately contact a gynecologist.

In the rehabilitation period, after stopping the bleeding, sedatives are used - tinctures of motherwort or valerian. Non-drug and physiotherapeutic treatment is recommended - acupuncture, endonasal galvanization, and so on.

As for traditional medicine, except for tinctures of motherwort and valerian, which have been used in obstetrics for a very long time, it is better not to use other herbs for bleeding, since in most cases they are ineffective, and in the worst case, harmful during pregnancy and can further aggravate the situation.

Complications of bleeding during pregnancy:

- miscarriages that cannot be treated;

- antenatal fetal death;

- infectious complications, septic shock, which occurs due to the presence of tissue remains of a dead fetus in the uterine cavity;

- with large blood loss, hemorrhagic shock may develop, which can lead to death;

- Choriocarcinoma is a rare malignant cancer that can occur after curettage for hydatidiform mole.

Prevention of bleeding:

- natural family planning - refusal of abortion;

— limitation of physical and sexual activity during pregnancy;

— timely treatment of chronic gynecological diseases (especially genital infections) before pregnancy;

- implementation of reproductive function up to 35 years.

Consultation with a doctor on bleeding during pregnancy

1. Can I use any medications to stop bleeding at home?

This is not possible, you must immediately consult a doctor.

2. How quickly can you get pregnant again after curettage?

After 3-6 months, after examination and appropriate hormonal treatment.

3. Do you have periods during pregnancy?

They don't exist.

4. Can bleeding occur during pregnancy due to sex?

They can.

5. I went into storage at 5 weeks. The bleeding did not go away and a miscarriage occurred, although she took hormones. Tell me, maybe the dose of hormones was insufficient?

Maybe, but unlikely. We need to find out why you had a miscarriage after the examination. The doctor probably prescribed hormones to compensate for the lack of progesterone in the body, which often happens with miscarriages. But a miscarriage can also occur due to genetic defects of the fetus (in 75% of cases) and then hormones have nothing to do with it.

6. How can you tell by the nature of the bleeding whether it’s a miscarriage or a frozen pregnancy?

No way, only a doctor can determine for sure after an examination and ultrasound.

7. I have placenta previa. There is no more bleeding. Is it possible to have sex?

It is forbidden. It is necessary to abstain from sexual intercourse until delivery.

8. I started spotting after I missed my period for a week. What is this?

Take a pregnancy test and see a gynecologist. Either it is pregnancy or ovarian dysfunction.

9. Can there be bleeding due to the bath?

Maybe all thermal procedures are undesirable during pregnancy, especially in the short term. source https://www.medicalj.ru/diseases/pregnancy/610-krovotechenie-pri-beremennosti-na-rannih-i-pozdnih-srokah

Why is spotting a concern in the later stages?

Among the main causes of bleeding in the later stages are:

Placenta previa. Occurs when the placenta is positioned incorrectly, partially or completely blocking the uterine os. It is at the bottom that the main load falls, which provokes rupture of the placenta. With such a diagnosis, the woman is put into preservation and they try to prolong the pregnancy as long as possible with the help of tocolytics and antispasmodics, iron supplements to treat anemia, as well as means to improve blood supply. If the therapy does not work and the bleeding does not stop, then an emergency caesarean section is performed to save the woman’s life.

Discharge in the first trimester

The first trimester is the most dangerous for preserving the fetus; the majority of miscarriages occur during this period.

Bloody discharge in early pregnancy may occur for the following reasons:

The consolidation of the fertilized egg is accompanied by the appearance of a small amount of blood; this is a physiological process.
During pregnancy, cervical erosion worsens due to increased blood flow, but this does not pose a threat.
Pathological conditions in the uterus - cyst or neoplasm. Constant monitoring by a doctor is required.
Low progesterone levels. This hormone is necessary for the proper development of the fetus. Its deficiency causes leucorrhoea mixed with blood.
Ectopic pregnancy. The diagnosis requires immediate surgical intervention.
Endometriosis. Changes in hormonal levels cause its exacerbation; constant monitoring and treatment are required.

If blood is detected in the secretion, you must notify your doctor. Bloody discharge at 6 weeks of pregnancy, accompanied by pain, may signal a spontaneous abortion or ectopic pregnancy

Ectopic pregnancy

An ectopic pregnancy is the development of an egg outside the uterine cavity - in the fallopian tube, peritoneum, or ovary. If the diagnosis is not made in a timely manner, the woman may die from blood loss and pain shock. In this case, it is not possible to save the fruit.

Bloody discharge during an ectopic pregnancy is of a different nature than during a normal pregnancy. This is due to the fact that the embryo is anchored in an area with a large number of blood vessels. Heavy bleeding begins when the pipe ruptures, accompanied by severe pain, decreased blood pressure, and weakened heartbeat . If severe bleeding appears and there is the slightest suspicion of the presence of this pathology, the patient must be hospitalized.

Risk of miscarriage

In most cases, spontaneous abortion occurs in the early stages. Often a woman is not even aware of her situation - menstruation comes late, it is heavy and painful. In this situation, you need to see a doctor for examination. The main signs of spontaneous abortion are bleeding and pain in the lower abdomen, radiating to the lower back.

A slight discharge of blood during pregnancy signals a threat of miscarriage; in this situation, there is a chance to save the fetus. Heavy bleeding with tissue fragments indicates that a miscarriage has already occurred. If blood secretions intensify and are accompanied by pain and spasms, urgent medical intervention is necessary.

To correctly determine the nature of the discharge, whether it is menstruation or an early miscarriage, we recommend reading additional information on this topic.

Injuries

Bloody discharge may occur due to premature abruption of a normally located placenta. The condition is accompanied by significant bleeding, which threatens the woman’s life.

Causes of pathology:

injuries - fall, blow to the stomach;
gestosis;
inflammatory process inside the uterus;
malformations of the reproductive organ;
large embryo;
the presence of two or more fruits;
polyhydramnios.

Bloody discharge during pregnancy, caused by placental abruption, is very profuse. Urgent hospitalization is required.

Frozen pregnancy

A frozen pregnancy has some distinctive features in comparison with a spontaneous abortion - the embryo dies, the process stops progressing, but there are no symptoms of miscarriage for some time. This phenomenon is most often observed in the first trimester. Over the course of some time, the woman notices the disappearance of toxicosis as pregnancy fades. Bloody or bloody discharge appears in the first trimester of pregnancy, associated with the beginning of detachment of the ovum. They are accompanied by pain in the abdomen or lower back, and a slight increase in temperature. To confirm the diagnosis, an ultrasound scan is necessary.

Uterine diseases

Bloody discharge in early pregnancy can be a consequence of uterine pathology - cervical erosion, injury, tumor, inflammation. Most likely, all these diseases existed in the woman before conception. With erosion and inflammatory processes, the amount of blood is insignificant, and injuries and tumors can lead to bleeding.

Insufficient secretion of progesterone

Progesterone is called the hormone of pregnancy; it ensures its safe course. Its normal level allows conception and preservation of the fetus to occur. Both excess and deficiency of this substance negatively affect a woman’s condition. Progesterone deficiency is especially dangerous before midterm as it can cause miscarriage. It is necessary to take tests to determine hormone levels and undergo a course of treatment.

When progesterone levels are low, a woman experiences bloody or bloody discharge from the genitals, the uterus is in good shape in the first trimester, and the expectant mother may experience pain in the lower abdomen and lower back. A lack of progesterone is more dangerous than its excess, especially in the early stages.

During the consolidation of the fertilized egg in the uterus, a small amount of blood may be released and mixed with mucus. This is similar to very scanty menstruation, the woman does not experience pain, the temperature remains normal. Increasing progesterone levels helps preserve the fetus. Discharge in the fifth week of pregnancy does not contain bloody streaks, since the embryo has already established itself.

Causes of bleeding at any stage

There are reasons that provoke bleeding at any stage of embryogenesis, these are:

Erosion. If a woman has cervical erosion, this may cause droplets of blood to appear. As a rule, a wait-and-see approach is used, and the erosion is cauterized after childbirth.
Myoma. It is a benign neoplasm in the uterus. Often fibroids were already present before pregnancy. However, changes in hormonal levels can trigger its growth. If you have fibroids in the 1st trimester, there is a high risk of bleeding and miscarriage due to increased tone.
Sexual intercourse. During sex, due to the strong blood supply to the uterine pharynx, blood vessels can be damaged. In this case, the bleeding will be weak, painless and will end in a couple of hours. This does not pose a danger to the child, however, it is better to choose safer positions and reduce the intensity of sexual intercourse.

Bleeding is also possible if a woman has increased blood circulation in the pelvic organs, has had physical activity, has cardiovascular diseases associated with a weakening of the inner layer of the walls of blood vessels, and also has polypous growths.

Pathological causes

Bleeding can also occur as a result of the development of pathologies in a woman. Among them is hyperandrogenism. It belongs to the category of endocrine diseases and is characterized by increased secretion of androgens.

Androgens are hormones produced by the testicles in men and the ovaries in women. The adrenal glands and thyroid gland also take part in the process of their production. With a high content of androgens, pregnancy cannot be maintained, since processes characteristic of the male body occur in the female body, as a result of which hair growth increases, facial features take on different shapes, etc.

https://youtu.be/RdV16L73Imc

In general, according to doctors, with the development of hyperandrogenism, conceiving a child naturally occurs extremely rarely (in 2 cases out of 1000). And if a woman still manages to do this, she needs to carefully monitor her well-being. Even a drop of blood with such a disease can signal the presence of a great threat to the further development of gestation, especially when the fourth or fifth week comes, when the embryo is transplanted into the uterus.

Treatment of this disease is carried out in several ways - surgically, used in advanced stages, and medicinally, that is, using hormonal drugs. Taking the latter can also provoke slight bleeding, which also should not frighten the pregnant woman.

If the doctor notices that a woman’s cervix is bleeding during examination in the second or third week of gestation, then he conducts an additional examination, which shows whether there is a threat to further development of gestation or not, and also whether treatment can be continued or should be postponed for more late date.

How to stop bleeding during pregnancy?

If a woman experiences spotting, the very first thing to do is not to panic. Bleeding is possible and does not always threaten the health and life of the woman and child, but panic can increase the tone and also lead to incorrect actions on the part of the pregnant woman.

To prevent this from happening you should:

take a horizontal position, placing a cushion under your feet;
call an ambulance;
take two tablets - no-shpa and valerian, and put a heating pad with ice on your stomach;
do not wash yourself, since the nature of the discharge is important for the doctor to make a diagnosis;
use a pad, do not use a tampon;
be ready to go with the ambulance for an examination.

If hospitalization is offered, you should not refuse. It is important to remember that a woman is responsible not only for her life, but also for her unborn child.

In the hospital, the doctor uses the following diagnostic tools:

gynecological examination;
early hCG analysis;
Late CTG;
Ultrasound.

Treatment will be prescribed depending on the specific cause of the bleeding. If it is caused by damage to the polyp, erosion, or there are no pathologies, then no therapy is required. If the reason is a threat of miscarriage, then the pregnant woman is admitted to a hospital and the following drugs are prescribed to stop bleeding:

hemostatic agents, for example, Dicynon;
antispasmodics – No-shpa;
hormonal - Utrozhestan;
sedatives – valerian;
vitamins – E, B9, magnesium.

If the cause is a frozen pregnancy, then curettage is required, after which antibiotics, anti-inflammatory, and hemostatic agents are prescribed. An ectopic pregnancy cannot be saved; only the fallopian tube can be saved, but not always. In case of placenta previa or abruption, if bleeding cannot be stopped, a caesarean section is prescribed.

Discharge rate

Not all discharge indicates pathology.
In the first weeks of pregnancy, the body has not yet had time to rebuild itself and for some time continues to work as before. Even the first, second, and sometimes third periods after conception are considered normal. Therefore, you can hear more than one story that until three months women are not even aware of their situation. Normally, a colorless or light mass remains on the daily, with virtually no odor. This is mucus with dead epithelium that comes out of the vagina. Any deviations should be a reason to consult a doctor. He will make a final conclusion only based on the results of the smear. And for a preliminary conclusion, it is often enough to see the structure and color:

yellow indicates the presence of inflammation or an allergic reaction to changing intimate hygiene products;
white and homogeneous are often the norm, and curdled ones with a “fishy” smell in combination with itching indicate thrush;
bloody red or brown have a wide range of meanings: from the attachment of an egg to the uterus to the threat of miscarriage and other problems.

The latter interests us most of all, and then we will talk about whether spotting during pregnancy can be normal and what possible deviations this means.