Bleeding during pregnancy is a very serious matter. The level of bleeding can vary from spotting to heavy bleeding; and, although it is not always dangerous, in many cases it will signify a problem. Therefore, if you do notice any bleeding during your pregnancy, please call us immediately. We will examine you as a matter of urgency and carry out scans to ensure that your baby is alive. Then, if there is a problem, we will be able to offer you further advice and treatment.
Bleeding during pregnancy may occur for the following reasons: all types of miscarriages (starting from threatened miscarriages, inevitable miscarriage, missed miscarriage, incomplete and complete miscarriages; and the loss of multiple pregnancies), recurrent miscarriages, ectopic pregnancy, Placenta Praevia and Placental Abruption.
In rare situations it may occur due to blood clotting disorders, bleeding from cervix or Cervical Polyps, or from the vaginal wall.
If you are concerned, please book an emergency appointment with one of our experienced gynaecologists. They will see you today.
Placental Abruption is an uncommon but serious complication of pregnancy. It occurs when the placenta starts to come away from the uterus before the baby is ready to be born. If this happens and the placenta has separated (either partially or completely), it can cause intrauterine bleeding and abdominal pain, in addition to deterioration in the fetal movements. If this happens, you must be admitted to hospital immediately, with a view to having an emergency cesarean section, as this matter is life threatening for both baby and mother. The patient’s condition will deteriorate very quickly. Out of nowhere, they will feel extremely faint; begin to sweat excessively; appear very, very pale; with feelings of dizziness and disorientation …. This is often mistaken for labour pain but it is not. It is life threatening and must be taken very seriously.
At the hospital… When the surgeons carry out the cesarean section, if the woman has experienced a complete abruption, her uterus may become blue (this is called Couvelaire Uterus) and she will require a large amount of blood transfusion. In some cases, she may also lose her baby and/or her uterus. However, if the woman receives immediate, urgent treatment, with a very fast recovery of the baby from the uterus, the baby can survive very well.
What are the main symptoms?
Women with Placental Abruption may experience the following symptoms:
If you experience any of the above symptoms, you MUST report to the nearest maternity hospital IMMEDIATELY. Placental Abruption is a life-threatening emergency for both baby and mother.
What is it caused by?
The exact cause of Placental Abruption is unknown. However, it if often associated with women who have:
Note: For patients whose baby is in the breech position. Some gynaecologist obstetricians will attempt external cephalic version to place the baby in the normal position, thus allowing a normal vaginal delivery. This can, on rare occasions, cause placental separation and lead to an immediate Placental Abruption, while the patient is on the table. Therefore, we advise that this procedure should only be performed by extremely senior gynaecologist obstetricians who have substantial experience in the area. In some countries worldwide, the procedure is not performed for this reason. However, here at The Queens Clinic, we are proud to say that our gynaecologist obstetricians have much experience in this area.
What happens if I have placental abruption?
Placental Abruption can be a serious condition for your baby as it has the potential to deprive your baby of vital oxygen and nutrients, resulting in growth problems and even premature birth. Furthermore, a large amount of bleeding can be dangerous for you both, sometimes causing the baby to be stillborn.
Women with Placental Abruption are often advised to give birth by cesarean section for the safety of themselves and their baby. This will be at a much earlier date than the pre-assumed date of natural delivery.
If you are concerned, please book an emergency appointment with one of our experienced gynaecologists today. They will perform a physical examination, arrange the necessary scans, determine the cause of the problem and offer you further advice.
Placenta Praevia occurs when the placenta surrounding the baby is partially (or wholly) blocking the cervix (i.e. the lower end of the uterus that connects to the top of the vagina). This can cause complications and cause severe bleeding before or during delivery of the baby.
Note: Regular scans can detect the low-lying placenta at an early stage during your pregnancy (e.g. the second trimester). Sometimes, the low-lying placenta will begin to appear around the cervix as the pregnancy progresses, partially or completely blocking the internal Cervical OS.
The placenta plays a vital role in providing oxygen and nutrients to your growing baby, and removing any waste products from its blood. In most pregnancies, the placenta will attach itself to the top or side of your uterus. However, if it attaches to the lower area of the uterus, the placenta may grow over the cervix, resulting in Placenta Praevia Centralis. If the vessels run over the internal OS, this is called Vasa Praevia, which may also result in severe bleeding.
What are the main symptoms?
Symptoms associated with Placenta Praevia include:
How is it diagnosed?
Most cases of Placenta Praevia are diagnosed during the second trimester ultrasound examination. It is often diagnosed in women who have been pregnant previously; have a large placenta (e.g. if the woman is pregnant with multiple babies); have uterine scarring due to previous surgery (e.g. a cesarean section or to remove uterine fibroids); use cocaine; are heavy smokers; or who are aged 35+.
If you have Placenta Praevia, your gynaecologist may suggest that you have a cesarean section to safely deliver your baby.
Ectopic pregnancies are a main cause of bleeding during pregnancy. They occur when the fertilised egg implants itself outside of the uterus (e.g. in the fallopian tubes). This is a dangerous condition because the fertilized eggs are multiplying, and will grow inside a lumen of the tube. This will erode the wall of the fallopian tube and will result in rupture (called Rupture Ectopic Pregnancy), causing severe internal bleeding. If this happens, it is life threatening and you will require urgent laparoscopy or laparotomy, depending on the case.
How is it diagnosed and treated?
An ectopic pregnancy may be diagnosed following a vaginal ultrasound; blood tests; laparoscopic surgery; or if the woman is experiencing abnormal uterine bleeding. If detected early, the embryo must be removed using medication (e.g. Methotrexate) or an operation (e.g. a laparoscopy). The exact treatment recommended by your gynaecologist will depend on your symptoms, the size of your pregnancy and the level of pregnancy hormone (i.e. Human Chorionic Gonadotropin (hCG) in your blood.
Important: An experienced gynaecologist will be able to detect an ectopic pregnancy early and carry out the appropriate line of treatment for the case, before the stage of rupture. This is the key to saving the fallopian tube that was affected.
What are the main symptoms?
Women experiencing an ectopic pregnancy often notice symptoms between the 4th and 12th weeks of pregnancy. Symptoms associated with an ectopic pregnancy include:
In some cases, the ectopic pregnancy can grow large enough to rupture, splitting open the fallopian tube. This is very serious and the fallopian tube must be removed immediately, sometimes with the ovary. Symptoms associated with a rupture include a combination of:
IMPORTANT: If you are experiencing these symptoms, you must call us or go to your nearest hospital immediately. This is URGENT!
A miscarriage refers to the loss of a pregnancy during the first 24 weeks. The main signs of miscarriage are:
If you are experiencing these symptoms, please book an emergency appointment with your gynaecologist immediately. They will examine you and perform the relevant tests and ultrasounds to check the health of your baby and advise you further.
What is a miscarriage caused by?
There are many reasons why a miscarriage can happen, although the cause isn’t usually identified. The majority of miscarriages are not caused by anything the mother has done. They are caused by chromosomal or genetic abnormalities.
If the miscarriage occurs during the first trimester of pregnancy (i.e. the first 3 months), it is usually caused by problems with the fetus (e.g. due to chromosomal problems or genetic problems). Approximately 75% of miscarriages happen during this period.
If the miscarriage happens during the second trimester of pregnancy (i.e. between weeks 14 and 24), it may be the result of an underlying health problem with the mother. For example:
How can I protect myself and my baby from miscarrying?
The majority of miscarriages cannot be prevented. However, if a woman has experienced more than three miscarriages, we may recommend that you take certain medication to help you through your pregnancy. This will be monitored under the care of one of our highly experienced gynaecologist obstetricians. You can also reduce your risk of miscarriage by avoiding smoking, drinking alcohol and using drugs whilst pregnant. It is also advisable to maintain a healthy weight and healthy diet, and reducing your risk of infection.
For most women, a miscarriage is a one-off event and they go on to have successful pregnancies in the future.
If you are experiencing these symptoms, please contact your gynaecologist immediately.
The term ‘recurrent miscarriages’ refers to when a woman has experienced three or more miscarriages simultaneously.
In this scenario, your gynaecologist may advise that you undergo the following examinations and testing:
If you are lucky enough to become pregnant again in the future, we will offer you an early ultrasound scan and regularly follow up throughout your pregnancy to monitor the baby’s development and ensure that you continue to have a healthy, successful pregnancy.
For more information, please book an appointment with one of our experienced gynaecologists and fertility specialists who will be able to offer you further advice.