
First trimester (trimester) bleeding
Most women experience spotting or bleeding during the first three months of pregnancy. In most cases of mild bleeding in the first trimester, the pregnancy proceeds normally. There is no definite link between the amount of bleeding or the presence of other symptoms and the severity of your condition. However, they can be a guide as to whether further investigation is needed. It is therefore important to describe your bleeding to your doctor and tell them if you have any other symptoms.
Causes of bleeding
–Conception bleeding; In the early stages of your pregnancy, you may notice a very small amount of spotting or bleeding. This is about 10-14 days after fertilization. It is also referred to as implantation or attachment bleeding. It occurs when the fertilized egg attaches to your uterus. It appears earlier, in drops and lighter in color than your normal menstrual bleeding. It does not last long. Some women think this light bleeding as menstrual bleeding and do not even realize that they are pregnant.
– Changes in the cervix; When you become pregnant, there is an increase in the amount of blood and blood flow in the cervix. This leads to the possibility of mild bleeding in this area after events such as sexual intercourse or abdominal exercises. This type of bleeding during pregnancy is usually normal.
– Miscarriage; Bleeding in the first trimester can also be a sign of miscarriage. 15-20% of known pregnancies end in miscarriage. Most of these happen in the first 12 weeks. However, bleeding does not mean that you have miscarriage. At least half of women who bleed in the first trimester do not miscarry.
– Ectopic pregnancy: This occurs when the embryo implants outside the uterus (usually in the oviduct). It is much less common than miscarriage. However, if the embryo implants outside the uterus, it is impossible to have a normal baby and this can cause severe internal bleeding. Ectopic pregnancies must be terminated to save the mother’s life. Other symptoms of ectopic pregnancy include abdominal pain (more intense on one side), dizziness and lightheadedness.
– Molar pregnancy; It is a rare condition. After fertilization, an abnormal tissue develops in the uterus instead of a baby. The most common symptom of molar pregnancy is bleeding, but it constitutes a very small proportion of bleeding in the first trimester.
– Non-pregnancy related causes; Trauma or tears in the vaginal wall can also cause spotting or bleeding. Some cervical infections can also cause bleeding in early pregnancy.
When to tell your doctor
If you have had light spotting during the day and it has gone, tell your doctor when you go for your check-up. If spotting or bleeding lasts longer than a day, tell your doctor within 24 hours.
These are the situations you should report urgently;
– Moderate or severe bleeding
– Bleeding accompanied by pain, cramps, fever or chills (the amount of bleeding is not important here)
– Tissue fragments coming from the vagina
– Your doctor will ask you many questions in addition to your examination. Depending on the severity of the symptoms, blood tests or ultrasounds may also be performed. With these tests, the heartbeat and development of your baby can be determined according to the week of gestation.
– Treatment of bleeding in the first trimester of pregnancy will also depend on the cause.
Second and Third Trimester Bleeding
The most common cause of light bleeding in the second half of pregnancy is enlargement and swelling of the cervix. But this bleeding can be life-threatening for you or your baby. The most common cause of severe bleeding in late pregnancy is related to the placenta. These are the placenta being located below or the placenta detaching from the uterus.
What are the causes of bleeding
– Miscarriage; although miscarriage in the second trimester is less common than in the first trimester, there is still a risk.
– Cervical problems: Infection of the cervix, enlarged or swollen cervix can cause bleeding in the second or third trimester. Sometimes light bleeding from the cervix can also be a sign of its failure. Spontaneous opening of the cervix can lead to premature birth. It often develops between 18-23 weeks of pregnancy and requires urgent intervention.
– Low placenta placement; The cause of moderate to severe bleeding in the second or third trimester may be a low placenta placement. The placenta is located so far down in the uterus that the opening to the birth canal is partially or completely blocked. The main symptom of this condition is painless light red vaginal bleeding. Sometimes this bleeding stops spontaneously, but it almost always starts again days or weeks later. It is a serious condition that requires urgent treatment. It usually occurs in the third trimester in one in every 200 pregnant women.
– Early separation of the placenta; It is a condition affecting 1-2% of pregnant women. The placenta begins to separate from the inner wall of the uterus before the birth event. This causes bleeding. The amount of bleeding can be different. It is little, a lot or moderate. But it is often accompanied by abdominal pain. This is usually seen in the last 12 weeks.
– Uterine rupture; In women who have previously given birth by caesarean section, it is the separation of the surgical incision in the uterus. It is a rare but serious condition. In addition to vaginal bleeding, there is severe abdominal pain and tenderness. It causes the baby to partially or completely enter the abdominal cavity.
– Premature birth; Mild bleeding in the 20-37th week of pregnancy may indicate premature birth. Especially if there is a feeling of pressure in the groin or abdomen, excessive low back pain, abdominal cramps or uterine contractions, it makes this situation more suggestive. If any of the signs of labor occur before 36 weeks, you should inform your doctor immediately.
– Onset of labor; During pregnancy, a thick mucus plug prevents the cervix from opening. This prevents bacteria and other germs from entering the uterus. As your body prepares for labor, the cervix becomes thinner and looser. This dislodges the mucous plug. This results in a thin or thread-like discharge. The discharge may also be mixed with blood. This is also popularly called engagement. It is a normal sign of labor and may appear one or two weeks before the expected due date.
When to inform your doctor
Tell your doctor if you develop any spotting or bleeding in the second or third trimester. The cause of the bleeding needs to be found. If there is even a small amount of bleeding accompanied by the following symptoms, contact your doctor immediately;
– Agri
– Cramp
– Fire
– Tremor
– Contractions
Most of the time there is an explanation why bleeding is not life-threatening for you and your baby. However, it is often not possible for your doctor to explain this over the phone. It is necessary to check by ultrasound whether the placenta is located below. If the placenta is not low, a vaginal examination is necessary to check whether the cervix is loose. You may even be monitored to check your contractions and your baby’s heartbeat. If you have lost a lot of blood, you may need intravenous fluids or a blood transfusion. Doctors will also closely monitor your baby to see if it is in distress. The treatment of bleeding in late pregnancy will depend on the cause of the bleeding, your health condition and the gestational age of your baby. Treatment includes bed rest, medication or emergency delivery of your baby.
Important points in diagnosis
You may feel embarrassed to talk about vaginal bleeding. However, your doctor will want to know all the details about the cause of the bleeding. These details are also necessary for further procedures. Please do not be embarrassed and do not leave out any symptoms. Tell us how much bleeding you have, whether there are clots or fragments, what it looks like. If you used pads for your bleeding, keep track of how many you used. With all this information, you will help your doctor to decide whether your spotting or bleeding is a normal course of pregnancy or a serious condition. You can then decide together what to do next.