Bleeding during pregnancy and after delivery

Pregnancy

Bleeding is a very common symptom in pregnancy, however while not all episodes of bleeding in pregnancy are causes for concern, others are potentially serious and can be life threatening both to Mother and the unborn baby. Of all the causes of maternal death during pregnancy, bleeding ranks among the Top 5, and should be taken seriously if any potential mother has symptoms. While it has been noted earlier that not all cases of bleeding in pregnancy are serious, only your Doctor or very experienced mid-wife can give you a clean bill of health (or otherwise) if you have symptoms.

Just as pregnancy has different stages, bleeding at any particular stage has different causes and implications depending on the stage, so we will classify bleeding episodes according to the stage of pregnancy in which they occur.

BLEEDING IN EARLY PREGNANCY

  1. Implantation Bleeding- This occurs very early in pregnancy when the newly formed baby is trying to attach itself to the womb. In fact, if the woman is not aware of her pregnancy, she may mistake it for her normal period. Its usually one or two episodes of spotting which eventually stops, and most women go on to have a normal pregnancy.
  2. Miscarriage- This occurs when the pregnancy is about to abort itself. The bleeding should be further investigated. Sometimes the bleeding stops, and the pregnancy progresses normally. At other times, a miscarriage occurs. Regardless of the outcome, the Mother (and pregnancy if still progressing) need follow up.
  3. Ectopic Pregnancy- This is a condition where the baby attaches itself and starts developing outside the womb. The womb is the baby’s natural environment for development. Some babies however may attach themselves outside this environment (e.g fallopian tube, stomach, ovary), and this is not suitable for both baby and mother. As the baby grows bigger, it starts tearing up the tissues of the mother (because of the smaller space). This leads to severe bleeding which can be fatal. It is usually an emergency that requires removing the baby to save the Mother.

BLEEDING IN LATE PREGNANCY

  1. Abnormalities in Placenta- The placenta is the tissue which serves as connection between the baby and the mother. It is usually located far away from the entrance of the womb (called the cervix). But sometimes, the placenta is located in such a way that it is either very close to the entrance, or totally blocks it. Sometimes, the placenta is at the normal location, but begins to detach itself from the womb long before birth, putting mother and baby at risk. These conditions lead to very severe bleeding that must be attended to.
  2. Changes in Condition of Cervix- As the pregnancy advances, the cervix usually becomes very soft and tends to bleed. Once this case has been confirmed by a Medical Professional, and there is no other cause of bleeding, there should be no need to worry.
  3. Infections- The cause of infection should be found and treatment started. It should be remembered that not all drugs are safe in pregnancy, so watch what you take and always seeks advise. Medications should preferably be taken on prescription by the Doctor.

BLEEDING FOLLOWING DELIVERY

A safe delivery does not necessarily mean the new Mother is out of the woods. Maternal deaths related to delivery have been known to occur up to 6 weeks after delivery, so follow up regarding delivery is generally done for up to 6 weeks, when the average after-birth bleed (called Lochia) usually stops.

HOW DO I KNOW OR SUSPECT IF I AM BLEEDING?

  1. Very obvious for many, you basically see blood coming from your vagina. Every first episode of vaginal bleed should be reported. If a particular bleed is heavier than the previous one, even if a clear was given, it should be reported.
  2. Abdominal Pain/Cramps- Sometimes not all cases of bleed are obvious, especially if the problem has to do with the placenta. If you have abdominal pains that are not going away, or that don’t feel like labour pains, please report to your Doctor.
  3. Extreme, or Increasing level of Tiredness- This is because blood is our primary source of energy. The more we loose blood, the less energy we have, and the more tired we become. Sometimes, this tiredness may be difficult to distinguish, as women with normal pregnancies also sometimes get easily tired. But if you feel your fatigue is unusual for your state, it might be worth going to the lab to do a blood test if there is nothing else.

HELPFUL INVESTIGATIONS

  1. Blood Test- This is about the most basic and cheapest to check a woman’s blood level. It is more specifically called haemoglobin level. This tells whether the woman has levels that are normal. Pregnant women are usually given iron tablets to make sure they remain normal. This test is also repeated at intervals to make sure the levels remain normal. They are also used to monitor blood loss if the mother has had any bleed.
  2. Ultra-Sound Scan- Apart from checking the growth of the baby, the scan also helps to locate the position of the placenta. If the placenta is abnormally located, it helps the Doctors prepare their mind on time which action they will take, rather than being caught by surprise. In some cases where the placenta has blocked the womb entrance, delivery has been by Cesarean section.

WHAT TREATMENT DO I EXPECT?

  1. Most times, the woman is only monitored, her blood levels are checked, and the levels also monitored to make sure they are within normal limits.
  2. Mothers with infections are treated with the appropriate anti-biotic. Please, do not self medicate. Not every drug is safe in pregnancy.
  3. Some cases of abnormal placenta have been delivered through cesarean section. Those who did not had to have very experienced hands available during delivery.
  4. Women with ectopic pregnancies almost always loose the pregnancy. Medical intervention is usually with the aim of saving the mother’s life and removing the baby. Usually the baby is less than 15 weeks old and does not survive.
  5. Women with miscarriages usually stop bleeding after the miscarriage has occurred. A few however still go on to bleed as they still have products of conception in their wombs. To stop this, the woman is usually admitted to hospital and those products removed to prevent infection.

In Conclusion, bleeding in pregnancy is quite common, in many cases all that is needed is monitoring and re-assurance, but please always consult your Doctor or mid-wife, as some cases can be life-threatening. Early intervention will increase your chances of having a wonderful and joy-filled pregnancy.

-Dr. Obinna Aligwekwe

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