Bleeding during pregnancy: which ones are dangerous and which are not?

Bleeding during pregnancy, especially in the first trimester, is very common. Quoting from the American College of Obstetricians and Gynecologists (ACOG), bleeding during early pregnancy occurs in 15-25 percent of women. However, this condition can be a sign of various dangerous complications, here is a full explanation.

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The characteristics of normal bleeding during pregnancy

It is normal for a woman to experience spotting bleeding after sexual intercourse during pregnancy or after undergoing internal tests performed by an obstetrician or midwife.

In addition, other bleeding may be completely unrelated to pregnancy and still be classified as normal, namely:

• Yeast infection
• Urinary tract infection
• Hemorrhoid - a common problem pregnant women encounter
• Breakthrough bleeding (fake menstruation because hormone levels are not high enough to stop the menstrual cycle)

Bleeding is still considered normal if the blood comes out only a little, sometimes in the form of spots during pregnancy, similar to bleeding spots experienced at the beginning or end of menstruation.

The color of bleeding during pregnancy can range from pink, dark red, to brown (the color of dry blood) - but never bright red.

Most bleeding during pregnancy occurs between weeks five and eight and in most cases, lasts no more than three days.

Quoting from the American College of Obstetricians and Gynecologists (ACOG), blood spots or spotting can occur 1-2 weeks after conception. When the fertilized egg attaches to the lining of the uterus.

In this phase, the cervix will be more sensitive and bleed more easily during pregnancy because many blood vessels develop there.

This is what makes bleeding during early pregnancy after sexual intercourse or after a pelvic exam.

Bleeding during pregnancy is not necessarily a sign of a miscarriage

About 15-25 percent of pregnant women can experience bleeding while pregnant. Bleeding usually occurs in the first trimester of pregnancy and this is normal.

Usually bleeding during pregnancy occurs at the same time as the menstrual period and can last for 1-2 days.

However, if bleeding during pregnancy occurs in the second or third trimester of pregnancy, you should immediately consult a doctor.

The reason is, bleeding that is not normal and occurs at gestational age before 20 weeks is often a sign of miscarriage.

Especially if heavy bleeding occurs accompanied by other symptoms (such as pain and contractions).

Types of bleeding during pregnancy that should be checked by a doctor immediately

All bleeding while pregnant should be reported to a doctor or midwife, even if the bleeding appears to have stopped.

Although the cause may be minor, the next action taken by the obstetrician will depend on the condition of the body.

The causes of abnormal bleeding during pregnancy include:

1. Vasa previa

Vasa previa is a complication of pregnancy in which the blood vessels from the umbilical cord are located in the amniotic membrane and near the inside of the cervix.

If the blood vessels burst, this can lead to injury and harm the fetus.

Quoting from Amboss, vasa previa is experienced by 1 in 2500 baby births in the world.

There are several risk factors for vasa previa, such as abnormalities in the placenta (velamentous umbilical cord insertion), multiple pregnancies, and having a history of surgery on the uterus.

The sign of vasa previa is bleeding from the vagina without pain and occurs suddenly after the water has broken.

To diagnose vasa previa, the doctor will perform a transvaginal ultrasound to see if the fetus is blocking the birth canal or not.

In addition, the doctor will also check whether there is a decrease in blood flow in the blood vessels or not.

If an emergency occurs, the doctor will perform a caesarean section to save the mother and the fetus.

2. The baby dies in the womb (stillbirth

The condition of the baby died in the womb (stillbirth) characterized by bleeding during pregnancy. WHO said, stillbirth occurs in infants at 28 weeks of age or older with no sign of fetal life.

Signs that pregnant women can feel when the baby experiences stillbirth is:

• Abdominal pain or cramps
• Bleeding from the vagina
• Contraction

Meanwhile, several risk factors for pregnant women experience stillbirth that is:

• Obesity
• Smoke
• Pregnant in old age
• Contain more than one baby (twins)
• Experiencing pregnancy complications

The baby dies in the womb (stillbirth) is a condition that can happen to anyone.

However, this condition can be avoided by reducing the risk factors, so it is necessary to discuss with the doctor if the mother has one of these risk factors.

3.Torn uterine (uterine rupture)

This is a condition when the uterus is torn during childbirth and is triggered by bleeding and occurs suddenly. When experiencing this, the stomach feels very painful which is indicated by a sudden pause in contractions.

A risk factor that increases this is a history of having a cesarean section and transmyometrial surgery.

4. Wounds on the cervix

Bleeding during pregnancy can also be caused by cervical trauma. This happens suddenly and is usually the result of sexual intercourse.

Usually the mother will feel mild to moderate pelvic pain, depending on the level of damage to the cervix.

Signs of this condition are bruising and the cervical area becoming softer.

5. Placenta previa

Sometimes the placenta implants itself very low under the uterine wall or sometimes just above the cervix to interfere with labor.

This condition is called placenta previa and occurs in about 0.5 percent of pregnancies and can cause bleeding during pregnancy.

Placenta previa inevitably causes bleeding during pregnancy at some point in the pregnancy, usually after 20 weeks.

The most common sign of bleeding during pregnancy is the bright red color of the vaginal blood during the second half of pregnancy.

Bleeding during pregnancy can range from mild to severe and is often painful. Some women also experience contractions accompanied by bleeding.

6. Placental abruption

Placental abruption or placental detachment is a serious condition in which the placenta is partially or completely separated from the uterus before the baby is born.

This condition can cut the pathway of nutrition and oxygen for the baby. In addition, placental abruption also causes severe bleeding that can harm both the mother and the fetus.

If you have placental abruption that can cause bleeding during pregnancy, you may see one or more warning signs. Contact your doctor immediately if you are pregnant and notice the following symptoms:

• Bleeding during pregnancy in the vagina with light to moderate intensity.
• A painful or painful uterus (may also feel hard or stiff).
• Has signs of early labor (including regular contractions and back or lower abdominal pain).
• Fetal activity in the womb decreases than usual.

Immediately contact a doctor if you have any of the above signs.

7. Bleeding during pregnancy as a sign of labor

This type of bleeding should be discussed immediately with a doctor. Reporting from the Amboss page, bleeding accompanied by mucus discharge from the vagina is a sign of labor. This is also a condition of an enlarged cervix.

What kind of bleeding during pregnancy is a sign of a miscarriage?

Quoted from the NHS, bleeding during pregnancy caused by a miscarriage will usually be accompanied by stomach cramps and pain in the lower abdomen.

In addition, this condition usually occurs heavier and more, sometimes there are blood clots that come out along with bleeding.

Apart from miscarriage, bleeding during early pregnancy can also be caused by an ectopic pregnancy, aka pregnancy outside the womb.

An ectopic pregnancy occurs when a fertilized egg attaches to a place other than the uterus, usually in the fallopian tube (the tube that connects the ovaries and uterus).

In the Handbook of Maternal Health Services at Basic and Referral Health Facilities from the Ministry of Health, bleeding as a sign of miscarriage has several types, namely:

Iminens miscarriage (iminens abortion)

This type of miscarriage is characterized by a small amount of blood coming out. In addition, this type of miscarriage is usually accompanied by an intensity of abdominal pain that is less painful.

Miscarriage (abortion) imminent means the threat of abortion that occurs at gestational age <20 weeks. D

where this pregnancy condition can still be maintained but you still need to be careful. No need for special treatment.

You only need to reduce excessive physical activity and bed rest (bed rest) .

If the bleeding has stopped, monitor the condition by checking Hb levels and pelvic ultrasound every four weeks.

Meanwhile, if the bleeding doesn't stop, you can check the fetus's condition via ultrasound to see if there are other possible conditions.

Incipient miscarriage (incipient abortion)

In the incident type of miscarriage, bleeding occurs quite a lot with pain in the abdomen is quite severe at the age of less than 20 weeks.

You need to see a doctor immediately to get further treatment.

Incomplete miscarriage (incomplete abortion)

Incomplete abortion is a condition where the pregnancy cannot be continued because part of the fetus has left the uterus.

In this situation, pregnant women will experience profuse bleeding accompanied by abdominal pain which makes it worse.

When bleeding occurs, you can find a lump like flesh that comes out of the birth canal. You need to do a curettage to clean the remaining tissue in the uterus.

Complete miscarriage (complete abortion)

Similar to an incomplete miscarriage, a complete miscarriage also prevents the pregnancy from continuing.

The difference is, in this condition the entire fetus has left the uterus. To find out for sure, it is necessary to do an examination by an obstetrician and ultrasound.

The results of these examinations will determine the next steps. Is it only given drugs or a curettage procedure that aims to clean the uterus.

When bleeding occurs, the egg cannot develop causing it to burst and the fallopian tube tissue shedding and causing bleeding.

Bleeding conditions during pregnancy should be treated immediately by a doctor. If not treated immediately, the mother can experience a lot of blood loss, causing weakness, fainting, pain, in shock , even death.