Did you know that some women have regular periods in pregnancy? This may mean you don’t know you’re pregnant until later than usual. But if you’ve been hot off the mark with a pregnancy test, it may also mean you realise you’re having a bleed a month into the pregnancy.
While any bleeding in early pregnancy has to be taken seriously, it doesn’t necessarily mean you’re having a miscarriage.
Many women who bleed in early pregnancy have no obvious underlying cause and go on to have normal and successful pregnancies. It’s just ‘one of those things’.
Bleeding that follows on from severe lower abdominal or pelvic pain is a more urgent problem as it may be due to an ectopic pregnancy. This is a much more serious problem, so should be assessed by a doctor or midwife as quickly as possible.
Pregnant women can have bleeding for all the same reasons that non-pregnant women get bleeding between periods. In fact, pregnancy hormones can provoke some of these problems, eg thrush can get worse in pregnancy and cause bleeding.
Cervical ectropion (previously known as cervical erosion) is quite common in pregnancy. A ‘soft’ fragile area develops on the outside of the cervix. This area can bleed at any time, but is more likely to bleed if touched, so commonly bleeds after sex. It’s not serious, and it usually puts itself right. It doesn’t lead to anything more serious.
Vaginal infections can lead to a small amount of vaginal bleeding. Thrush is particularly common in pregnancy, and can produce bleeding, either as a result of inflammation or the almost inevitable scratching!
If you find spots of blood in your underwear, it’s worth checking where it’s coming from. Piles are common in pregnancy and can leave some blood spots on pants after going to the toilet. Dab the lower vagina and then your bottom gently, with separate bits of tissue paper.
In later pregnancy (after about 27 weeks) bleeding may be due to a low-lying placenta (placenta praevia). This is a potentially serious problem, but the symptoms can start quite innocently with a small amount of painless bleeding. Early diagnosis and assessment of severity of the condition is important, so always report the bleeding, even if you’ve had bleeding earlier in the pregnancy from a more simple problem such as cervical ectropion.
Accidental haemorrhage (placental abruption) is unmistakeable and is a medical emergency. It occurs from about 28 weeks onwards and usually causes sudden severe abdominal pain with some dark red bleeding or clots. There’s no chance of you ignoring this one.
About three-quarters of cases of bleeding after 28 weeks have no serious cause. About 35% are due to things like cervical ectropion or cervical polyp. In another 40%, no cause at all is found.
Towards the end of pregnancy, you may get a small amount of blood mixed with mucus; this is a ‘show’ and indicates that the cervix is preparing for labour. Many women don’t get a ‘show’ until labour has started, but it can happen 2 or 3 days in advance. Let your midwife know; and make sure your case is packed!