Sunday, November 30, 2008

Bleeding during early Pregnancy

Is spotting during pregnancy normal?
Spotting is light bleeding from the vagina similar to, but lighter than, a period. It varies in colour from red to brown. While it's not exactly normal, light bleeding or spotting during pregnancy - particularly during the first three months - is fairly common. It's estimated that about 15 to 25 per cent of women experience some sort of bleeding in the first trimester. Often it turns out to be caused by something minor or "just one of those things". However, it can be a sign of a more serious condition that could put you and your pregnancy at risk. This is why it's always best to take any bleeding in pregnancy seriously and get the bleeding checked out.
What should I do if I notice bleeding?
Call your doctor, midwife or hospital straightaway for advice, even if it eventually stops. You may need a vaginal examination or an ultrasound to rule out any complications and to make sure you and your baby are fine. You will probably be given a urine pregnancy test and blood test (to check your hormone levels). You may be referred to an Early Pregnancy Assessment Unit (EPAU) or clinic (EPAC), where the facilities are specially tailored to care for women with complications in the first trimester of pregnancy. (Find out if there is an EPAU in your area.) An examination using "transvaginal" ultrasound is often the best way to check whether all is well. In a transvaginal ultrasound, an ultrasound probe is gently inserted into your vagina, giving a clearer view of where the pregnancy is situated and whether the embryo is developing normally. Severe, persistent abdominal pain with or without bleeding can be a sign that the pregnancy has implanted outside of the uterus - an ectopic pregnancy - in which case you will need to go to hospital immediately.

What causes bleeding during early pregnancy?
There are many causes for spotting or bleeding early in pregnancy, some of which are more of a concern than others. Two common causes of early bleeding, which usually clear up on their own without any problems are: • "Breakthrough" bleeding - the hormones that control your menstrual cycle can cause breakthrough bleeding when your period would have been due. Some women experience this sort of bleeding more than once during their pregnancy, generally at times that fitted their previous menstrual cycle. • "Implantation" bleeding - when the fertilised egg attaches itself to the wall of the uterus causing bleeding. You may experience some spotting or light bleeding, which usually lasts a day or two. Another much rarer cause of bleeding is a molar pregnancy. This happens when the embryo doesn't develop properly but some of the cells that form the placenta continue to grow abnormally. For your safety, both molar and ectopic pregnancies have to be removed as soon as possible. Bleeding can also be a sign of an underlying condition, which may need treating or for you to take precautions during the rest of your pregnancy. Bleeding can be caused by: • An irritated or inflamed cervix - pregnancy hormones can change the surface of the cervix (the lower section and entrance to your uterus) making it more likely to bleed. You may bleed a bit after sex or a cervical smear, for instance. • A cervical or vaginal infection. • A cervical polyp - a small, benign growth that has formed on the cervix. • Fibroids - particularly large fibroids that have formed within the lining of the uterus, or fibroids situated where the placenta has implanted. • An inherited bleeding disorder - such as, Von Willibrande disease. • A "vanishing twin" - when one or more embryos in a multiple pregnancy miscarries leaving an embryo behind. This can happen in naturally conceived pregnancies but it has been seen more frequently in assisted conception pregnancies where more than one embryo has been implanted. Bleeding can also be set off by trauma of some kind, such as a fall, a car accident, or as the result of domestic violence.
What does bleeding in early pregnancy mean?
The worst case scenario is that the bleeding is a sign that your pregnancy is going to come to an end. Spotting or light bleeding can be an early sign of miscarriage or an ectopic pregnancy, especially if accompanied by abdominal pain or cramping. Try to prepare yourself, but don't lose all hope. Depending on the cause, many pregnancies continue despite early bleeding problems. It is estimated that about half of women who seek help because of bleeding in early pregnancy go on to have their baby successfully.
What causes bleeding in late pregnancy?
In the third trimester bleeding or spotting can signal a condition called placenta previa, placenta abruptio (whereby the placenta separates from the uterus), or premature labour. If you notice spotting after 37 weeks, it's most likely to be just a sign that the cervix is beginning to soften, maybe even dilate. You may notice a blood-tinged mucus discharge - part of the mucus plug that has sealed your cervix shut during pregnancy coming away. This is more commonly known as "a show" and is one of the signs that labour is going to start.
Is my baby at risk?
It is difficult to predict whether spotting or bleeding is going to end in miscarriage. However, there are some factors which are more strongly associated with pregnancy loss than others. These include: • increasingly heavy bleeding • your age - if you are under 25 years or over 35 years of age, your risk of miscarriage is increased • whether you smoke or are exposed to passive smoking - both of which have been associated with miscarriage • a history of miscarriages Spotting or light bleeding in early pregnancy is linked to a slightly increased risk of some pregnancy complications, such as pre-eclampsia and premature birth - when the baby arrives before the end of the 37th week of pregnancy. Placenta abruptio (when the placenta separates from the uterus) in late pregnancy has also been linked to bleeding in early pregnancy. Heavy bleeding in early pregnancy is also strongly associated with problems with the placenta, such as placenta praevia, placenta abruptio, and having a baby that is small for dates. These are all potential complications which your maternity care team will be looking out for in any case. But the increased risks with heavy bleeding may mean that your antenatal care becomes more consultant-led than midwife-led so that any potential problems are monitored more closely. As scary as all this may sound, spotting or bleeding is more often a harmless mystery. article can be found at http://www.babycentre.co.uk/pregnancy/antenatalhealth/physicalhealth/vaginalspottingorbleeding/

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