Menstruation or intermenstrual bleeding?
Pregnant or not? Many women make the answer to this question dependent on the absence or onset of menstruation. However, women often do not know that bleeding is relatively common, especially in the early stages of pregnancy. It is not always easy to distinguish what vaginal bleeding is: the onset of the period, an early miscarriage or harmless spotting?
Pregnant: Always have bleeding clarified!
Bleeding during pregnancy – whether light or heavy – should always be taken seriously. Depending on the time of pregnancy at which bleeding occurs, different reasons are likely. You should always have these clarified. This is especially true if bleeding during pregnancy is accompanied by pain in the lower abdomen or fever. Then you should see a doctor or the hospital immediately! Also, if there is a lot of bright red blood and/or a lot of blood loss, possibly with blood clots (blood clots), urgent medical help is needed. These signs indicate a serious cause of bleeding.
Early pregnancy: Possible causes of bleeding
- Implantation bleeding: occurs on the 7th to 12th day after fertilization when the egg implants in the uterus due to injury to small vessels; usually bright red, short bleeding
- hormonal changes during pregnancy
- Cervical polyp: polyp-related bleeding in early pregnancy can easily be mistaken for miscarriage. Polyps promote infections and associated risks
- Infections of the vagina or cervix: not threatening to the baby, but must be treated to avoid preterm labor or premature birth
- Ectopia: protrusion of the endometrium onto the cervix; painless
- Contact bleeding: injury to small vessels through sex or vaginal examination; favored by infections and ectopy; usually manifests as spotting
- Ectopic pregnancy: implantation of the fertilized egg in the fallopian tube; lower abdominal pain, spotting, life-threatening if blood is lost into the abdomen!
- Bladder mole: very rare maldevelopment of the placenta; no viable baby
- Ovarian cysts (mostly corpus luteum cysts): When bursting, blood vessels can be damaged; painful; danger to life in case of severe internal bleeding!
- Miscarriage (abortion): Early abortion (up to 12th SSW) or late abortion (13th to 24th SSW).
- Cervical cancer: in the early stages, mainly contact bleeding; advanced carcinomas are manifested by spotting or bleeding in between.
Pregnant women should always take blood loss seriously, even in the first few weeks. Especially if bleeding during pregnancy is accompanied by pain, cramps or fever, a gynecological examination is absolutely necessary.
Bleeding in the second half of pregnancy
- Placenta praevia (anterior wall placenta): placenta mistakenly sits close to or in front of the cervix; usually painless, sudden bleeding; no to mild contractions
- Premature placental abruption: placenta detaches prematurely from the uterine wall (e.g., due to an accident); painful bleeding of variable intensity
- Uterine rupture: complete or partial rupture of the uterine wall; painful; danger to life of mother and child!
- Bursting of varicose veins in the area of the pubic or vagina after vaginal examination or during delivery: life-threatening blood loss possible
- Drawing bleeding: slight vaginal bleeding before the 35th week of gestation, possibly with discharge of a bloody mucus plug; may indicate impending premature birth!
- Late abortion, premature birth or stillbirth: usually labor-like pain in the lower abdomen, low back pain and discharge of amniotic fluid
- Contact bleeding: after vaginal examination or sexual intercourse
- Placental rim hemorrhage: minor bleeding without contractions
- “Drawing” after the 35th week of gestation: with a bloody plug of mucus or a light spotting, the beginning of labor is announced (opening period)
How is bleeding in pregnancy clarified?
Whether bleeding threatens the pregnancy or the health of mother and child, the gynecologist can find out by a careful examination. Especially in the case of heavy bleeding during pregnancy, it is crucial to identify the source as quickly as possible. The gynecologist can get an initial impression of the seriousness of the situation as early as the precise palpation. Furthermore, a contraction recorder (CTG) and ultrasound examination help in the search for the cause.
Pregnancy: What to do in case of bleeding?
If bleeding during pregnancy is judged by the doctor to be harmless, he will recommend that you take care to rest, avoid stress and refrain from sexual intercourse.
In case of serious bleeding during pregnancy, there may be danger to the life of mother and child. Especially in the case of high blood loss, the bleeding must be stopped quickly, because in the worst case, a so-called hemorrhagic shock threatens. In the case of an imminent miscarriage, labor-inhibiting drugs and bed rest can usually prevent worse. In the event of severe complications in the second half of pregnancy, such as placenta praevia, premature placental abruption or uterine rupture, an emergency cesarean section must usually be performed. If bleeding during pregnancy is due to a bladder mole, a curettage may be necessary.
