Menstrual bleeding in the 1st trimester of pregnancy

In the first trimester and early pregnancy there are some dangerous and harmless causes. In the case of miscarriage, apart from the ultrasound examination, no further action apart from bed rest is necessary. Another cause of bleeding in the first trimester is ectopic pregnancy.

Here the fertilised egg has implanted itself in one of the two fallopian tubes. This can lead to severe bleeding, which is usually associated with severe to very severe lower abdominal pain and lateral pain. Also known as ectopic pregnancy (EUG), ectopic pregnancy is a gynaecological emergency because there is a risk of the fallopian tube tearing.

With the EUG, circulatory instability and shock of the mother can also be associated with life-threatening situations. The EUG is diagnosed by means of an ultrasound and the treatment is carried out by means of an immediate emergency operation. The rare bladder mole can also cause vaginal bleeding in the first trimester.

A bladder mole is a benign and non-scattering tumour that has formed in the area of the uterus and the fertilised egg during pregnancy. The bladder mole results from a fertilisation disorder with chromosomal changes. The treatment is done by scraping the uterus. The pregnancy is thus terminated, as a normal development of the child cannot be guaranteed.

Menstrual bleeding in the second trimester of pregnancy

In the case of the so-called placenta praevia, the placenta is not in its intended place in the uterus, but near the inner cervix. In this case, however, the pregnancy can still be maintained. However, heavy bleeding can occur during birth and the bleeding occurs before the bladder bursts.

During pregnancy, bleeding may occur again and again, but it will disappear again. If a placenta previa is known, the gynaecologist must carry out appropriate blood tests and check whether the iron and haemoglobin values may need treatment. Pregnant women with a placenta previa must also be monitored very carefully during the birth, as the mother’s circulation may collapse and there may be heavy bleeding after the birth.

Sometimes it may be necessary to perform a caesarean section. However, this also depends on the exact location of the placenta and cannot always be performed. A caesarean section would be considered more if there is heavy bleeding during pregnancy and the 36th week of pregnancy has been exceeded.

Menstrual bleeding in the 3rd trimester of pregnancy

One in 200 to 500 births leads to premature placental abruption, which leads to severe bleeding in the pregnant woman and is an absolute emergency, as the supply of the embryo is no longer guaranteed in this case. The causes of premature placental abruption are pre-emclampsia (high blood pressure during pregnancy), trauma or changing pressure conditions within the uterus (e.g. after rupture of the bladder and birth of a twin). The sometimes extremely heavy bleeding is usually combined with severe lower abdominal pain.

The uterus is as hard as a board, the heartbeat of the child is hardly detectable. There is also the risk of shock to the pregnant woman with circulatory instability and a drop in blood pressure. Premature placental detachment is diagnosed by ultrasound and must be treated immediately.

Before the 34th week of pregnancy, a caesarean section is performed if the mother’s condition allows it. The pregnancy must be terminated by this procedure. After the 34th week of pregnancy, a Caesarean section is also carried out, in which the prematurely born child is usually placed in a premature infant ward.

There is also heavy bleeding, caused by tearing of the blood vessels that run over the egg skins and supply them. This clinical picture is also called Insertio velamentosa. This bleeding can be very severe, usually occurs after the rupture of the bladder and leads to an immediate Caesarean section operation.