Causes of Bleeding During the First 3 Months of Pregnancy-

•           Implantation bleeding- Implantation bleeding usually happens just before you expect your period to begin and can cause bleeding or light spotting.

•           Miscarriage – Most miscarriages happen in the first trimester of pregnancy. It can be present as spotting or lighter bleeding or heavy bleeding. If heavy bleeding occurs in the first trimester, especially associated with pain, might be linked to a miscarriage.

•           Ectopic pregnancy-An ectopic pregnancy happens when the fertilized egg implanted somewhere outside the womb. Most common site of ectopic pregnancy is in the fallopian tubes.

•           Cervical polyp- small,finger-like tissue growthon the cervix, the gateway from the vagina to the uterus. When they get inflamed or irritated may lead to bright red bleeding.

•           Sexual intercourse- can cause first trimester bleeding. You shouldavoid intercourse especially in first 3 months of pregnancy.

•           Molar pregnancy-This rare but serious complication happens in almost 1 in every 1,000 pregnancies.A molar pregnancy or “mole” happens when the placental tissue grows abnormally due to a genetic error during fertilization.

•           Sub-chorionic hemorrhage- It is bleeding that happens when the placenta slightly detaches from the wall of the womb.

•           Infection- An infection in your pelvic area or in the bladder or urinary tract can also cause spotting or bleeding and may be caused by viruses and bacteria.A serious yeast infection or inflammation (vaginitis) can also cause bleeding. Infections typically cause spotting or light bleeding that is pink to red in color

 

Second and third trimester bleeding-

Causes-

•           Placental bleeding (70%) -

a)         Placenta praevia- when placenta partially or totally covers the internal os of cervix.

b)         Abruptio placentae- premature separation of the normally situated placenta from the uterus.

•           Unexplained (25%)

•           Extra placental causes (5%)

a)         Local trauma

b)         Cervical polyp

c)         Carcinoma cervix

 

Symptoms-

a)         Placenta praevia- sudden onset, painless bleeding, recurrent episodes, without any uterine contractions and blood will be bright red in color.

b)         Abruptio placentae-bleeding may be varying in amount according to separation of placenta & dark in color and associated with abdominal pain. High blood pressure can be present and fetal movement may be absent.

c)         In case of severe bleeding patient can be presented with shock in emergency.

Complications-

•           Maternal complications-

1)         Varying degree of shock

2)         Anemia

3)         Preterm labor

4)         Increase chance of post partum hemorrhage.

5)         Maternal death

•           Fetal complications-

1)         Sudden intra uterine death

2)         Fetal growth restriction

3)         Cord prolapse

4)         Fetal hypoxia

5)         Respiratory distress

Management-

•           Immediately consult your doctor whenever you have bleeding during your pregnancy. Your doctor will treat accordingly to your clinical examination and ultrasound report.

What is show?

At the time of onset of labor, there is profuse cervical secretion with slight oozing of blood from rupture of capillary vessels of cervix and raw decidual surface because of separation of membranes. So expulsion of cervical mucus plug with blood is called “SHOW”.

Whenever your doctor does per vaginal examination at term, you can feel blood mixed mucus discharge after that. So, nothing to worry for this, it is a sign of onset of labor.