15 Bleeding in Pregnancy
Description
This article is from the Miscarriage FAQ, by Laura Brooks brook006@mc.duke.edu with numerous contributions by others.
15 Bleeding in Pregnancy
The question came up about bleeding during pregnancy and whether or not
that indicates miscarriage. The summary of what I have to say is that I
have been told that more than half of the women who bleed during pregnancy
go on to deliver a full-term child, but pay attention and don't take it
lightly if you find yourself bleeding.
When I miscarried, I spotted for three days, lost the baby, and then
continued to bleed for another week. I read like mad before I lost the
baby, so I found all sorts of information. The three best books I had were
"The Well Pregnancy Book," "A midwifes Guide to Pregnancy and Childbirth,"
and "Preventing Miscarriage: the Good News." I also talked to about 5
doctors in the course of being given 2 ultrasounds and some phone advice in
the face of various changes. Things I learned (this is graphic):
All vaginal bleeding *OF*ANY*KIND* should immediately be reported to your
doctor. Don't wait until lunch, don't wait until morning, don't wait to
make the drive: call and report what you can to whoever is in a position to
advise you.
Heavy bleeding is more likely to indicate miscarriage than spotting, but
even women who bleed heavily do carry to term. One book said some women
shed the uterine lining that is not near the embryo's implantation site.
Bleeding accompanied by cramping or any kind of abdominal pain is more
likely to indicate miscarriage. It is also an indicator for an ectopic
pregnancy--especially if the pain is more on one side than the other.
(Ectopic pregnancies will lose you a fallopian tube if you don't catch them
*very* early.) Don't panic if you do have cramps, because digestive
distress and stretching of uterine ligaments can cause abdominal pain too.
Bright red blood is much more likely to indicate miscarriage than dark
brown blood. Anything gray or pink is a very, very bad sign, since it
usually indicates embryonic tissue or placenta. In my case, the fetal sack
itself was unmistakable and left me no room for doubt (or hope).
Bleeding that continues for three days or more is more likely to indicate
miscarriage than some spotting that stops.
Bleeding that occurs when you would have had your period is much less
worrisome than bleeding that occurs during what would have been mid-cycle.
Implantation bleeding is *very*common*, and it occurs around when your
first period would have been. Many women will have bleeding at their normal
menstrual points for up to three months.
If you have a fever, faintness, or nausea markedly worse than it has been
until you started bleeding (especially if it is accompanied by worsening
abdominal pain), you may have an ectopic pregnancy that needs emergency
treatment: don't wait to make that call--you need to receive further
instructions based on your case.
Two of my books told me that women who bleed and can get an ultrasound
should be totally reassured once they see a strong regular fetal heartbeat.
One book told me that 90% of the women who are bleeding but have a fetal
heartbeat shown with ultrasound will carry to term. You have to be careful
though, because those statistics are for abdominal probe ultrasounds, and
apparently seeing a heartbeat using the trans-vaginal probe is not so
reassuring. (I only found that last out because I lost my baby after seeing
a strong heartbeat on the ultrasound monitor.) So I guess the amended rule
is that if you are far enough along to see the heartbeat with an abdominal
probe (and you see the heartbeat), stop worrying.
The last, and most depressing thing I have to say is that if you do start
losing anything gray or pink (or anything solid), you need to save it and
give it to your doctor. What you lost can tell them if you have miscarried,
if you might need a D&C to make sure no tissue is left behind, and (in very
rare cases) clues to the cause of the miscarriage. Mostly, you will never
know what caused it, but if you are like me, you have a tremendous need to
try to find out how this happened.
In my case, the fetal sack was a good clue because it was much too small
for my stage of pregnancy. Even though I had a baby with a beating heart,
something was wrong. Two doctors suggested that even though the
cardiovascular system of my little one was showing signs of working well,
the baby was not getting enough in the way of nutrients. They suggested
that it might be an implantation problem. This is all conjecture, but even
having a plausible scenario helped me. I needed an explanation of how I
managed to violate the maxim about no longer worrying about the bleeding
once you see the heartbeat.
Tracy Larrabee larrabee@cse.ucsc.edu
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Tracy, thank you for a very informative article on bleeding in pregnancy,
however, I would like to point out one thing about the statistic above. The
fact that over 50% of women who bleed during pregnancy go on to deliver a
full-term child doesn't mean (and you didn't imply this, either, but I'm
sure someone will read this this way) that if you do bleed you have a 50%
chance of miscarriage.
I am currently 24 weeks pregnant with my second child, and with both
pregnancies I bled and had cramps at the beginning. The first one was worse
and I spent three months thinking a miscarriage was imminent. I had
intermittent, heavy, bright red bleeding accompanied by sometimes severe
cramps. Fortunately, everything turned out fine, and I delivered a big
healthy baby boy. If I had read this article during those first three
months, however, I would have freaked out.
Anyway, maybe you could add a note to your FAQ article pointing out that
every pregnancy is different and that although bleeding is a signal that
you should get checked by the doctor, it doesn't necessarily mean
miscarriage is likely, or even indicate a 50% chance of miscarriage for any
particular woman.
BTW, in my case it turned out that I wasn't bleeding from the uterus after
all, but that I have what they call a "friable cervix," which means that it
has a lot of blood vessels in it that bleed easily. So despite all my
worrying, I probably wasn't in any more danger of miscarriage than in any
non-bleeding first-trimester pregnancy.
Anyway, this is just my experience.
Thanks,
Judy Drake judy@pendragon.cna.tek.com
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I first want to preface this by telling you that I had a perfectly healthy
baby boy - 8 lbs 11 oz, 23 1/2 " long! At 7 weeks, before my first Dr.'s
visit, I had spotting of the dark brown kind. This was over the weekend, so
the Dr. told me to schedule an ultrasound on monday morning to see if
everything looked normal. The baby's heartbeat and growth all looked
perfectly normal, so he said I could continue all regular exercise. Don't
take up a new sport, but he specifically said my horseback riding was
perfectly fine, just no jumping. At 10 weeks, I tried out a friend's horse
for only 10-15 minutes, but when I got off the horse, I had floods of blood
running down my legs. I was hysterical, and my friend rushed me to the
emergency room. I assumed I had miscarried because I couldn't believe there
could be so much blood and the baby could live. They called in an
ultrasound tech, and the ultrasound showed a healthy baby with a normal
heartbeat. 10 weeks is before the placenta is completely formed, but they
guessed that I had a low lying placenta and had torn off a piece of it. I
was given strict orders for bedrest for a week, but before the week was
out, I had hemorrhaged again. This heavy bleeding continued off and on
until 14 weeks even with bedrest. For no apparent reason, I would stand up
and the floods would just start. It went away on its own. Later sonograms
confirmed that I had a small piece of placenta that had torn off. They
explained that the danger passed because as I got bigger, the placenta
moved up with my expanding uterus. At the time, all they could tell me as a
diagnosis was "threatening to miscarry". Any unexplained vaginal bleeding
during a pregnancy gets this label. I carried my pregnancy to term, but the
next time I am pregnant, I will not ride a horse regardless of what the Dr.
says!
Michelle Schott MBS4@psuvm.psu.edu
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I think when you start to bleed in the first trimester, this is not good,
but not always bad. My doctor had me check the color (bright red is bad),
as well as the amount of bleeding. I was in my 8th week when I started to
spot.
My doctor told me that if bed rest doesnt slow down my bleeding they would
have me take a quanitative pregnancy test. The test showed that my HCG
level was down very low and this is why I was bleeding and if it continued
to drop that meant that I was miscarrying. I miscarried after 1 1/2 days of
bed rest. I got pregnant 4 months later and gave birth to a healthy baby
boy in May. I feel that my first pregnancy that ended in miscarraige was
not meant to be. It took some time to get over, but I did. I do think about
it, I did all through my second pregnancy, and I thank God for giving me
Zachary.
I think its important that women who are pregnant be aware of what may or
may not happen. I went into my first pregnancy thinking that every thing
would be perfect, I had no worries, then boom it happened. With my second
pregnancy I knew what could happen, so I took it one step at a time. I
didnt tell anyone until I was well into my third month. Then when I started
to show and I heard the baby's heartbeat I just sat back and enjoyed being
pregnant.
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I had spotting with both my pregnancies (one ended with a lovely girl, the
other was a miscarriage at around 6 weeks) and the only difference I could
see was that the spotting was a little heavier for the one that miscarried.
So spotting may not be a definite indicator of an impending miscarriage.
I also disagree with the doctor who said to keep on with normal activities
even with the spotting. My doctor recommended taking it easy the first
trimester (the spotting ended after that) because that's the time when you
are most likely to miscarry and a little extra care (no heavy lifting, no
athletic exercise beyond walking, etc.) would go a long way to prevent any
sad endings.
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