Understanding Bleeding During Pregnancy: What You Should Know

Introduction

Bleeding during pregnancy is a common yet concerning issue. While it may not always signal a complication, it requires proper evaluation. According to Dr. Mini Salunkhe, nearly 20–30% of pregnancies experience bleeding, especially in the first trimester. However, bleeding in the second and third trimesters is less common but more serious and requires immediate attention.

Types of Bleeding by Trimester

1. First Trimester Bleeding (Weeks 1–12)

Bleeding during early pregnancy is often due to:

✅ Implantation Bleeding

• Occurs when the embryo attaches to the uterine wall

• Usually mild and mistaken for a light period

• Not a major concern

✅ Threatened Miscarriage

• Heavier bleeding with or without cramps

• Requires bed rest and progesterone supplementation

• If untreated, can progress to incomplete or complete miscarriage

✅ Ectopic Pregnancy

• Implantation occurs outside the uterus, usually in a fallopian tube

• Symptoms: sharp pelvic pain, irregular bleeding

• Requires urgent diagnosis via ultrasound and blood tests

✅ Molar Pregnancy

• Abnormal fertilization leads to a non-viable pregnancy

• Causes excessive bleeding, requires uterine evacuation

✅ Cervical Causes

• Trauma, sexual activity, or polyps may trigger bleeding

2. Second Trimester Bleeding (Weeks 13–28)

Though less common, second trimester bleeding is often more serious.

✅ Placenta Previa

• Placenta grows near or over the cervix

• Bleeding may occur with exertion or physical activity

• Often improves as the uterus grows and placenta moves upward

✅ Placental Abruption

• Placenta detaches from the uterine wall

• A serious condition often linked to hypertension or diabetes

• Requires immediate medical attention

✅ Cervical Insufficiency

• Weak cervix leads to painless dilation and potential preterm labor

• Managed with cervical cerclage (stitching)

3. Third Trimester Bleeding (Weeks 29–40)

Late-pregnancy bleeding is rare but can be an emergency.

✅ Preterm Labor

• Uterine contractions with bleeding before 37 weeks

• Can lead to premature delivery if untreated

✅ Placental Abruption

• Similar risks as in the second trimester, often more severe

✅ Uterine Rupture

• Rare, but may occur in women with previous uterine surgery (fibroid removal, C-section)

✅ Bloody Show

• A small amount of bleeding mixed with mucus near labor onset

• Typically harmless, but still monitored

Symptoms to Watch For

Pay attention to:

• Bleeding with abdominal pain or cramping

• Previous miscarriages or surgeries

• Bleeding after sexual activity

• Heavy or persistent bleeding

• Any signs of trauma or cervical irritation

Diagnosis and Tests

To identify the cause, doctors may conduct:

• Ultrasound (Pelvic/Transvaginal): To check placenta, cervix, fetus, and uterus

• Blood Tests: Hormonal levels, Rh status, and coagulation profile

• Urine Tests: Rule out infections

• Cervical Examination: For signs of trauma, polyps, or erosion

• Advanced Imaging: In case of suspected ectopic or molar pregnancies

Treatment and Management

Treatment varies based on cause and trimester:

General Measures

• Bed rest and pelvic rest

• Feet elevation

• Hydration and IV fluids (if needed)

Supportive Medication

• Progesterone supplements

• Antibiotics if infections are present

• Blood thinners (in certain high-risk conditions)

Hospital Admission

• For severe bleeding, risk of miscarriage, or suspected placental issues

Special Injections

• Anti-D injection for Rh-negative mothers to prevent blood group incompatibility

Emotional & Mental Support

Along with medical care, emotional counseling and reassurance are crucial. Bleeding can be alarming for the mother and family, and a calm, supportive approach improves outcomes.

When to See a Doctor

Seek immediate medical help if:

• Bleeding is heavy or clot-filled

• Accompanied by pain or fever

• There’s history of previous high-risk pregnancies

• There are pre-existing conditions like fibroids, hypertension, or diabetes

Conclusion

While bleeding during pregnancy is common, it should never be ignored—especially in the second and third trimesters. The right diagnosis and treatment can prevent complications and ensure a healthy pregnancy journey.

If you or someone you know experiences pregnancy bleeding, don’t wait. Visit your gynecologist immediately. For expert care, visit Momstory – Sahyadri Hospital, Hadapsar, and consult Dr. Mini Salunkhe for personalized, compassionate guidance.