spotting / bleeding during pregnancy

Vaginal spotting or bleeding during pregnancy may occur in early or late in pregnancy. Spotting may occur due to various reasons.
Sex is one of the reasons of spotting, bleeding of the cervix may occur during sex.
Infection may also lead to bleeding. During pregnancy infection of the vagina and cervix also seen very frequently.
Slight spotting or bleeding stops on its own. But if bleeding is very severe, you should consult your doctor.

Bleeding during early pregnancy–
Slight spotting or bleeding during pregnancy, which is manageable. But heavy bleeding during early pregnancy may mean something more serious. A miscarriage may cause heavy bleeding.

Bleeding during late pregnancy–
Light bleeding may occur because of infection of the cervix, which can be treated. Heavy bleeding may be seen in this phase. Placenta problems and preterm labor are the two main causes of heavy bleeding during late pregnancy.
Placental Abruption and placenta previa- The placenta is attached to the uterine wall.

There are many causes of bleeding.
1. Ectopic Pregnancy
2. Miscarriage
3. Hydatidiform mole
4. Ante-partum hemorrhage
5. Intra partum hemorrhage
6. Incidental causes

1.Ectopic Pregnancy – Ectopic pregnancy is one in which the fetus develops outside the uterine cavity. The commonest site is the Fallopian tube. The length of a Fallopian tube is about 10 cm long and diameter of lumen varies from 1 mm to 5mm.
Ectopic pregnancy may be the result of tubal abnormality which obstruct or delay the passage of fertilized ovum.
Causes of Ectopic pregnancy are–
A tubal inflammation
Previous tubal surgery (attempted sterilization)
Intra Uterine Contraceptive Device (IUCD)
Congenital abnormality of the tube.
If the fertilized ovum didn’t reach to the right place. Implantation may occur in a Fallopian tube only. The ampula is the commonest site of implantation, followed by an isthmus.
The muscle wall of the tube has not the capacity of uterine muscle for a growth of a fetus, ultimately the pregnancy ends with rupture of the tube and death of the ovum.

2. Miscarriage – it is the expulsion of a fetus before 24 weeks gestation. Miscarriage can occur any time in the first half of pregnancy. Mainly it occurs in the first 13 weeks. It happens in about 15-20% pregnancies.
Up to 12 weeks, before the placenta is independently developed, miscarriage may be complete, but from the 12th to 24th weeks of gestation sac is likely to rupture leading to the expulsion of the fetus, while the placenta is retained.
Miscarriage may happen because of-
Abnormal development of the ovum.
Maternal condition- Fever, infection, severe rhesus iso-immunization and chronic maternal illness may increase risk of pregnancy loss.
Uterine causes- fibroids, congenital abnormality of the uterus.
Sign and Symptoms of miscarriage–
Vaginal Bleeding.
Cramps in lower abdomen.
Tissue passing from the vagina.

Hydatidiform Mole / Choriocarcinoma-
Hydatidiform (the growing mass of tissue) changes in the placenta is a form of trophoblastic neoplasia, which may change to a frankly malignant proliferation of trophoblast cells, known as Choriocarcinoma.
It looks like a bunch of whitish grapes. The size of the mole is up to 3 cm.
Symptoms of hydatidiform moles’s are-
Bleeding
Hyperemesis
Pallor and dyspnoea.
The cause is unknown, factors include age ( under 20 and over 45), environment and genetic factors.
Heavy Bleeding usually involves a problem with the placenta.

Ante-Partum Hemorrhage-
Ante-partum hemorrhage is a bleeding from the genital tract after the 24th week of pregnancy and before the birth of the baby.
This includes two conditions-
1. Placenta Praevia (Inevitable Hemorrhage)
2. Placental Abruption (Accidental Hemorrhage)
Placenta Praevia
It depends on the position of the placenta when the placenta lies low in the uterus, it may partly or completely block the cervix. This is called Placenta Praevia.
The exact cause is unknown. The incidence rises with maternal age. This is common in women who have previously been delivered by caesarean section. Twin pregnancy is also one of the causes of placenta praevia.
This commonly occurs around the 32nd week, but may begin as early as the mid-trimester of pregnancy.
Blood loss may be slight and painless.
Placental Abruption
The placenta is attached to the uterine wall. It may detach from the wall before or during labor. Abruption means the separation of a normally situated placenta. Bleeding occurs when it happens. The bleeding may come outside through the vagina or may form a clot inside the uterus.
Many factors are being responsible for an abruption –
Folic Acid deficiencies
Trauma/ direct blow to the uterus.
Anemia
Symptoms–
The patient complains of abdominal pain which may be severe and constant. Pain is greatest when there is a blood clot in the uterus and may be minimal or absent where bleeding is through a vagina. The uterus may be tense and tender due to the retention of the clot and the extravasation of blood into the uterine wall. The term, ‘Couvelaire uterus’ is used to describe this condition.

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