Blood is precious and any loss of blood, especially in these fearful days of AIDS, is of concern. In the first trimester of pregnancy, bleeding can herald a miscarriage. About half of early pregnancies that experience significant bleeding are lost.

Miscarriages are part of a selection process in the womb and it is a way of allowing only the healthiest babies to make it into the later trimesters of pregnancy. At least 1 in 5 pregnancies miscarry, but the earlier we look, the more tenuous this little life is and the more miscarriages are seen. The time-honored treatment for threatened miscarriage is bed rest.

Tubal pregnancies also can have vaginal bleeding as well as pain and internal bleeding. This is the most common cause of maternal death in the first trimester. This condition is evaluated with careful physical examination, sonograms and hormone tests that evaluate the strength of the pregnancy. Even though there can be bleeding in the abdomen with a tubal pregnancy, the vaginal bleeding is not from the tube being injured, but from the poor implantation of the pregnancy in the tube. There is not enough hormones being produced to prevent the lining of the womb from bleeding.

Later in pregnancy, abnormal bleeding is generally from the afterbirth, through which the baby gets his food and oxygen in the womb. The "placenta" is the medical name for the afterbirth. If it covers the opening of the womb, it is called a placenta previa (pronounced previa, unlike the Toyota mini-van). If the mouth of the womb is covered, an increase in abdominal pressure from straining or lifting can tear the placenta in this area and cause bleeding. Many placenta previas go away as the uterus enlarges. If the placenta is blocking the cervix at full term, a cesarean is generally indicated to prevent blood loss.

Placental injury is, the other cause of late pregnancy bleeding. This is a premature separation of the placenta from the uterine wall and is called placental abruption. It can be life threatening to both mother and child. High blood pressure, toxemia, abdominal injury, cocaine use and cigarette smoking can increase the likelihood of placental abruption. The bleeding is frequently accompanied by pain and often pushes the woman into labor when it occurs. The risk to the baby is directly proportional to the amount of placental separation from the uterus, a small separation may just be observed if the baby is not mature, a larger separation may indicate immediate delivery.

There are other causes of bleeding in pregnancy that can cause concern, but they are not usually a threat to the pregnancy. The cervix, during pregnancy, is more easily injured and can bleed after any vaginal trauma such as intercourse. With dilation in labor, the cervix can also bleed. It is this bleeding combined with cervical mucus that produces the "bloody show" seen by many women as labor starts. Any bleeding in pregnancy should be brought to the attention of your doctor for evaluation.



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