Experiencing a breakthrough bleed during your pregnancy can rattle the calmest of women. Knowing what you’re dealing with can help you take the right action as soon as possible. Watch for symptoms and know how to tell them apart so that you can supply your doctor with accurate information on your condition. Remember, regardless of the cause, vaginal bleeding during pregnancy always merits a trip to your doctor as soon as possible.
How Common Is Breakthrough Bleeding In Pregnant Women?
According to data from the US National Library of Medicine, as many as 1 in 4 pregnant women experience vaginal bleeding of some form while they have a baby on board. Early pregnancy bleeding in the first trimester is more common. And those with twins are more susceptible.1
Pregnancy-Related Breakthrough Bleeding
1. Implantation Bleeding
If you experience bleeding just a week to 12 days after you conceive, you can breathe easy. This is a normal phenomenon that occurs as the egg implants itself in the interior lining of your uterus. A third of all women experience implantation bleeding. Besides the period-like bleeding that marks the beginning of your pregnancy, you may also find your breasts have become more tender. Symptoms like nausea crop up.
The discharge you experience is brownish or pink in color, making it subtly different from a normal period bleed. The consistency is same for all the blood, unlike during a period where you may find some clots are passed. The flow itself may be constant or could be spotty.2
2. Sensitive Vaginal Tissue
Sometimes, just having sensitive tissue in the vaginal region could bring on breakthrough bleeding. If this is the reason, the bleeding happens after the area experiences abrasion – for instance, after intercourse or after a pelvic exam due to trauma to the tissue. Typically nothing needs to be done about this, but you should have it checked anyway to rule out underlying infections or possible complications in the pregnancy.3
3. Cervical Polyps Or Infections
Cervical polyps can also cause breakthrough bleeding in pregnant women.4 Cervical polyps can cause bleeding as well yellow white mucus to be passed. You may see bleeding after douching or intercourse. During a pelvic exam, your doctor will be able to see red or purple finger-like growths from the cervix – these are the polyps. Women who have already had one child or more and those over 20 years are more likely to have this problem. The polyps are usually removed surgically in a polypectomy.5 An infection of the cervix may also cause breakthrough bleeding and will need to be treated.6
4. Ectopic Pregnancy
If the fetus implants outside of your uterus, it is called an ectopic pregnancy. This often happens in the fallopian tubes. Signs of such a pregnancy manifest anywhere from the fourth to the twelfth week after conceiving.
The bleeding or discharge is usually watery and starts and stops abruptly. Look for dark brown blood unlike the fresh red blood of a period. Also watch for stomach pain that is on the lower abdomen, to one side of your body only. Pain during bowel movements and diarrhea are other associated problems. Some women also experience pain at the tip of the shoulder. This could be due to internal bleeding and needs emergency medical attention.
If the ectopic pregnancy actually ruptures the fallopian tube, you may need to check if immediate surgery is required. It is dangerous if untreated. Sudden dizziness, feeling faint or actually fainting, a pale appearance, and a very intense and sudden sharp pain in your abdominal region are some signs of a rupture.7
If you’re over 35 or got pregnant while using an intrauterine device, have had your tubes tied over 2 years ago, have had a lot of different sexual partners, or have had infertility treatments, you’re more prone to this problem. Because the pregnancy cannot survive in such an environment and could even put your health at risk, it must be terminated.8
5. Molar Pregnancy
Another cause, albeit quite rare, for breakthrough bleeding during the first trimester is molar pregnancy. In such cases, the initial stage of fertilization goes awry, causing abnormal tissue to develop instead of a normal placenta and fetus. The tissue that develops has either too many chromosomes (69 instead of 46) in the case of a partial molar pregnancy or too few (just 23 instead of 46) as in a complete molar pregnancy. Symptoms of a molar pregnancy are dark and irregular vaginal bleeding, brisker than normal growth of the pregnancy in the abdominal area, severe forms of morning sickness, and abdominal pain. Women over 35 and under 20 are more at risk. Those who have had a previous molar pregnancy or have polycystic ovary syndrome (PCOS) are also susceptible. If your intake of carotene vitamin A is very low, you could be at greater risk of having a molar pregnancy. Once diagnosed, a surgery will be done to remove the tissue.9
6. Placental Abruption
A rare cause for breakthrough bleeding is placental abruption where the placenta separates from the uterus anytime after the twentieth week of your pregnancy. It happens in just 1 percent of all pregnancies and can be treated, but should be taken care of immediately. The vaginal bleeding is accompanied by rapid contractions, tenderness in the uterus, and abdominal pain. Your doctor may also detect abnormal fetal heart rate. Because it affects oxygen and nutrient flow to your baby, it requires urgent attention. For partial separation, bed rest and transfusion may be all that’s needed. For complete separation, the doctor will usually help you deliver the baby right away.10
7. Placenta Previa
In some pregnancies, the placenta may lie very low in your uterus. This can cause the cervix to be partially or completely covered, causing breakthrough bleeding. During labor, as your cervix dilates, the placenta could end up separating from the uterine wall, which is why your doctor will want to monitor it closely. About 1 in 200 women have this third-trimester problem. Those who have had more than one child or are carrying twins or triplets are more prone. Previous surgery on the uterus as well as a cesarean birth in earlier pregnancies may also increase the risk of placenta previa. Painless bleeding accompanied by premature contractions or a uterus that is bigger than is typical for the stage of pregnancy are other warning signs. Your baby may also be in transverse or breech position. Bed rest and frequent follow-up visits to your doctor are usually prescribed. In some instances, steroid injections may be needed to boost lung development of the baby. If bleeding is controlled, your doctor will perform a cesarean delivery immediately.11
8. Preterm Labor
If you’re past the midway mark of your pregnancy, breakthrough bleeding may actually be a sign of preterm labor. You may pass out mucus along with the blood, have cramps, or experience pressure or pain the lower abdomen. A low dull backache and regular contractions are other signs that you’re going into preterm labor.12
Breakthrough bleeding could occur if you are experiencing a miscarriage. A miscarriage may occur in early pregnancy and affects as many as 15 to 20 percent of all pregnancies, typically before week 12. If you notice tissue passed along with the blood or have cramping that’s more intense than the normal menstrual cramps you are used to, you may be having a miscarriage.
This doesn’t prevent you from future healthy pregnancies and is only the body’s way of managing a pregnancy that wasn’t healthy or viable in this instance. Women over 35 have a greater risk of miscarriage and this risk increases with age. Watch for mild to severe back pain, passing of pinkish white mucus, or contractions as in actual labor. Sometimes, bright red or brown bleeding may occur without any cramps. You may also experience weight loss and find that other symptoms of pregnancy like nausea go away.13
What To Do If You Experience Bleeding
Any kind of bleeding, barring early implantation bleeding, demands urgent attention from your doctor. While it could just be sensitive tissue that’s brought this on or an infection that can be easily tackled with a course of antibiotics, it is critical you attend to it, to prevent further complications. On the off chance that it is a more serious problem, getting help on time could make all the difference. Do not try and self-medicate and avoid intercourse until your doctor gives you the green signal.14
You should also go on complete bed rest if you can or limit yourself to light chores around the house, if permitted. If the bleeding or your cramps become very severe, restrict food intake to fluids only.15
|↑1, ↑3, ↑4, ↑6, ↑15||Vaginal bleeding in pregnancy. U.S. National Library of Medicine.|
|↑2||Implantation Bleeding. American Pregnancy Association.|
|↑5||Cervical polyps. U.S. National Library of Medicine.|
|↑7||Ectopic Pregnancy. National Health Service.|
|↑8||Ectopic Pregnancy. U.S. National Library of Medicine.|
|↑9||Molar Pregnancy. Tommy’s.|
|↑10||Placental Abruption. American Pregnancy Association.|
|↑11||Placenta Previa. American Pregnancy Association.|
|↑12, ↑14||Bleeding During Pregnancy. American Pregnancy Association.|
|↑13||Miscarriage. American Pregnancy Association.|