Bleeding During Pregnancy
(If there is bleeding after >24wks gestation it is known as an antepartum haemorrhage)
Bleeding during pregnancy can have several causes:
- Ectopic Pregnancy
- Molar Pregnancy - this is a trophoblastic disease where there is over proliferation of the placental tissue, (there may or may not be a foetus present). As the placenta produces beta hCG, the levels will be very high, patients present with bleeding or extreme symptoms of early pregnancy (e.g. nausea and vomiting). Molar pregnancies are either benign (hydratiform mole) or malignant (choriocarcinoma)
- Placental abruption – painful, can have a rigid abdomen and clinically be in shock. A common, worrying cause of bleeding in later pregnancy. May be obvious, or concealed
- Uterine pain, shock, fetal distress. Signs: Tense, tender uterus, difficult to palpate fetus.
- May be associated with trauma, pre-eclampsia, IUGR
- Placenta praevia (low lying placenta) – painless. A common, worrying cause of bleeding in later pregnancy. Give Anti-D, consider early delivery by Caesarean section to reduce risk of Rhesus iso-immunisation.
- Showing – normal, light bleeding during labour as cervix dilates and damages capillaries.
- Infection (vaginal or Urinary Tract Infection)