A B C D E F G H I J K L M N O P R S T U V W

BLEEDING IN LATE PREGNANCY

What is Bleeding in Late Pregnancy ?

Bleeding in late pregnancy is bleeding from the vagina after the 20th week of pregnancy. About 1 in 30 (3%) or pregnancies will be affected. In about one-third, the bleeding is due to the afterbirth (placenta) lying in the lower part of the uterus or womb (placenta praevia). In another one-third, the bleeding is due to the afterbirth separating from the womb (uterus). This is called an abruption. In another one-third of cases, no cause for bleeding in late pregnancy is found. The bleeding may affect the mother or the growing baby. The problems that occur depend on the cause and the amount of bleeding. This can vary from slight spotting of blood to extremely heavy bleeding. Very heavy bleeding can be serious and cause shock and collapse. The clotting system and the kidneys may be damaged. These problems are more likely with an abruption than with placenta praevia. Less heavy bleeding may not be quite so dramatic but still be enough to cause anaemia. If the bleeding is very heavy, then the supply of blood to the womb will be reduced. The baby is more likely to be affected by the type of bleeding caused by an abruption. If a large part of the afterbirth has separated from the womb, the baby may die. In smaller abruptions, the baby's growth may be affected. Growth of the baby can also be interfered with by placenta praevia. This is because the blood supply to the lower part of the womb is already less than to other parts of the womb. Bleeding may be heavy enough for your doctors to feel that early delivery of the baby is needed. Then prematurity of the baby can also be a problem.

How does Bleeding in Late Pregnancy occur ?

Placenta praevia can be major, where the placenta covers to opening of the womb, or minor, where it is close to, but not covering the opening. People also describe different grades of placenta praevia, from first grade to fourth grade. First grade is where the afterbirth just reaches down to the lower part of the womb. Fourth grade is where the afterbirth lies right over the neck of the womb. In abruption, bleeding begind the placenta causes it to be peeled off the wall of the womb.

Why does Bleeding in Late Pregnancy occur ?

The cause of placenta praevia is not known, although is it more common in twin pregnancies. In most cases, no cause for an abruption is found. However, an abruption is more likely to occur if you smoke, are carrying a twin pregnancy, or have had an injury affecting your womb.

Treatment Involved for Bleeding in Late Pregnancy

Whenever bleeding occurs in late pregnancy, you must get to hospital as soon as possible. A small amount of bleeding may soon be followed by much heavier bleeding. In cases of very heavy bleeding, blood transfusion and other emergency treatment may be needed. The doctor's first step is to decide whether the bleeding is due to placenta praevia or an abruption. In placenta praevia, the bleeding is often painless, the womb will feel soft to the doctor and the baby will be easier to feel. An abruption is more likely to have given you a cramping or aching pain, with little or no bleeding from the vagina. This is because the blood may have collected between the womb and the afterbirth. When your doctor or midwife examines you, your womb may feel hard and tender, and it is often more difficult to feel your baby. An ultrasound (a type of radar) scan will often be performed. If this shows that the afterbirth is in the lower part of the womb, then a diagnosis of placenta praevia can be made. Abruptions can be very difficult to see on a scan. The clinical signs detected by the doctor or midwife will usually provide the diagnosis.

Treatment will depend upon whether you have placenta praevia, have had an abruption or some other cause is suspected. Placenta praevia : A blood sample will be taken to make sure that you are not anaemic, and to check your blood group. This is because you may need to be given blood. If you are bleeding heavily, or in labour, or if the baby is mature (over 37 weeks), then your baby will be delivered by Caesarean section. Even if your doctors do not feel that your baby needs to be delivered straight away, the risk of further severe bleeding means that you must stay in hospital. Plans will be made to perform a Caesarean section to deliver your baby when it is mature.

Should you go into labour or have heavy bleeding before then, a Caesarean section can be quickly, easily and safely performed. Every 2 weeks or so, your womb may be scanned to check the baby's growth. We can also check that the afterbirth is still over the lower part of the womb. In fact, as the womb grows in the later stages of pregnancy, the position of the afterbirth relative to the neck of the womb may change: the afterbirth may no longer lie in the position of a placenta praevia. This is obviously more likely to happen with first grade than with fourth grade placenta praevia. Abruption : Blood samples will be taken to check for anaemia, and to assess your blood group, clotting system and kidneys. Treatment depends on whether you have had a large or a small abruption. If you have had a small abruption and your baby is not yet mature (less than 37 weeks), then your doctors may decide not to deliver your baby. You will be advised to stay in hospital until the bleeding and any pain settles. This will also enable the wellbeing and growth of your baby to be checked by ultrasound scan and by measuring the baby's heartbeat.

Labour will usually be induced once your baby has reached maturity. If you have had a large abruption and your baby is still alive, then an emergency Caesarean section will usually be done, unless a vaginal examination shows that your baby is about to be delivered vaginally. Sadly, sometimes the baby is no longer alive. Labour will then be induced by breaking your waters and increasing the contractions of the womb with a hormone infusion given into a vein. Bleeding after the birth of your baby is more likely to occur in pregnancies complicated by an abruption. A hormone infusion may well be started to keep your womb properly contracted and so reduce the amount of bleeding. Other causes of bleeding are suspected in about one third of women who bleed. The causes are many and varied. It may be bleeding because the neck of the womb is inflamed or infected. More mild bleeding may occur from the edge of the placenta (marginal bleeding) or may not be from the vagina at all, such as small haemorrhoids (piles). If bleeding occurs after sex, an inflamed or slightly fragile neck of womb may be the cause. Deciding the actual cause may prove impossible. The doctor may take some vaginal swabs to look for infection, and arrange an ultrasound scan to look at the growth of the baby and to check that the placenta is not low in position. Because bleeding is from the edge of the placenta in some cases, you will be offered slightly more frequent checks at the hospital to make sure that this is not affecting the growth of the baby.

During Treatment for Bleeding in Late Pregnancy

If the bleeding has been mild, you may be sent home. It is important that you contact the doctor or midwife if you experience any further bleeding.

After Treatment of Bleeding in Late Pregnancy

Although there is a slightly increased risk of an abruption recurring, it is unlikely that any future pregnancy will be affected in the same way. If you smoke, it is important that you consider stopping. Smoking increases the risk of re-bleeding.

If Bleeding in Late Pregnancy is Left Untreated

Bleeding in pregnancy is serious. It can affect your health and that of the growing baby. It is very important that your health and that of the baby is carefully and regularly checked.

Effects on Family of Bleeding in Late Pregnancy

Bleeding in pregnancy is frightening. You will be naturally upset and worried. The support of your family and friends is important at this crucial time.