Bleeding in Pregnancy

Bleeding or Hemorrhage in pregnancy can be broadly classified into – 

1. Hemorrhage in early pregnancy
2. Ante partum hemorrhage
3. Post partum hemorrage 

• Hemorrhage in early pregnancy

The cause of bleeding in early pregnancy are broadly divided into two groups ;

1. Those related to the pregnant state – Abortion(95%), ectopic pregnancy, hydatidiform mole and implantation bleeding. 
2. Those associated with the pregnant state – cervical lesions, polyps, ruptured varicose veins and malignancy. 

In Abortion, bleeding patterns are :

• Threatened miscarriage – bleeding will be slight, brownish or bright red and stops spontaneously 
• Inevitable miscarriage – increased vaginal bleeding 
• Complete miscarriage – vaginal bleeding becomes trace or absent 
• Incomplete miscarriage – persistence of heavy vaginal bleeding
• Missed miscarriage – persistence of vaginal discharge, trace or brownish bleeding 
• Septic abortion – offensive purulent vaginal discharge 

• Ante partum hemorrhage

Bleeding from or into the genital tract after the 28th week of pregnancy but before the birth of the baby (including first and second stage of labour) 

Causes can be placental bleeding (70%) i.e., 

• Placenta previa (placenta implanted partially or completely over lower uterine segment) – vaginal bleeding is the only symptom, blood is bright red, often occurs during sleep.

• Abruptio placenta or accidental hemorrhage or premature separation of placenta – bleeding occurs due to premature separation of normally situated placenta. Bleeding can be revealed, concealed or mixed. Blood is dark coloured. 

• Post partum hemorrhage

Amount of blood loss in excess of 500 mL following birth of the baby. 

Any amount of bleeding from or into the genital tract following birth of the baby up to the end of the peurperium, which adversely affects the general condition of patient by rise in pulse rate and falling blood pressure is PPH. 

PPH can be minor (<1L), major (>1L) or severe (>2L) 

Types 

1. Primary Bleeding occures within 24 hours following birth of the baby. This can be again two – bleeding occurs before expulsion of placenta or subsequent expulsion of placenta.
2. Secondary bleeding occurs within 8th and 14th day of delivery. Bleeding is bright red and of varying amounts. 

Thus, Bleeding can occur due to various reasons and must be managed as soon as possible after ruling out the causes.