Is bleeding during pregnancy normal? 

BENGALURU: Bleeding during pregnancy is quite common and typically, one in three women may experience bleeding during the first trimester of pregnancy. The condition can also become critical depending on the trimester in which it occurs, quantity of blood loss and accompanying symptoms. Vaginal bleeding during the first trimester could last from a few hours to a few days. Bleeding occurs in 20-30 per cent of pregnant women in early pregnancy and could be a part of the physiological process of implantation that typically occurs 1-14 days after conception. 

Some of the serious causes of bleeding in the first trimester includes ectopic pregnancy (when the embryo implants outside the uterine cavity like the tubes or ovary) or abortions (it could be a threatened abortion or missed abortion). Most cases of bleeding in early pregnancy do not signal a major problem.

However, it is best to consult your obstetrician in case of bleeding. Bleeding in the later trimesters of pregnancy, however, is usually serious. The patient must see her obstetrician immediately. The other serious causes of bleeding in pregnancy are: 

Incompetent cervix
In this the cervix opens up early causing abortions and one may need a stich to reinforce the cervix in order to continue pregnancy.

Preterm labour
Onset of labour earlier than 37 weeks can be associated with bleeding. 

Placental abruption
In placental abruption, the placenta detaches itself from the wall of the uterus before or during birth. The foetus may not get enough oxygen, and the pregnant woman can lose a large amount of blood. 

Placenta previa
When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs without pain. If placenta previa does not resolve, you may need to have the baby early by cesarean delivery. 

Placenta accreta
When the placenta or part of the placenta invades and is inseparable from the uterine wall, it is called placenta accreta. Placenta accreta can cause bleeding during the third trimester and severe blood loss during delivery. 

When to seek medical care
It is vital to consult your doctor if you experience heavy bleeding, discharge with clots or tissue, intense cramping, severe nausea and pain, chills, dizziness or fainting and fever of 100.4° F (38° C) or higher. A quick examination will tell your doctor the cause of bleeding. However, you may need physical examination, blood test, Doppler and ultrasound exam. Your doctor may also look at markers of pregnancy. Blood test will reveal your hormone levels and of the most important hormone during pregnancy, human chorionic gonadotropin (HCG).  

(The author is a consultant, obstetrics and gynaecology, Aster CMI Hospital)