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A problem you can’t ignore
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WOMEN & WELLNESS Bleeding in late pregnancy can be a health risk for both the mother and the foetus
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Samhita is 20 weeks pregnant. She was in her office when she found she was bleeding. She rushed to her obstetrician to make sure that her baby was fine.
Bleeding in the second trimester may be due to a growth (polyp) on the cervix. This can be diagnosed by the obstetrician when she inspects the cervix. Bleeding can also follow intercourse since the cervix is soft and congested in pregnancy. The conditions which need to be watched out for are:
Miscarriage: Although miscarriage is less common in the second trimester than the first, a risk still exists.
Cervical incompetence or insufficiency: Occasionally, light bleeding from the cervix along with profuse white discharge, may be a sign of cervical incompetence, a condition in which the cervix opens painlessly, leading to preterm delivery. This condition occurs most frequently between 18 and 24 weeks of pregnancy and requires prompt medical attention.
Preterm labour: Preterm labour can start off with vaginal bleeding and will then progress to cramping. If the obstetrician thinks that you are going into preterm labour, she will advise bed rest and may also start you on tablets or injections which will arrest labour.
Managing bleeding in the second trimester
Bed rest: If the bleeding is slight you may be advised bed rest at home. If the bleeding is moderate or heavy, you might be admitted to the hospital for a few days till the bleeding stops. You will be asked to gradually increase you level of activity and if there is no further bleeding for 1-2 weeks, you will be asked to resume your routine. It is best to avoid intercourse for 2 weeks following any vaginal bleeding.
Cervical cerclage: If there is evidence of cervical incompetence or insufficiency (painless dilatation of the cervix), an attempt will be made to suture the cervix shut. The suture will be left in place till term and then it will be removed to allow for labour. Sometimes the cervix may have dilated too much and the cerclage procedure may not be feasible.
Bleeding in the third trimester (29-40 weeks)
Bleeding late in pregnancy may threaten the health of the woman or the foetus. Bleeding in late pregnancy will usually require hospitalisation. The two commonest causes of heavy vaginal bleeding in late pregnancy are due to a problem with the placenta. They are placental abruption and placenta praevia.
Placental abruption
One of the emergencies that can occur before or during labour is placental abruption. This problem occurs only in one out of a 100 pregnancies. In this condition, the placenta separates or detaches from the uterine wall, either before or during labour. This may cause vaginal bleeding. This can also be associated with severe abdominal pain. Placental abruption can occur spontaneously but can occur more often in women who have high blood pressure in pregnancy.
Placenta praevia
Placenta praevia occurs in one woman in 200. When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta praevia. Placenta praevia can cause painless vaginal bleeding. Most of the time, this is managed conservatively. You might be admitted to the hospital for observation. If the bleeding is profuse and uncontrollable, then an emergency caesarean section will be done, whatever the age of the foetus.
Management of bleeding in the third trimester:
Bleeding in the third trimester requires immediate medical attention. You may need to be admitted to the hospital to find its cause. After labour has been ruled out, an ultrasound scan may be advised to determine the cause of the bleeding. If the bleeding stops and the health of the foetus is not in jeopardy, you may be kept under observation for a few days or even weeks. If the bleeding has been profuse and a large amount of blood has been lost, a blood transfusion may be required.
Conditions that cause bleeding in late pregnancy can be a health risk for both the mother and the foetus. It may lead to immediate delivery, often by caesarean birth.
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)
GITA ARJUN
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