Causes of Bleeding During First Trimester

Posted by Healthfitline On Sunday, November 4, 2012
The cause of bleeding during pregnancy is usually diagnosed by looking at the stage when bleeding occurs. Pregnancy is divided into three stages; First Trimester, Second Trimester and Third Trimester. In each stage, there are possible causes that are associated with bleeding. In this post, we will be focusing on conditions that are associated with bleeding during the first trimester.

Conditions Associated with Light or Heavy Bleeding During First Trimester Pregnancy 
The two main causes of bleeding during the first trimester are; Spontaneous Miscarriage and Ectopic Pregnancy. However, it is important for a pregnant woman to understand that, spotting during early pregnancy may very innocent since something as simple as the movement of the uterus may irritate some blood vessels hence leading to bleeding. 

This kind of bleeding is usually very slight ranging from pinkish, brownish or reddish color and it is easily contained by use of a panty liner. If the bleeding continues or it requires the use of sanitary towel, this could be a sign that something else might be going on and pregnant woman need to seek medical advice, promptly. 
 
1.  Spontaneous Miscarriage
Spontaneous Miscarriage occurs when there is an interruption of pregnancy before the fetus reaches the viable age or the age at which the fetus can survive outside the mother's womb if born at that time.  A fetus is defined as viable if born after 20 - 24 weeks or weighs atleast 500 grams and above during birth.
 
An early spontanous miscarriage is suspected if  the miscarriage occurs before the 16th week of pregnancy and a late miscarriage occurs between 16th and 24th week of pregnancy. Bleeding occuring before the 6th week of pregnancy is usually mild since the placenta is not well attached. If bleeding occurs after the 12th week, it may lead to heavy or severe bleeding since the placenta is deeply implanted.  
 
Luckily, in most cases,  uterine contractions causes the fetus to be expelled as in normal process of child birth before the placenta detached  itself, hence controlling the placenta bleeding.
 
Causes of Miscarriage
The most common cause of miscarriage is due to fetal abnormalities, teratogenic factors such as ingestion of drug, excessive alcohol consumption and chromosomal abnormalities. Other causes may have something to do with immulogical or embryo rejection, implantation abnormalities or lack of adequate hormones like progesterone which is responsible for maintaining pregnancy. Infections such as Syphilis, Rubella,  Poliomyelitis, cytomegalovirus during pregnancy can lead to a miscarriage.
 
Signs and Types of Miscarriages
There are different types of miscarriages and each one of them present itself with different signs and symptoms. 

(a) Threatened Miscarriage Signs
  • Vaginal bleeding
  • Begins as scant bleeding and eventually turn to bright red bleeding.
  • Woman may experience slight cramping.
  • No present of cervical dilatation on vaginal examination. 
Treatment for Early Miscarriage or Threatened Miscarriage
  • Woman may be advised to go to clinic for further examination.
  • The woman is advised to avoid streneous activities for 24 to 48 hours.
  • Spotting usually stops after 24 to 48 hours after reduced activities.
  • 50% of women who experience a threatened miscarriage continue to have a normal pregnancy. 
Threatened Miscarriage Complication
In 50% of the woman who experience a threatened miscarriage, it usually change from treatened to imminent or inevitable miscarriage.
 
(b) Imminent or Invevitable Miscarriage
  • Presence of uterine contractions and cervical dilatation.
  • Fetal expulsion cannot be stopped. 
Treatment or Management for Imminent Miscarriage
  • Women is requested to go to the hospital immediately.
  • Advised to save all tissue fragments that she may have expelled out and come with them to the hospital for further examination.
  • If no presence of fetal heart beat and sonogram test reveal no fetus in the uterus, a vacuum extraction to remove the products of conception is performed.
  • The woman is also requested to monitor bleeding by counting the number of pads she uses in every hour. If she is saturating more than one pad in one hour, heavy bleeding is suspected.  
(c) Complete Miscarriage
In complete miscarriage, all the products of conception including the fetus, membranes and placenta are expelled without any assistance.
  • Bleeding usually decreases after 2 hours and stops after a few days. 
(d) Incomplete Miscarriage
Incomplete miscarriage occurs when part of products of conception is expelled. Usually the first part to be expelled is the fetus. The membrane and placenta is left behind.
  • It can lead to maternal hemorrhage if a part of the placenta is retained in the uterus since this condition prevent the uterus from contracting normally.
  • Curretage and dilation is usually performed to remove the remaining products of conception from the uterus. 
(e) Missed Miscarriage
Missed miscarriage is also known as early pregnancy failure. It occurs when the fetus die inside the mother uterus and is not expelled out.
  • Usually no signs of fetal growth when fundal measurement is taken.
  • Painless vaginal bleeding may be present or no signs at all.
  • No presence of fetal heart beat.
  • If the fetal is more than 14 weeks, labor may be induced. Otherwise, curretage and dilation is performed.
  • If the dead fetus is not medically expelled, spontaneous miscarriage occurs after 2 weeks but there is risk of allowing this to happen since it can lead to DIC (disseminated intravascular coagulation), a fatal cause of maternal hemorrhage. 
(f) Recurrent Pregnancy Loss
If a woman experience pregnancy loss for atleast three times consecutively, occuring at the same gestational period, then the woman can be described as having a recurrent pregnancy loss.  Possible cause of recurrent pregnancy loss are;
  • Abnormalities in spermatozoa or ova.
  • Endocrine problems
  • Abnormal formation of uterus
  • Presence of infection
  • Other autoimmune disorders such as lupus. 
Complication of Miscarriage
  • Can lead to maternal hemorrhage (rarely does fetal hemorrhage occurs).
  • Can lead to DIC ( Disseminated Intravascular Coagulation).
  • Can lead to infection (most common to woman who have lost alot of blood).
  • Possible cause of Isoimmunization.   
Isoimmunization occurs when the fetal blood mixes with the maternal blood during placental dislodgement. Incase the fetal Rh (Rhesus factor) is positive and the mother Rh is negative, the mother produces antibodies against the fetal Rh positive blood,  if the next fetus has blood with Rh positive, the antibodies produced by mother will attempt to destroy the red blood cells of that fetus while is in the uterus. 

This is the reason why after a miscarriage, the woman should receive Rh (D antigen) immune globulin (RhIG) since the blood type of the fetus is not known. This prevent the mother from developing antibodies incase the next fetus Rh is positive.
 
2.  Ectopic Pregnancy
Ectopic pregnancy is  also another condition that is associated with bleeding during the first trimester. Read previous article on Ectopic Pregnancy. 
 
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