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Bleeding from the Vagina during Pregnancy – Causes and Treatment

Bleeding during all stages of pregnancy can be dangerous; you should call your healthcare provider if there are any signs of vaginal bleeding during pregnancy. Vaginal bleeding is any blood from the vagina (the canal leading from the uterus to the external genitalia). This usually refers to abnormal bleeding not associated with a regular menstrual period. Some basic things to know about bleeding are:

– If you are bleeding, you should always use a towel or panty liner so you can control how much you are bleeding and the type of bleeding you are experiencing.
– Never use a tampon or introduce anything else in the area of the vagina as a douche or sexual intercourse if you are experiencing bleeding.
– If you are also experiencing any of the other symptoms mentioned below in connection with a possible complication, you should contact your healthcare provider immediately.

The time period of the bleeding can be:
– The first trimester bleeding is vaginal bleeding during the first 3 months of pregnancy. Vaginal bleeding can vary from light spotting to severe bleeding with clots. Vaginal bleeding is a common problem in early pregnancy, complicating 20-30% of all pregnancies.
– Any vaginal bleeding during the second and third trimesters of pregnancy (last 6 months of a 9-month pregnancy) is abnormal.
– Bleeding from the vagina after 28 weeks of pregnancy is a true emergency. Bleeding can range from very mild to very quickly and may or may not be accompanied by abdominal pain. Haemorrhage (another word for bleeding) is the most common cause of maternal death in the United States. It complicates 4% of all pregnancies.

Causes:
Many women have a certain amount of vaginal bleeding during pregnancy. Some studies show that up to 30% of pregnant women experience some degree of vaginal bleeding during pregnancy. Vaginal bleeding during pregnancy is more common in twins and other multiple pregnancies than singleton pregnancies.

Sometimes women experience very little amount of bleeding in the first two weeks of pregnancy, usually around the time of the expected menstrual period. This light bleeding is sometimes referred to as “implantation bleeding.” Doctors do not know for sure what causes this bleeding, but can occur as a result of a fertilized egg from implanting in the uterine wall.

The amount of bleeding, the stage of pregnancy, and any associated symptoms can help determine the cause of vaginal bleeding during pregnancy. While vaginal bleeding during pregnancy does not mean a problem with the pregnancy, women who experience bleeding during pregnancy should always be evaluated by a physician.

Treatment:
Drugs for treatment of irregular vaginal bleeding depend on the cause. Examples are described below:
– If the cause of bleeding is the lack of ovulation (anovulation), doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive containing progesterone for proper hormone balance. This treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.

– If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone drugs can be prescribed to reduce the accumulation of pre-cancerous tissue lining the uterus in an attempt to avoid surgery.

– When a woman has not menstruated for less than six months, the cause may be the menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern to provide complete contraception until menopause, and to relieve hot flashes.

– If the cause of irregular vaginal bleeding is benign polyps or other tumors, they are sometimes removed surgically to control bleeding, and can not be treated with medication.

– If the cause of bleeding is infection, antibiotics are necessary. Bleeding during pregnancy requires urgent evaluation by an obstetrician. Endometriosis can be treated with medication and / or surgery.

– Sometimes, the cause of excessive bleeding is not evident after the completion of the test (dysfunctional uterine bleeding). In these cases, oral contraceptives may improve cycle control and reduce bleeding.

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