Pregnancy is one period in the life of a woman when she and everyone around her make every effort to prevent stress, unhealthy practices and harm from coming to her for the sake of her unborn baby and her own life. For a good number of women, registering and going for antenatal care is the major step they take to be armed with the necessary education to ensure a healthy and safe pregnancy.

However, despite taking this necessary measure, a woman may still develop a complication in pregnancy; this could be due to a risk which she had before pregnancy or due to having experienced a similar complication in previous pregnancies or the circumstances surrounding the delivery of previous pregnancies. One of such complications is bleeding from the vagina in pregnancy which can occur anytime in the 9 months of pregnancy.

1. Bleeding in the first 3 months of pregnancy is usually an indicator of an ongoing miscarriage (spontaneous abortion). This bleeding can manifest in several ways depending on the nature of the miscarriage.

If a woman experiences minimal bleeding without any pain, it is likely what doctors call a threatened abortion. This is a type of miscarriage in which the developing baby is likely still intact but will eventually be expelled if the mother does not see a doctor (an obstetrician) immediately she noticed the bleeding.

In some other instances, the pregnant woman in her first 3 months can bleed very heavily with the blood coming in thick clots which are parts of the forming baby in her womb. In addition, such a woman will experience severe abdominal pain because of the contraction of the womb in its attempt to expel the dead baby.

2. Bleeding in the 2nd 3 months of pregnancy (2nd trimester) may also be a sign of an ongoing miscarriage, although about 80% of all miscarriages occur in the first 3 months of pregnancy. Bleeding in a pregnant woman in her 2nd trimester may be a pointer to a miscarriage caused by trauma to her abdomen (like gunshot or heavy blunt strike which may occur during a fight) or Rhesus incompatibility (the mother’s blood group has the negative sign and that of the unborn baby has the positive sign).

3. Bleeding in the 3rd trimester, especially after 28 weeks, is a serious emergency as both the woman and the unborn baby can die if an intervention is not initiated immediately. Bleeding in this phase of pregnant is largely due to 2 conditions: the location of the placenta at the wrong site in the womb, especially towards the lower end of the womb near the opening of the cervix and the premature separation of the placenta from the wall of the uterus. Bleeding in this phase of pregnancy may also be due to a genetic bleeding abnormality (inability of the blood to form clots after a wound) in the woman which leads to excessive bleeding from any injury no matter how small.

These two conditions are associated with massive bleeding in the pregnant woman who has any of them and the bleeding can any time from the 28 weeks of pregnancy up to the time the baby has been delivered before the delivery of the placenta. The danger of bleeding at this phase of pregnancy is the risk posed to the life of the mother and that of the unborn baby.

Risk factors that contribute to the premature separation of the placenta from the wall of the womb or its attachment at the wrong site in the womb include development of hypertension after 20 weeks of pregnancy, being pregnant with twins or more babies, a woman who has given birth to more than 5 children, a woman who has had multiple abortions in the past or who was delivered of her previous babies by operation (caesarean section).

Bleeding in pregnancy is an emergency and is the commonest cause of death in pregnant women in Nigeria because of late presentation to the hospital and many women not registering for antenatal care. As a pregnant woman, it is your duty to register for and receive antenatal care regularly as early as possible (starting from the first 3 months and attending the clinic until you give birth to your child); it is also your duty to call for help and report to the hospital at the slightest of bleeding from your private part.

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Written by Dr. Okechukwu Amako, MB;BS (Ibadan)

Tags: abortion, antenatal care, bleeding in pregnancy, hypertension in pregnancy, miscarriage, pregnancy

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