Q/ 1. 1) Hello Doctor, I am five months pregnant and was told I have blood clots in the uterus. Is my baby at risk? What causes it and how is it treated? Cynthia.
A/ Dear Cynthia,
Bleeding inside the uterus while pregnant (known as subchorionic bleeding), at times manifesting as vaginal bleeding during pregnancy, can be scary.
However, it is not always a sign of trouble. Bleeding in the first trimester (weeks one through 12) is very common and one of the major reasons why women visit hospitals in the first trimester.
Most women who experience bleeding during pregnancy go on to deliver healthy babies.
Still, it is important to take intrauterine bleeding or vaginal bleeding during pregnancy seriously.
Sometimes bleeding during pregnancy indicates an impending miscarriage or a condition that needs prompt treatment.
This bleeding develops between the gestational membranes like placenta and the uterus.
It can collect inside the uterus without flowing as vaginal bleeding (Concealed Uterine bleeding) or it can collect and eventually flow out as vaginal bleeding or an expulsion of a clot.
The outcome of the pregnancy depends on the size of the bleed, the mother’s age and the fetus’ gestational age.
Rates of miscarriage increase with advancing maternal age and increasing size of the bleed.
Vaginal bleeding during pregnancy has many causes. Some are serious, and many are not.
First trimester
Possible causes of vaginal bleeding during the first trimester include:
-Ectopic Pregnancy: where the fertilized egg implants and grows outside of the uterus, such as in a fallopian tube.
-Implantation bleeding: which occurs about 10 to 14 days after conception when the fertilized egg implants in the lining of the uterus.
-Miscarriage: the spontaneous loss of pregnancy before the 28th week (seven months).
-Molar Pregnancy: a rare occurrence in which an abnormal fertilized egg develops into abnormal tissue instead of a baby.
-Problems with the cervix, such as a cervical infection, inflamed cervix, or growths on the cervix.
Second, third trimester
Possible causes of vaginal bleeding during the second or third trimester include:
-Incompetent cervix: a premature opening of the cervix, which can lead to preterm birth (Birth that occurs before the 37th week).
-Miscarriage: before the 20th week or intrauterine fetal death.
-Placenta abruption: when the placenta, which supplies nutrients and oxygen to the baby separates from the wall of the uterus.
-Placenta Previa: when the placenta covers the cervix, resulting in severe bleeding during pregnancy.
-Preterm Labor: which might result in light bleeding; especially when accompanied by contractions, dull backache, or pelvic pressure.
-Problems with the cervix, such as a cervical infection, inflamed cervix, or growths on the cervix.
-Uterine rupture: a rare but life-threatening occurrence in which the uterus tears open along the scar line from a prior C-section.
Normal bleeding
Light bleeding, often mixed with mucus, near the end of pregnancy could be a sign that labor is starting. This vaginal discharge is pink or bloody and is known as bloody show.
Treatment depends on how far long you are in your pregnancy, and size of the hematoma (bruise).
Your doctor may recommend that you reduce on activity levels, limit travel, and hospitalization for strict bed rest for those that have very large hematomas. Supplementation with progesterone helps if early in pregnancy.
Preterm labor treatment can also be given if cramping or contractions occur.
Answered by Dr Joesph Kafuuma.
