Vaginal bleeding during pregnancy is not normal and is considered to be a deviation from the norm. Each vaginal bleeding must identify – where it originates from, its amount, its nature, etc., which occurs at a specialized gynecological examination with speculum, digitally and, if necessary, an ultrasound scan. Although bleeding itself is a pretty disturbing sign for most pregnant women, they should be aware that vaginal examinations do not jeopardize their pregnancy.
Various factors and reasons may cause bleeding. Another important factor is the time when the bleeding occurred compared to the week of pregnancy.
Bleeding may not be a sign of a threatening miscarriage. It can be caused by different processes in the vagina and cervix. These may be infections, polyps, ectropion, wounds, etc. Some of these problems can be successfully treated during pregnancy and leave no trace of their existence.
Approximately 20% of all pregnancies show bleeding from the uterus in early periods of pregnancy, i.e. one in five pregnant women bleed during the first months. We know that far fewer women have a miscarriage. A major part of a miscarriage is due to severe fetal disturbances – genetic and chromosomal. Fortunately, these are sporadic events that can rarely be repeated. What is important to emphasize are two things when an abortion occurs – 1. No one is to blame! Neither the woman nor her partner or even a third person, must take the blame for what happened!; 2. Once a woman becomes pregnant she will become pregnant again! It may be necessary to do further examinations to search for the cause of the miscarriage, but not to try to blame; this should be an attempt to solve an existing obstacle in pregnancy!
Causes of bleeding during the second half of pregnancy can again be conditions that do not endanger it. In a small percentage of cases, and in most cases with a certain condition, bleeding from the uterus may occur. The most common causes are low attached placenta and placental detachment located in a normal place. Both conditions may have different bleeding rates, but both should be established by a physician, actively monitored and treated. Both conditions are quite rare and should be provoked for other reasons – contractions, high blood pressure, external stroke, drainage of a large amount of amniotic fluid, and so on. In any of these conditions the woman has very strong contractions, dizziness, vertigo, fatigue, etc., and if something serious happens to you, you will surely understand.
What should you do if you have bleeding? In the case of minor bleeding, which is still worrying, without panicing ask someone to take you to your gynecologist or even better in a hospital with a Department of Obstetrics and Gynaecology. You may have to stay for a few days under surveillance, but it’s a low price to pay compared to the higher goal you have, namely to become a mother! If the bleeding is abundant and you do not feel well, do not hesitate to call Emergency by telling them that you are pregnant, have plenty of bleeding and you are not feeling well! If it occurs to you, it is a good idea to tell them what month of pregnancy you are. It is important to mention that you should always have a document with your blood group and a rhesus factor with you! This is an examination you need to do when you know you are pregnant.
Uterine contractions can occur throughout the whole pregnancy – from the first months to birth, where contractions are the main substrate of this great moment! Not every contraction is accompanied by pain or even felt by the woman. There are contractions that remain unrecognized by the pregnant woman and are accidentally detected during an examination, ultrasonography or fetal recording. All these ‘hidden’ contractions do not endanger pregnancy. These may be due to the growth of the fetus, the placenta and the amniotic fluid that lead to the uterus and its supporting structures expanding. There may be a hardening of the abdomen in the third trimester, the so-called Braxton Hicks contractions in which the uterus prepares and ‘trains’ for labour. These contractions are painless and do not last for more than 10-20 seconds, they can occur several times a day and become more frequent as the due date nears.
Contractions that you should be bothered about are intense, painful, prolonged, may be accompanied by bleeding, anxiety, dizziness, and so on. If contractions associated with one or more of the above complaints occur, you should seek medical attention but these are rare states. In a high percentage of cases, even in painful contractions, they pass in a few hours or days. We recommend a reduction in provoking moments, which can be from stress, hard physical work, long trips, and so on – including refraining from sexual intercourse. But we do not recommend bedtime mode. This regime is recommended by many doctors as well as relatives. Being bed ridden does not lead to prolonging pregnancy, but leads to unintended consequences such as muscle atrophy, depression, and increases the risk of thromboembolism, which is elevated by pregnancy itself in the third trimester. So we recommend moderate physical activity that leads to a reduction in stress. In case of premature delivery, hospital treatment is mandatory in order to optimize the conditions for survival of the premature child!
One of the disturbing complaints during pregnancy is the vaginal discharge. We know that under the influence of different hormonal and homeostatic factors the vaginal discharge of pregnant women increases. If it is accompanied by burning, itching, stinging (burning while urinating), unpleasant odour, then it is most likely bacterial vaginosis or infection of vulva and vagina. Most of these tendencies are cured by treatment within a week. There are cases where this therapy should be longer and require antibiotics.
An antibiotic therapy may also be necessary if there is no vaginal discharge or any complaints. This is because a routine examination of the vaginal microflora may reveal the presence of pathogenic (disease carrying) microorganisms (microbes). Treatment of these microbes is necessary to prevent the woman from further infection and spreading the infection in the body and the uterus, and to protect the fetus from infection that will pass through the natural birth canal. Preventing the woman from infection is also intended to protect the pregnancy. Sometimes these infections can lead to premature leakage of the amniotic fluid and lead to premature birth.
Sometimes the woman may be deluding that there is bleeding from the genitals because the vaginal discharge is dark, almost brown. This leads to worries and anxiety. Some microbes can cause a flow with such a colour. Treatment is again with different local medicaments or antibiotics.
If vaginal discharge occurs, consultation with a specialist is imperative. Gynecological examination and secretion sampling will help to diagnose and treat the condition properly.
Taking whatever medication always raises the question: ‘Can this harm the fetus?’ This question is very important and we are aware of this! For most medicines, we have an answer to this question. There are other medications for which we assume that have no effect on the fetus or the undesirable effects are minimal. It is important to assess the ‘benefit-risk’ effect of a given medicine, procedure, and so on. I.e. if the supposed benefits are more than the risks, we tend to prescribe a medication.
Regarding antibiotics, we know exactly which antibiotic groups we can prescribe because they have no effect on the fetus and do not cross the placenta barrier, and which groups are not to be prescribed because they are toxic to the fetus. During the second half of the pregnancy, higher doses of antibiotics may be needed than those compared to a non-pregnant woman.
