Bleeding during pregnancy does not necessarily mean that something is wrong. Some bleeding can be “anniversary rules”. Explanations.
Losing blood while pregnant is cause for concern. Many things can explain it, and if the bleeding can indicate that something is wrong, it is not always serious. These are called the “birthday rules“, but the name of this bleeding is actually “metrorrhagia”. However, it is always recommended to consult a doctor or a midwife in case of bleeding during pregnancy.
Bleeding during pregnancy, is it serious?
In the first 20 weeks of gestation, vaginal bleeding is observed in 20% to 30% of women. They can be a sign that something is not going well: an aborted ectopic pregnancy, or in the process of abortion, an ectopic pregnancy (outside the uterus), a so-called “evanescent” twin (the one of the fetuses stops developing), trophoblastic abruption, spontaneous abortion, or molar pregnancy.
But only half of these cases result in a miscarriage spontaneousrecalls the MSD Manual.
A CNRS document also emphasizes that the metrorrhagia are not rules, they arise outside. In 50% of cases, they are therefore not a serious symptom. They can be related to anything other than pregnancy: lesions of the cervix, for example, or a decidual hematoma (a marginal portion of the placenta comes off). That said, this bleeding is associated with rather high-risk pregnancies, which must therefore be controlled.
Depending on the symptoms and the aspect of the periods: what diagnosis?
In general, they last a maximum of 5 days and are not very abundant, specifies a CNRS document. But the Professional body of doctors practicing gynecology and obstetrics in France (CNGOF) explains that certain symptoms are more leaning towards a spontaneous abortion: especially when the hemorrhage is frank with red blood and clots and “debris”. But also pelvic pain that evokes menstruation and contractions.
If the bleeding is scanty and blackish, accompanied by “lateralised, dull pelvic pain, with more intense bouts, sometimes scapulargia or malaise”, the CNGOF believes that this leans towards the option of an ectopic pregnancy.
But if the hemorrhages are isolated, without pain, recurrent, the diagnosis will lean towards an evolving intrauterine pregnancy.
What to do in case of bleeding?
The answer can only be given after certain examinations. The first thing to do, therefore, is to consult a gynecologist or a midwife to understand where the bleeding is coming from. In general, a general examination of the patient, then a speculum examination is carried out. “The diagnosis is based on the clinical examination but also on the quantitative plasma assay of the β component of the chorionic gonadotropin hormone (βHCG) and the pelvic ultrasound, most often endovaginal”, explains the EM Consulte website. What doctors want to know is: where is the pregnancy located and if it continues to evolve.
It may happen that this bleeding is due to an infectious cause, in which case antibiotic therapy may be prescribed. Antispasmodics and analgesics may also be administered. In most cases where the pregnancy continues to progress despite the bleeding, no cause is found, specifies the CNRS study.
What are the risk factors?
THE anniversary menstruation, or metrorrhagia could be related to the age of the mother, with a tendency to increase over time: before 20 years, it is estimated at 11%, against 16% for women after 34 years. Two other factors can promote bleeding: the fact of having your first pregnancy (primiparity) and the fact of having undergone in vitro fertilization (IVF). At least when it comes to bleeding that occurs in the first trimester. When you have experienced it during a pregnancy, there is a greater risk that it will happen again during a future pregnancy.
Sources: CNGOF, CNRS, EM Consulte, MSD Manuel.