Pregnancy losses

Changes in basal temperature, nausea, drowsiness, breast tension and the more frequent need to urinate are disorders that appear with some frequency during pregnancy. To these is added the weight gain, which the future mother can keep under control by following a varied diet and the advice of the gynecologist, who, knowing the state of health of the woman, will give the most useful indications for the diet.

Sometimes, breastfeeding can also be difficult because the nipples are sore and feeding can be difficult.

Fortunately, all these inconveniences should not worry the future mother as these are completely normal situations and destined to disappear.

Among the most frequent inconveniences for those who are pregnant there are also blood loss, which can occur days or weeks after conception, both natural and after assisted fertilization, and considered among the symptoms of pregnancy. However, a few drops of blood are enough to make a pregnant woman worry, because the fear of losing her child becomes pressing. In these cases, it is therefore better to contact a doctor, who can reassure the patient or decide to subject her to tests.

Causes and consequences can be very different from each other, especially depending on the gestation period in which they occur.

In addition, depending on the calculation of the beginning of pregnancy, losses can take on different meanings and should not always be a concern.

During the first weeks of gestation, there may be losses due to the detachment of the trophoblast , a kind of placenta that provides nourishment to the embryo. Although most of the time this problem does not impair the growth of the fetus, it is good to ascertain its nature.

Other times, the losses can be due to so-called “false menstruation”, i.e. slight losses around the days when ovulation or the monthly cycle should have occurred.

In other cases, any red traces on the briefs may instead be due to the presence of polyps, varicose veins, small fissures or hemorrhoids. In these cases, therefore, they do not indicate that something is wrong in the course of pregnancy and the treatment should be prescribed after a careful examination. If the disorders are mild and the gynecologist deems it appropriate, the woman can continue to do her usual life.

Different meanings

Blood loss can be distinguished from a qualitative and quantitative point of view.

The color can range from pinkish to bright red to brown: in the first case it is a very small loss, which mixing with normal vaginal secretions, tends to take on a lighter color than bright red, which instead indicates a fairly conspicuous and recent loss. If, on the other hand, it tends to brown, it means that the emission of blood through the vagina has been slow, giving time to oxidation phenomena to change its color.

If the leaks are dense and foul-smelling, or have a greenish, yellowish or whitish color similar to cottage cheese, burning and itching is present, it is good to contact a gynecologist who will prescribe a tampon. These losses, in fact, could depend on a vaginal infection, which must be treated as soon as possible to prevent germs from going up from the vagina to the cervix, increasing in some cases the risk of premature birth.

In terms of quantity, the losses can range from a few drops that you notice only by urinating, to real bleeding with blood clots: a greater loss, compared to a smaller one, is not always an indication of a more unfavorable prognosis. Sometimes, minimal losses indicate an interrupted pregnancy, while other times copious bleeding does not compromise the progress of the pregnancy and the well-being of the fetus.

Finally, losses can be limited to a single episode or repeated on several occasions. Whatever the characteristics, it is good not to be alarmed, but to consult the gynecologist, who will evaluate whether it is appropriate for further studies and possible therapies. In the case of very abundant bleeding, however, it is advisable to go to the hospital.

First trimester

In the first 3 months of gestation, the causes of bleeding often do not indicate particular problems. If they are brown in color, they are not abundant, they do not cause pain, they can be the so-called “implantation losses”, due to the settlement in the uterus of the fertilized egg.Different is the case in which the losses are more abundant and bright red, especially if pelvic pain is also present. In these cases they could indicate a threat of miscarriage or an incomplete adhesion of the placenta to the uterine wall, a condition to be verified with special tests and examinations.

Typically, bleeding can be:

– the so-called “morula sign”, i.e. the implantation of the embryo in the uterus at the level of the endometrium, which can cause the rupture of some capillary and therefore a minimum loss of blood, completely harmless

– the presence of a polyp at the level of the cervix or an ectropion (a small extroflexion of the endocervical mucosa, commonly called “piaghetta”), or the rupture of a varix or capillary. In these cases, bleeding can occur more easily following sexual intercourse, even in later stages of pregnancy, and has no effect on the health of the fetus.

– a threat of abortion, due to the so-called amniocorial abruption, not to be confused with placental abruption, which occurs at a later stage of pregnancy. It is a detachment of the two tissues that form the placenta, namely the amniotic sac and the chorionic sac, during which, in addition to blood loss, abdominal pain may also appear. In most cases the detachment resolves spontaneously; In others it will be necessary to follow some indications of the gynecologist, who may recommend the administration of progesterone or simply to stay at rest and not make efforts. In others, unfortunately, there is a real abortion, which occurs more frequently when the losses are very abundant and tend to continue for several days

– an ectopic (or ectopic) pregnancy, which occurs when the newly fertilized egg implants outside the uterine cavity, for example in a tube or at the level of the cervix. In this case, blood loss is very frequent and is associated with the impossibility of ultrasound visualization of the gestational chamber inside the uterine cavity. Ectopic pregnancies cannot be carried to term and represent a danger for the pregnant woman: if not recognized in time, they can in fact cause serious bleeding due, for example, to the rupture of the tube in which the embryo is nested. In this case, surgery may be required; If, on the other hand, the diagnosis is made early, the gynaecologist may evaluate methotrexate therapy.

Second and third trimesters

Problems in the placenta most frequently cause vaginal bleeding in the last two trimesters of pregnancy. The causes can be:

– a detachment of the placenta from the walls of the uterus, which occurs physiologically after the birth of the child (secondment), but which can also occur during gestation, causing blood loss, the extent of which is directly proportional to the extent of the detachment. In the case of a limited area, it is possible that the prognosis is favorable and the pregnancy continues without consequences for the fetus. In the case of a very extensive detachment, a timely intervention is appropriate to safeguard the health of both the future mother and the fetus; In some cases it is possible that it is necessary to perform an emergency caesarean section.

– the so-called placenta previa, i.e. the implantation of the placenta not in the upper part, but in the lower part of the uterus, near or at the orifice of the cervical canal, through which the fetus passes during childbirth. The bleeding will also be caused in this case by a detachment of the placenta: the lower part of the uterus tends to increase in size as the pregnancy proceeds; The placenta is instead made up of an extensible tissue, which therefore cannot follow the expansion of the uterus, and from which it will inevitably detach. That is why blood loss due to the placenta previa occurs only in the most advanced stages of pregnancy; Once diagnosed, the expectant mother will be constantly monitored, to assess the moment in which it will be appropriate to carry out the caesarean section.

Finally, it is possible that small blood loss occurs near the end of gestation, often at the leakage of the mucous plug, which indicates the approach of the beginning of labor. After the 36th week, in fact, the losses can be caused by the dilation of the cervix that is preparing for the birth of the baby. During labor, moreover, the cervix can also bleed due to changes due to contractions.

In summary, here is a comparison of the causes of bleeding in the first and second and third trimesters of pregnancy.