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What is it about ?
Vaginal bleeding during pregnancy does not necessarily mean that you are having a miscarriage. There may be other causes.
This guide only talks about bleeding before the 28e week of pregnancy. It is important to find the cause, especially between the 22e and the 28e week of pregnancy, because the fetal lungs are not yet fully developed. At 25 weeks, there is a little more than a one in two chance that the fetus will survive. From 28 weeks, the chances of survival are generally good. In the event of bleeding with loss of the fetus before 25 weeks, it is called a miscarriage. After 25 weeks, it is called a premature birth.
The causes of bleeding can be varied:
- miscarriage due to fetal abnormalities, genetic abnormalities, rejection by the mother’s immune system, abnormalities of the uterus and diseases during pregnancy, such as diabetes, thyroid disease, hormonal disorders and infections;
- ectopic pregnancy ;
- causes related to the placenta;
- infection, polyp, lesion, tumors of the vagina or cervix.
How to recognize it?
We distinguish the threat of miscarriage, missed abortion, miscarriage and septic miscarriage:
- a threatened miscarriage is accompanied by bleeding and mild stomach pain. The sounds of the fetal heart can be heard perfectly. The size of the uterus is normal for the stage of pregnancy (gestational age) and the cervix is closed. The fetus has no worries.
- in missed abortion, the fetus died, but it was not expelled. This does not cause actual bleeding. You may notice rather brownish and watery discharge. Stomach aches can happen, but not always. The size of the uterus is smaller than normal for the stage of pregnancy, and heart sounds are not heard. The cervix is closed.
- a miscarriage is usually accompanied by stomach pain and heavy bleeding, sometimes containing clots. The fetus is also expelled, but you don’t always notice it. We do not hear the sounds of the heart. The cervix is dilated. A miscarriage can be complete (all tissue is evacuated, including the placenta) or incomplete (there is residual placenta inside the uterus). In a complete miscarriage, the bleeding usually stops spontaneously after a few days. In an incomplete miscarriage, bleeding persists and the risk of infection is greater.
- a septic miscarriage is caused by an infection in the uterus. It is accompanied by intense bleeding, stomach aches and fever.
How is the diagnosis made?
If your GP suspects a miscarriage, they will almost always refer you to your gynecologist. The urgency depends on the viability of the fetus and the nature of the complaints. The gynecologist examines the uterus: the size, tenderness, contractions, dilation of the cervix, the origin of the bleeding. He then looks for sounds of the fetus’ heart to check if it is still alive. If he hears heart sounds, he will also do an ultrasound to examine the fetus, its heart, and the placenta.
What can you do ?
See your doctor if you have any bleeding during pregnancy. If there is a threat of miscarriage, you need to rest. This means that you no longer have to exert strenuous efforts. It is therefore not necessary to remain bedridden 24 hours a day. The pursuit of moderate activities, alternating with periods of rest, is perfectly possible. It is best to avoid intercourse. When you are bleeding heavily and are over 22 weeks pregnant, it is advisable to go to the hospital.
What can your doctor do?
If there is a threat of miscarriage, the doctor will advise you to rest and carry out regular checks. The usefulness of drug therapy has not been demonstrated. After a complete miscarriage, no medical intervention is necessary. After an incomplete miscarriage or a missed abortion, curettage is usually done. In some cases, the evacuation of the fetus is caused by drugs. If you have an infection you will be treated with high doses of antibiotics.
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