Bleeding in late pregnancy

What is it about ?

This is vaginal bleeding during the third trimester of pregnancy, when the baby is already viable. As this bleeding can threaten the life of the mother and the child, a check-up in the hospital is always advised.

The causes of this bleeding can be very variable:

• the onset of labor and the opening of the cervix before childbirth;
• bleeding from a recent pelvic exam;
• bleeding after intercourse;
• bleeding from a polyp in the cervix;
• bleeding from trauma;
• bleeding from the mucous membranes in case of inflammation of the vagina;
• bleeding from the placenta that comes out of the uterus (placenta previa);
• bleeding due to the (partial) detachment of the placenta.

How to recognize them?

Placenta previa

A placenta previa is a placenta that has developed in the bottom of the uterus. It can block, partially or totally, the exit of the uterus. It can also bleed. This problem is more common in women who have had a previous uterine procedure, such as curettage or cesarean section. Bleeding usually starts spontaneously without triggering factors. Bright red blood loss is observed but painless.

Premature placental abruption

A (partial) detachment of a normally positioned placenta may be related to

• trauma (accident, blow) in the stomach area;
• a sudden decrease in the volume of the uterus, as after the rupture of the water sac;
• a diabetes or maternal preeclampsia;
• alcohol consumption or drugs ;
• smoking;
• the risk is also higher in women whose placenta has already peeled off or who have had placenta previa.

The main symptoms are pain and a tight and tender uterus. Internal and localized bleeding under the placenta is sometimes possible. In this case, the blood loss is not visible. Sometimes the bleeding is profuse and comes with signs of shock, such as pallor, sweating and low blood pressure.

How is the diagnosis made?

In the event of bleeding at the end of pregnancy, the doctor will avoid performing an internal examination so as not to aggravate the bleeding. This is why he will first listen to the sounds of the baby’s heart with a Doppler to check that everything is in order. The doctor can also see the beating heart with a ultrasound. If it is really necessary, the doctor will place a speculum to examine the cervix and vagina.

What can you do ?

A pregnant woman who has vaginal bleeding should always go to the hospital.

What can your doctor do?

If the bleeding is light and the pregnancy has not yet ended, the doctor will closely monitor the mother-to-be. In the event of heavy bleeding and placental abruption, the woman is infused, her anemia possible is treated and we will privilege the cesarean section.

Want to know more?

• Give birth by cesarean, here, Where to find on this page of Cliniques St Luc UCL

Source

Foreign clinical practice guide ‘Bleeding at the end of pregnancy’ (2004), updated on 11.05.2016 and adapted to the Belgian context on 15.10.2018 – ebpracticenet