Bleeding in early pregnancy

Ventre de femme enceinte en début de grossesse

Approximately 25% of pregnant women experience genital bleeding during the first trimester of their pregnancy . Therefore, this blood loss is common and generates many questions and concerns among those most affected. Is this normal? Are these rules ? Is there a risk for the development of the embryo ? Is this necessarily a sign of a miscarriage or an ectopic pregnancy ? In reality, these early pregnancy bleedings are of different natures, have various causes and do not present the same level of severity. Explanations in this article.

In all cases, the occurrence of genital bleeding at any time during pregnancy should alert you and lead you to consult a competent health professional.

Bleeding at the start of pregnancy: metrorrhagia in the first trimester

Bleeding of uterine origin occurring outside of menstruation is called “metrorrhagia”. When they appear during pregnancy, we speak of “metrorrhagia of pregnancy”. These mainly occur at the beginning of pregnancy, but can also appear or repeat during the second and third trimesters. Their occurrence before thirteen weeks of gestation, or fifteen weeks of amenorrhea, gives them the more specific name of “first trimester metrorrhagia”.

Even if it is blood loss, pregnancy breakthrough bleeding is not a period. Having your period and being pregnant are not compatible. In the event of a confirmed pregnancy, the bleeding noticed by the pregnant woman is not menstruation: it is generally less abundant, more punctual and of shorter duration than menstruation. Not to be confused with the term menorrhagia, which refers to abnormally heavy and/or long periods.

Such bleeding during the first 20 weeks of pregnancy is common: 1 in 4 pregnant women are affected. But the reason for their occurrence is not always identified and understood. They may be linked to a more or less serious medical problem, which it is essential to diagnose and treat. They can also remain unexplained, disappear on their own and have no consequences on the pregnancy.

The main causes of metrorrhagia in early pregnancy

Minor cervical injuries

During pregnancy, the genitals are weakened and therefore more sensitive. This is particularly the case for the cervix. Sexual intercourse or a gynecological examination such as a vaginal exam can cause light and brief bleeding, which is completely benign, in this area. These are not metrorrhagia in the strict sense of the term, because the bleeding does not come from the uterus, but the precise identification of their origin is sometimes difficult, they are often assimilated to this category.

The nidation

When the fertilized egg implants in the endometrium, about 6 to 10 days after fertilization, some blood vessels may rupture and cause bleeding. These do not present any risk: they are generally very short - no more than two days - and very sparse - a few drops of blood forming a "stain", "spot" in English, hence the name "spotting nesting”.

Loss of a twin embryo

In the case of a twin pregnancy, that is to say involving twins, the loss of one of the two embryos can occur and result in blood loss. In three-quarters of cases, the remaining embryo continues its development normally.

An intrauterine hematoma

During the first two months of pregnancy, “trophoblastic detachment” may occur. It occurs when the “trophoblast” (the covering surrounding the embryo from which the placenta forms and develops) becomes slightly detached from the uterine wall, causing bleeding and creating what is called a “decidual hematoma ". In most cases, with medical supervision and rest, the hematoma resolves on its own and the pregnancy continues favorably. On the other hand, if the hematoma persists, the risks of partial or total placental abruption, miscarriage or premature delivery greatly increase.

A molar pregnancy

In rare cases (1 to 3 pregnancies out of 1000 in France), it turns out that:

  • the fertilized egg is abnormal, containing no embryo or containing an embryo that cannot subsequently develop properly;
  • and the cells of the placenta grow excessively, forming a tumor called a “hydatidiform mole”.

We then speak of “molar pregnancy”. It is characterized by an overly large uterus, vaginal bleeding, severe nausea and vomiting, and very high blood pressure. The main risk of a hydatidiform mole is that it develops into a cancerous tumor. But most of the time, it is benign: it is treated by curettage or is naturally rejected by the body.

A miscarriage

Also called spontaneous abortion, miscarriage is the loss of the fetus before the 20th week of pregnancy. Between 10 and 15% of known pregnancies (many go uncounted since they occur before women even know they are pregnant) end in miscarriage. It is called early when it occurs during the first 12 weeks (85% of cases of miscarriage) and late when it occurs between the 13th and 20th weeks (15%). It manifests itself as more or less heavy bleeding depending on how far along the pregnancy is, often accompanied by abdominal cramps linked to uterine contractions.

An ectopic pregnancy

In 1 to 2% of cases, the pregnancy does not start in the right place: the egg implants elsewhere than in the uterus, often in one of the fallopian tubes. We are talking about ectopic pregnancy. The fetus is then not viable, but its development can continue for several weeks, which becomes dangerous for the pregnant woman. This type of pregnancy must be terminated as quickly as possible, to avoid spontaneous rupture and possible severe hemorrhage. Light vaginal bleeding and more or less acute pain in the lower abdomen may be felt early, before the rupture of the fetal structure. Termination of such a pregnancy is done either by injection of medication or by surgical intervention.

Pregnant women are frequently exposed to bleeding early in their pregnancy. Even if they are common, often not serious, this blood loss can also be a sign of an obstetric complication that must be taken care of quickly. If you yourself are affected, contact your gynecologist or midwife to identify the cause of this bleeding as quickly as possible. And if they are benign, but they bother you in your life as a pregnant woman, consider using menstrual panties , perfect for absorbing this type of intimate loss.

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Written by cd