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Heavy Bleeding During Pregnancy And Birth

How do you know when heavy bleeding is something to worry about? Find out everything you need to know about heavy bleeding during pregnancy and birth here.

A small amount of vaginal bleeding during labour is normal (an amount less than a normal period). This can be pink, bright red or dark brown in colour, sometimes mixed with mucus as a show or sometimes mixed with amniotic fluid as the waters break. Slight bleeding can be something noticed on a sanitary pad, on underwear or when wiping with toilet paper. However, some women don't experience any vaginal bleeding at all during their labour, only at the birth.

A small amount of blood can come away during prelabour, and/or the first and second stages of labour (continuously or intermittently), as the cervix dilates and your baby negotiates the birth canal. It can also start (or become slightly heavier) after an internal vaginal examination.

Significant bleeding (soaking a pad or more) during labour is of concern, and is referred to as an intrapartum haemorrhage (IPH). Very heavy bleeding after your baby is born is referred to as a postpartum haemorrhage (PPH).

The main culprits of heavy bleeding

The main causes of an intrapartum haemorrhage are placenta previa (low lying placenta), placental abruption (the placenta separating too early from the wall of the uterus) or unusual placenta formations such as vasa previa and velamentous insertion.

Placenta previa

In most pregnancies, the placenta implants high in the top of the uterus (called the upper segment or 'fundus'). Occasionally, (in 0.5 percent of pregnancies) part of the placenta - or all of it, will implant in the lower segment of the uterus. The lower segment is the part of the uterus that absorbs the cervix as it dilates during labour.

Most cases of placenta previa are known to be present before the labour begins, due to bright, painless, bleeding in the last three months of pregnancy which is normally investigated with an ultrasound, showing the placenta to be low. Occasionally, you may not be aware that you have placenta previa before the labour, especially if the baby is premature. In this case, your caregiver will suspect it if you start to bleed more heavily than normal during labour.

If you are aware that you have placenta previa, or you start to bleed more heavily than normal in labour, your caregiver would monitor any bleeding closely. Other interventions can include:

  • Monitoring your baby - your baby's heart rate will be continuously monitored with a CTG machine, aimed at detecting if the blood being lost is affecting your baby; blood loss from the placenta can affect the blood flow to your baby, and the transport of oxygen and nutrients to them. If severe, it can cause foetal distress, and be life threatening for your baby. If this happens, a caesarean would need to be performed.
  • Monitoring you - your pulse and blood pressure will be monitored more closely and an intravenous (IV) cannula will be placed in your arm which can be used to attach to a drip if the bleeding becomes heavy. This is used to give fluids through the vein (or in severe cases,) a blood transfusion. It can also be used if you need to go the operating theatre for an emergency caesarean.
  • Ultrasound - a portable ultrasound may be brought into the labour room to investigate any heavy bleeding, if you are not aware that you have placenta previa. This will give your caregiver information about why you may be bleeding, if it is wise for you to continue labouring, and to let the doctor know where the placenta is actually lying, before a caesarean is performed.
  • An internal vaginal examination - done in the operating theatre to determine how far away the edge of the placenta is (if it is not actually covering the cervix), your doctor will place their fingers inside your cervix and gently feel up inside the uterus, until they come to feel the edge of the placenta. If they feel it is far enough out of the way, a vaginal birth may be possible.

Placental abruption

A placental abruption (also called an 'accidental haemorrhage') is a rare complication (about 0.5 percent of pregnancies) that happens when the placenta lifts off the wall of the uterus, usually in the middle of the placenta. This allows blood to pool and clot behind the placenta between the placenta, and the wall of the uterus (called a 'retroplacental clot').

The signs of a placental abruption in labour usually include:

  • Your contractions stopping abruptly.
  • Your baby's heart rate dropping abnormally low.
  • Severe, constant abdominal pain or back pain that may be associated with some vaginal bleeding.

Because much of the blood accumulates behind the placenta, the amount of blood that can be noticed coming away from the vagina may not be that much. If you, or your caregivers, feel the uterus, it is often very tender, or painful to touch.

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