why and when to worry?

During pregnancy, the expectant mother is even more connected to her body. She discovers new sensations and sees her silhouette change over the days. However, being more attentive, she can also worry more easily at the slightest "abnormal" feeling. One of the little ailments of pregnancy that worries expectant mothers the most is bleeding. Losing blood while pregnant is indeed a real source of stress… even if most of the time, this loss is quite benign. One in four women would be affected by this bleeding. Anyway, if you are suffering from them, it is necessary to consult your obstetrician-gynecologist, midwife or doctor, as they can also be a sign of a more serious problem, such as pregnancy. ectopic, bleeding or miscarriage.

Learning about the subject is still a good way not to worry more about the subject. What are the causes of this bleeding? How long do they last? How do you know if it is serious? We enlighten you on blood loss during pregnancy.

See also: 9 months pregnant in 90 seconds

Video by Catherine nowak

Bleeding in early pregnancy

According to the MSD Manual, 20 to 30% of women experience vaginal bleeding during the first 20 weeks of pregnancy. If in half of the cases, this unfortunately ends in a miscarriage – remember that this affects 10 to 15% of pregnancies in France – this bleeding can also have another explanation. Mild blood loss can also be caused by implantation or the “birthday period”, which is harmless for the rest of the pregnancy. Jonathan Cohen, obstetrician-gynecologist and author of the book “To prepare well for childbirth”, published by Ellébore editions, explains the different causes of this bleeding at the start of gestation.

Mild vaginal bleeding

• Birthdays rules : If you are suffering from bleeding while pregnant and the discharge corresponds to the date of your usual period, we are talking about “birthday periods”. Rest assured, this metrorrhagia (bleeding that occurs between periods) is painless and does not stay in the long term. You will suffer from it especially at the beginning of pregnancy. In fact, the bleeding is often less profuse and lasts less than a real period.
• Implant bleeding : Did you know ? After fertilization, the embryo takes no less than seven to eight days to implant in the uterus. This is called the implantation process (also called implantation). This is a natural occurrence that can cause some symptoms in the mother-to-be, such as a slight pulling in the abdomen and bleeding. These losses are harmless to the fetus and the mother.
• Bleeding after sex : during pregnancy, the cervix is ​​weakened. It is therefore not uncommon to see bleeding after sex or a gynecological consultation. Rest assured, these losses are not serious.

Risky vaginal bleeding

• Miscarriage: as noted above, miscarriages affect between 10 and 15% of pregnancies. It can be accompanied by symptoms, such as pain in the lower abdomen (which is really uterine contractions) and heavy bleeding. But it can also appear in an insidious way: no symptoms are felt and the bleeding is discreet. This is why it is necessary to consult a health professional when in doubt.
• The loss of a twin : This is a partial miscarriage, where the expectant mother loses one of her babies. In 75% of cases, the pregnancy continues with the surviving embryo. The symptoms are the same as for a total miscarriage.
• Decidual hematoma: this hematoma occurs during implantation. It is caused by a slight detachment of the trophoblast, which is none other than the future placenta. This phenomenon causes slight blood loss and is usually not serious: the hematoma resolves on its own. However, in more severe cases, it can lead to miscarriage.
• Ectopic pregnancy: in this type of pregnancy, the fertilized egg cannot reach the uterine cavity. The embryo then implants outside the uterus, either in the fallopian tube (90% of cases), in the ovary, the cervix or the abdominal cavity. This can lead to bleeding. Unfortunately, the embryo is not viable and it is necessary to terminate the pregnancy. Note that the risk factors for an ectopic pregnancy are: endometriosis, smoking or sexually transmitted infections.
• Molar or hydatidiform pregnancy: This is an abnormality that occurred during fertilization, leading to abnormal development of the placenta. A small tumor, called a mole, then forms (hence the term molar pregnancy). If the mole is complete, the embryo is nonexistent. If the mole is partial, the embryo exists, but is not viable. The pregnancy must then be terminated. This is a very rare occurrence, but possible. Note that bleeding is not the only symptom of a molar pregnancy: you can also experience nausea and vomiting.

Second and third trimester bleeding

You should know that second and third trimester bleeding is rarer, explains the obstetrician-gynecologist. They can be caused "For non-dangerous reasons, such as a fragile cervix that bleeds for example (as explained above for the beginning of pregnancy, editor's note) " or "For reasons more risky for pregnancy ".

So, second and third trimester blood loss can be caused by:

• A change in the cervix: bleeding may occur if the cervix dilates or becomes shorter. Contractions can also be felt. Attention, be sure to consult urgently. It can be a sign of a premature labor. If you are full term, it may mean that labor has started (be careful not to confuse bleeding with loss of the mucous plug, which may be speckled with blood).
• Placenta previa: this happens when the placenta is inserted abnormally into the top of the uterus. This can lead to placental abruption and bleeding.
• A retroplacental hematoma : Here, the placenta is normally inserted, but the pregnant woman still suffers from a placental abruption. The latter will cause a hematoma between the lining of the uterus and the placenta. Bleeding will appear, as well as contractions (the symptoms are different in different women).

When to consult?

Be sure to visit or go to the maternity ward (for the second and third trimester of pregnancy) as soon as bleeding appears. Even if it is mild, it is important to know the cause. Jonathan Cohen always recommends having "Your blood group card on you" because rh negative must be reported to the doctor or gynecologist in the event of bleeding. According to the expert, it is "Ultrasound and / or the rate of growth of the level of HCG in the blood" which makes it possible to recognize one cause compared to another.

Bleeding during pregnancy should be monitored as well as the healthy development of the baby in utero. The obstetrician-gynecologist will not be able to recommend that you rest if you have it, and not to make too many movements.

The bleeding and complications of the second and third trimester of pregnancy can unfortunately compromise the plan for a natural vaginal birth. In most cases, it will be triggered, even prematurely. Most often, healthcare workers will opt for a Caesarean section.