Abnormal bleeding occurs in over a third of pregnant women for various reasons. While some bleeding is expected during the postpartum period, excessive bleeding can be life-threatening. Dr Hlabisa advises that any bleeding during or after pregnancy should prompt immediate medical evaluation.

Understanding and addressing the dangers associated with abnormal bleeding during pregnancy and postpartum can be lifesaving for both mothers and infants.

Dr Mzuvele Archwell Hlabisa, an obstetrician and gynaecologist at Netcare Kingsway Hospital, emphasises the importance of identifying the cause of bleeding in pregnant patients.

Prevalence and initial assessment 

Abnormal bleeding occurs in over a third of pregnant women for various reasons. While some bleeding is expected during the postpartum period, excessive bleeding can be life-threatening. Dr Hlabisa advises that any bleeding during or after pregnancy should prompt immediate medical evaluation.

First-trimester bleeding 

Approximately 35% of women experience bleeding in the first trimester. As pregnancy progresses, the likelihood of bleeding decreases. However, bleeding in early pregnancy can indicate a miscarriage or threatened miscarriage. Severe pain and bleeding may signify a placental abruption, needing urgent medical assessment.

Spotting in early pregnancy 

Spotting, often less than a teaspoonful of blood, may occur when the embryo implants in the uterine wall. This can also result from cervical or urinary tract infections, haemorrhoids, or sexually transmitted infections. The quantity and context of bleeding help differentiate spotting from more serious conditions.

Significant bleeding and associated risks 

Heavy bleeding, especially with severe pain in the back, signals a need for immediate medical evaluation. Symptoms of anaemia, such as headaches, weakness, and dizziness, are red flags for potential complications like reduced placental blood flow, which can be life-threatening for the baby and may result in preterm delivery. Even mild bleeding can have long-term neurological effects on the infant.

Hospital evaluation and treatment 

Patients presenting with bleeding during pregnancy should undergo a thorough evaluation, including internal examination, urine and blood tests, and a basic ultrasound to assess foetal well-being. Treatment varies based on the cause and severity of the bleeding. Bed rest, abstinence from sex, and antibiotics for cervical infections are common interventions. Iron supplementation, infusions, or blood transfusions may be necessary for anaemic mothers. Immediate delivery is required for placental abruption.

Postpartum bleeding 

Postpartum bleeding is normal as the uterus contracts back to its pre-pregnancy size. Typically, bleeding resembles a moderate menstrual period initially, tapering off over weeks.

Persistent or severe bleeding, especially with anaemic symptoms, requires medical evaluation. Causes include episiotomy, tears, retained placental fragments, and infections.

Risk factors and monitoring 

Factors increasing the risk of abnormal postpartum bleeding include large babies, multiple births, difficult deliveries, prolonged labour, uterine fibroids, hypertension, and underlying blood disorders.

Patients on blood thinners are also at higher risk. Continuous monitoring of bleeding patterns and associated symptoms is crucial for differentiating between normal and abnormal postpartum bleeding.

Conclusion 

Medical professionals should recommend that patients seek immediate medical attention for any abnormal bleeding during or after pregnancy. Early intervention can prevent severe complications and ensure the health and safety of both mother and baby.