Pregnancy, often described as a miraculous journey, brings immense joy but also a fair share of anxiety, especially for first-time parents.
Expectant mothers frequently experience anxiety related to their health and the development of their unborn child.
Hormonal changes can exacerbate feelings of unease, with worries ranging from dietary choices and exercise routines to fears about labour and delivery complications.
The unpredictability of pregnancy can make even minor symptoms seem alarming.
The health of both mother and child is paramount, and among various concerns, abnormal bleeding during and after pregnancy can be particularly distressing.
Dr Mzuvele Archwell Hlabisa, an obstetrician and gynaecologist at Netcare Kingsway Hospital, urged women to be aware of the dangers of abnormal bleeding during and after pregnancy, highlighting that recognising these risks could save lives.
"Many people don't realise that over a third of pregnant women experience bleeding for various reasons. It's crucial to determine the exact cause of any bleeding."
According to Hlabisa, while some bleeding is normal after childbirth, excessive bleeding can be life-threatening.
"It’s not always easy for women to know if their bleeding is normal, but a good rule is that any bleeding during pregnancy should be checked by a healthcare worker."
He points out that around 35% of women experience bleeding in the first trimester.
"As the pregnancy progresses, the chance of bleeding decreases, so it's reassuring when women get past their mid-trimester, which is between 13 and 28 weeks.“
He added: “Bleeding could indicate a miscarriage or a threatened miscarriage. Bleeding accompanied by severe pain could be related to placental abruption, which is a serious pregnancy complication in which the placenta separates prematurely from the womb.
“These conditions require urgent assessment by a healthcare worker.”
Spotting during early pregnancy
In the early stages of pregnancy, some women may notice light bleeding known as spotting. This happens when the embryo attaches to the wall of the uterus.
Hlabisa said that the amount of blood is key to identifying spotting.
"Spotting is usually less than a teaspoon. It can also be caused by a cervical infection, a urinary tract infection, or even haemorrhoids during pregnancy. Sexually transmitted infections can also lead to bleeding.“
When to be concerned
He warned that heavier bleeding is more alarming and might indicate a serious issue. "If a pregnant woman experiences bleeding that lasts for over an hour or has severe pain in her upper or lower back, she should see a healthcare worker immediately," he advised.
He also noted that women might show symptoms of anaemia, such as headaches, weakness and dizziness.
"These are danger signs that need quick medical attention. There might be reduced blood flow to the placenta, which is life-threatening for the baby. Anaemia could also lead to preterm delivery.
“Even less severe bleeding can have long-term effects on the baby's neurological development.”
What to expect at the hospital
“An internal examination may be needed to assess the cause of the bleeding. The woman may have their urine tested for the presence of any blood or have their blood tested to check whether they’re becoming anaemic or to see if there are any underlying bleeding disorders.
“A basic ultrasound may be done to assess the foetal wellbeing.”
According to Hlabisa, treatment for abnormal bleeding during pregnancy can be as simple as bedrest, abstinence from sex or treatment with antibiotics if it is caused by a cervical infection, for example.
“Anaemic mothers can be given iron tablets, iron infusions or even blood transfusions. The supplements women are advised to take during pregnancy also help to reduce the risk of becoming anaemic.”
Pregnant women experiencing abruptio placenta, also known as placental abruption, where the placenta detaches prematurely, requires immediate delivery.
Treatment for bleeding due to placenta praevia, a condition where the placenta is low in the uterus, depends on the pregnancy's stage and the bleeding's severity. Different treatments are tailored to address specific causes.
Postpartum bleeding normal
According to Hlabisa, postpartum bleeding and cramping are normal as the uterus returns to its usual size after delivery.
"Initially, it feels like a moderate menstrual period. Over time, the bleeding lessens and may stop after a week, but some women might experience a brief return of bleeding a few weeks later.”
He stressed that in the first six weeks after delivery, it is considered normal to have some bleeding, “but if the bleeding causes the mother to have symptoms of anaemia like a headache, weakness or dizziness, the bleeding is probably abnormal”.
Bleeding can also occur from an episiotomy, which is an incision to the birth canal, a tear, or when a piece of the placenta is left behind. Infections can also result in bleeding following pregnancy.
“The only way to determine the reason for the bleeding is for the mother to return to medical care.”
Abnormal blood loss after childbirth is associated with having a big baby, having twins, a difficult delivery, or a prolonged second stage of labour.
“An underlying gynaecological condition like uterine fibroids also carries a higher risk of bleeding, while hypertension may mean a higher risk of developing an abrupted placenta.
“If you have an underlying blood disorder or you are on blood thinners because of a health condition, these may all increase your risk”
It is imperative for women who notice abnormal bleeding to go to their gynaecologist, general practitioner, or nearest medical facility without delay.
“Their doctor differentiates between normal postpartum bleeding and abnormal bleeding that requires medical attention by monitoring the rate of their bleeding and taking note of symptoms such as weakness, a fast heartbeat, or light-headedness associated with any amount of bleeding.”
“When in doubt, seek help from your medical practitioner without delay.”