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Bleeding during Pregnancy – What You Need to Know

Thursday, May 22nd, 2014

Vaginal bleeding during pregnancy is almost always a source of worry for a pregnant woman, but it’s not always a sign that something is wrong. Studies such as this one show that around 20% of pregnant women experience early bleeding, and little more than half of those pregnancies end in miscarriage.  Even in this study, the number of pregnant women may have been underreported and therefore, the true number of women who have bled in early pregnancy is not known.  However, it is a common occurrence, which must be investigated by your practitioner when it happens.

Less Serious Causes

One of the most common reasons for bleeding early in pregnancy is implantation. Implantation bleeding occurs around two weeks after conception and is the result of the fertilized egg burrowing into the endometrial lining. Sometimes this bleeding is mistaken for a normal period, so a woman may not realize she is pregnant until the following month. Those women who are Rh-negative should be very cognizant of this fact because what is believed to be a late normal period, actually may be a miscarriage in disguise and can cause problems for subsequent pregnancies with respect to alloimmunization. Please refer to my health book, “Inside Information for Women” for more on Rh-alloimmunization.

Other causes of bleeding during pregnancy that do not indicate harm to the fetus can include a cervix that is more sensitive and tender than usual, which can lead to bleeding, especially after intercourse. However, there is no way to know for sure what is causing your bleeding without an examination, so bleeding during pregnancy should always be evaluated by your doctor.

More Serious Causes

Ectopic pregnancy is another reason for bleeding early in pregnancy. These are pregnancies that implant in the fallopian tubes or other location outside the uterus. This type of bleeding may be accompanied by pain, either sharp pain or cramping, and lower-than-normal levels of hCG, or there may be no pain at all, that is, until it ruptures. Women who have had ectopic pregnancies before, pelvic surgery, or infection in the fallopian tubes are more likely to experience an ectopic pregnancy in a subsequent pregnancy. Untreated, an ectopic pregnancy can result in a ruptured fallopian tube, causing massive hemorrhage and may lead to death of the patient.

A miscarriage, which is the lay term for a spontaneous abortion, will also cause bleeding, and unfortunately, cannot usually be prevented or stopped. Most miscarriages occur during the first trimester (the first 12 weeks of gestation), and may cause vaginal bleeding, cramping, and the passage of tissue through the vagina. A miscarriage, while heartbreaking in many instances, is not a sign that the mother did anything wrong, nor is it a sign that future pregnancies are likely to end in miscarriage.

Bleeding in the second half of pregnancy is more likely than earlier bleeding to be caused by something serious. These causes can include placental abruption, or placenta previa. In placental abruption, the normally-implanted placenta separates from the uterine wall prematurely, such as after a motor vehicle accident or after a fall or other blunt trauma. In placenta previa, the abnormally-implanted placenta is positioned too low in the uterus, partially or completely covering the cervix. Any bleeding during pregnancy requires immediate attention in order to properly diagnose and treat the condition.

Again, to emphasize the importance of bleeding during pregnancy, let me reiterate: Any bleeding during pregnancy warrants an immediate call to your doctor to rule out serious causes or take appropriate measures to treat them.

– Yvonne S. Thornton, M. D., M. P. H

Newly Discovered Dangers of Secondhand Smoke

Thursday, April 10th, 2014

Researchers already know that secondhand smoke, or passive smoking, is linked to myriad risks, including an increased risk of hearing loss, diabetes, and obesity. Now they have discovered new risks to add to the growing list: the increased risk of ectopic pregnancy, miscarriage, and stillbirth.

The new study points out that while smoking during pregnancy is known to be related to a higher risk of birth complications and miscarriage, more information was needed to determine whether passive smoking by pregnant women has similar effects. The study included over 80,000 women who had been pregnant at least once and gone through menopause.

Some of the women were current smokers (around six percent), some were former smokers, and some had never smoked. The women who had never smoked (or, more specifically, had smoked fewer than 100 cigarettes in their lifetimes), were divided into groups according to their secondhand smoke exposure as children, adults at home, and adults at work.

The study found that women who had been smokers during their reproductive years had a 44% higher risk of stillbirth, a 43% higher risk of ectopic pregnancy, and a 16% higher risk of miscarriage than the women who had never smoked and had not been exposed to secondhand smoke.

This was probably not a huge surprise to anyone, but the really interesting results were found in the group of never-smokers. The ones who had experienced secondhand smoke exposure also had a higher risk of miscarriage, stillbirth, and ectopic pregnancy compared with the ones who had never smoked and had not been exposed to secondhand smoke. In addition, the increase in risk was directly related to the level of secondhand smoke exposure the women had experienced.

The women with the highest levels of secondhand smoke exposure – over ten years either as a child, as an adult at home, or as an adult at work – had an extremely elevated risk of miscarriage, stillbirth, and ectopic pregnancy. The risk of having an ectopic pregnancy was a whopping 61% percent greater than that of women with no cigarette smoke exposure, and they were also 55% more likely to have experienced a stillbirth and 17% more likely to have had a miscarriage.

With many states enacting bans on smoking in public places and places of business in recent years, we are certainly headed in the right direction. However, the new research certainly highlights the need for more progress, especially in the states that still have no bans on smoking in public places whatsoever, in order to further protect women and their future babies from secondhand smoke, which appears to be even more harmful than previously thought.  

– Yvonne S. Thornton, M. D., M. P. H

Can A Myomectomy Prevent a Second Miscarriage?

Monday, February 18th, 2013

A miscarriage is a horrible experience for any woman. When the excitement of pregnancy is suddenly cut short by the unexpected news of loss, the grief is difficult to manage. Many women who go through this feel they need many months to heal after the ordeal, but some move on and feel ready to try again right away. Luckily, recurrent miscarriages are rare, but that’s not to say it’s easy to trust that the second pregnancy won’t go the same as the first.

Before we continue, let’s define some terms.  Miscarriage is a lay term for a “spontaneous” abortion, occurring before 20 weeks of gestation.  When most people hear the term “abortion”, they quickly recoil because they believe it to be an “induced” abortion, which is the loss of a pregnancy before 20 weeks by artificial methods.  Fibroid is a lay term for myoma, which is the appropriate term for a benign tumor of the smooth muscle of the uterus. This growth is not fibrous.

Studies show that women who had a miscarriage (spontaneous abortion) as a result of uterine fibroids (myomas) are more likely to have one in their second attempt. However, those same studies show that the surgical removal of said myoma can greatly increase a woman’s chances of having a live birth despite a previous miscarriage.

Fibroids (Myomas) are benign tumors that grow on the walls of the uterus, and they actually affect a significant number of adult women. Twenty-five percent of all women have myomata, with the percentage rising  to 50% in Black women.  When myomas grow into the uterine cavity and thus distorting the inner contour of the womb , they can cause miscarriages (spontaneous abortions). In other locations, such as growing on the outside of the uterus like Mickey Mouse ears (subserosal), they are absolutely harmless and women don’t even know they have them.

Once a doctor diagnoses myomas (myomata) as the cause of a spontaneous abortion (usually in the second trimester), he or she might recommend surgical removal before a second attempt at pregnancy. This surgery is technically called a myomectomy (not fibroidectomy), and it is a relatively safe procedure. Unfortunately, there is a 25% chance the myoma could come back over time, but in many cases, they don’t reappear until years later.   For further information about myomas and myomectomy, you are referred to my book, INSIDE INFORMATION FOR WOMEN on the topic.

If you have had one or more spontaneous abortions, your gynecologist should perform a comprehensive evaluation of your uterus to determine whether or not myoma played a role. This may include a sonohysterogram, and/or a hysterosalpingogram. Most often, spontaneous abortions are totally random, but in some cases, they are caused by an abnormality in the reproductive system. Should your doctor find intramural or submucosal myomata (myoma in the wall of your uterus), you should consider surgery before trying again. While a second attempt at pregnancy won’t make up for the disappointment of the first loss, addressing the problem and correcting it will go a long way in achieving a successful outcome.

 – Yvonne S. Thornton, M. D., M. P. H.