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Obstetrical bleeding is bleeding in pregnancy that occurs before, during, or after childbirth. [4] Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. [4] Bleeding may be vaginal or less commonly into the abdominal cavity. Bleeding which occurs before 24 weeks is known as early pregnancy bleeding.
Implantation bleeding may be confused with a regular period. [4] [5] Heavy vaginal bleeding in the first trimester or bleeding associated with pain, may be a sign of a complication, such as a miscarriage or an ectopic pregnancy, that would need to be assessed by a healthcare provider. [6]
Approximately 25 percent of pregnant patients have spotting or light bleeding in the first trimester, but this is not an official “period,” says Dr. Ziebarth.
Placenta previa is primarily diagnosed by ultrasound, either during a routine examination or following an episode of abnormal vaginal bleeding, often in the second trimester of pregnancy. Most diagnosis of placenta previa occurs during the second-trimester. [citation needed]
[1] [2] Such bleeding could be visible or external, namely bleeding from the vagina, or it could be internal into the pelvic cavity or form a hematoma. Normal menstruation is not considered a gynecologic hemorrhage, as it is not excessive. Hemorrhage associated with a pregnant state or during delivery is an obstetrical hemorrhage.
Vaginal bleeding occurs during 15–25% of first trimester pregnancies. [29] Of these, half go on to miscarry and half bring the fetus to term. [30] There are a number of causes including complications to the placenta, such as placental abruption and placenta previa.
Vaginal bleeding early in pregnancy may also be a sign of a threatened abortion, which is when there is light to moderate vaginal bleeding but the cervix is still closed. Threatened abortion does not mean that miscarriage is inevitable; about 50% of women with bleeding before the third trimester will progress to a live birth. [26]
"She was wrapped in a pink knitted Barbie-size blanket. Her skin looked like tissue paper ― translucent and fragile. Her face, not fully formed, resembled an alien. She moved her arm once."