Why do Mothers Bleed in Pregnancy

An introduction for non-medical audiences

Dr Max MongelliNepean Clinical SchoolUniversity of Sydney

Bleeding during pregnancy is common

• May affect up to 20% of all pregnancy• Can occur in any trimester, during and after delivery• Often difficult to predict• In most cases in not severe• Usually treatable

Bleeding in the first trimester• Also known as a threatened miscarriage• However most women will not miscarry• May be due to bleeding from the placenta• Or could be due to local causes such as lesions on the cervix or in the

vagina

Bleeding in the second trimester

• Same causes as in the first trimester• Requires medical assessment and ultrasound

Bleeding in the third trimester• From about 24 weeks onwards• Could be due to an abnormally low placenta -

known as “placenta previa”• Sometimes caused by separation of the placenta

from the uterus – “placental abruption”• If significant, admission to hospital is required• If heavy, may lead to preterm delivery. An

emergency cesarean section may be indicated• Often, no cause can be found

Bleeding during labor• Also known as “intrapartum bleeding”• Usually minor• Requires close monitoring• If heavy, urgent delivery is needed

Bleeding after delivery• Known as post-partum hemorrhage• Up to 500 ml of blood may be normal• Most common cause is a floppy uterus - “uterine

atony”• Most cases (90%) can be treated with medications• Some cases require surgery• Very heavy bleeding can be life-threatening

Bleeding after delivery: maternal deaths

• Most deaths from bleeding occur in developing countries

• Due to poor access to medical facilities• Poor antenatal care • Geographical barriers to reach hospitals• Inadequate medical facilities• Lack of blood for transfusions

What YOU can do to help

Support :• Project Hope: www.projecthope.org• UNICEF: www.unicef.org• CARE: www.care.org