Hemorrhagic Conditions of Early and Late Pregnancy

Hemorrhagic conditions during pregnancy are complications involving excessive blood loss that can jeopardize the health and well-being of the pregnant patient and fetus.

In general, conditions that increase the risk of hemorrhage during pregnancy include multiparity, which refers to having two or more previous pregnancies; multiple gestation or being pregnant with more than one fetus at a time; and using assisted reproductive techniques, like in vitro fertilization or intrauterine device contraceptives. Other risk factors include a history of uterine surgery, sexually transmitted infections, or a hemorrhagic condition during a previous pregnancy; as well as alcohol use, excessive caffeine consumption, or cigarette smoking during pregnancy.

First, let’s review early hemorrhagic conditions, which occur before 20 weeks of gestation, starting with spontaneous abortion. Spontaneous abortion, also known as miscarriage, is the involuntary loss of pregnancy during the first 20 weeks, or the loss of a fetus weighing 500 grams or less. Threatened abortion is when there’s only vaginal bleeding and the cervix remains closed. This can progress to cervical dilation, membrane rupture, and loss of the uterine contents, at which time it’s called a complete abortion. A missed abortion is when the fetus dies but remains in the uterus.

Another early hemorrhagic condition is ectopic pregnancy, which is when the fertilized ovum doesn’t complete its journey to the uterus and implants elsewhere, like the abdominal cavity, ovaries, fallopian tube, or cervix. Depending on the implantation site, the embryo may receive enough blood supply to cause early pregnancy signs and symptoms, like a missed menstrual period. But eventually, the implantation site can no longer support the embryo.

And if the ectopic pregnancy happens in the fallopian tube, the growing embryo eventually runs out of space and damages the walls of the tube, potentially causing it to rupture, leading to massive internal bleeding and hypovolemic shock.

Alright, late hemorrhagic conditions occur after 20 weeks of gestation. Placenta previa occurs when the placenta implants in the lower part of the uterus and partially or completely covers the opening of the cervix. As the pregnancy advances, the lower uterus stretches and thins, and the cervix begins to dilate. This causes the placenta to separate from the uterine wall, leading to painless bright red vaginal bleeding.