Women's Healthcare Topics

Late Pregnancy Bleeding Can be From Previa, Abruption or Postpartum

Reviewed by James Brann, M.D.

Understanding Placenta Previa

Placenta previa occurs in a pregnant woman when the placenta ends up covering the opening of the cervix. Usually, the placenta isn’t even near the cervix.

Placenta previa may lead to severe vaginal bleeding. It’s more common with either women who had placenta previa during a previous pregnancy, or women who’ve had more than one C-section. This type of surgery is used to deliver a baby.

Other things that increase your chances of placenta previa include several previous deliveries, smoking and being pregnant with twins or multiples.

Symptoms
For most women, the signs of placenta previa include blood leakage from the vagina. For some women, their uterus will also tighten. This is called a contraction. Sometimes your belly feels hard during a contraction.

Some women don’t have any symptoms at all.

Testing
There are tests available for placenta previa. Your doctor may want to use an ultrasound. This type of imaging test makes a picture of the inside of your womb and your baby inside. It will also show the placenta.

If you are having vaginal bleeding and you’re pregnant, call your doctor or midwife immediately.

Treatment
If you have placenta previa, you’ll be told to abstain from sex. Having sex can make you bleed more. As well, putting anything deep into your vagina can also cause bleeding.

As far as treatment, it will depend on what kinds of symptoms you’re having, and where you are in your pregnancy. If placenta previa isn’t causing bleeding, you’ll likely need to have an ultrasound to check on it every few weeks. Sometimes, the placenta moves into a more normal position.

If your placenta previa is bleeding, though, you’ll probably need hospital treatment immediately. This includes even just a little bleeding. Your doctor will want to:

  • See how much you’re bleeding

  • Give fluids to you through an IV. This thin tube goes into your vein. The fluids help keep your blood pressure normal.

  • Check your blood pressure and heart rate, as well as your baby’s heart rate

If the bleeding remains heavy without slowing, your doctor may:

  • Deliver your baby early with a C-section

  • Give you a blood transfusion with blood from a donor

A majority of women with placenta previa don’t need to deliver their baby at the onset of bleeding. Certain women may need to stay hospitalized until delivery, while others may go home after the bleeding stops. While in the hospital, you may be given these things:

  • Steroid medicines - This is to prepare your baby’s lungs for being born early. You won’t need these if you’re at least 34 weeks pregnant, or you don’t have any symptoms. These aren’t the same as the steroids athletes use in building muscle.

  • Shot of Rh immune globulin if you’re Rh-negative (your blood cells don’t have Rh factor, a protein)

  • Iron pills (If you’ve lost a lot of blood)

If placenta previa doesn’t go away, your doctor will likely want to deliver your baby via a C-section a before your actual due date. Vaginal delivery and labor could cause severe bleeding if you have placenta previa. This could be dangerous for both your baby and you.

Understanding Placental Abruption

Placental abruption refers to an uncommon condition that leads to bleeding during a woman’s last half of pregnancy. This can be dangerous for both a mother and her unborn baby.

The placenta forms between the baby and mother during a pregnancy. This organ helps bring a baby oxygen and nutrients. It also carries waste away. When the placenta ends up separating from a mother’s uterus before she delivers, it’s called placental abruption.

Causes
Doctors don’t always know why women have placental abruption. Some women are more likely to have one, though, if they:

  • Use cocaine
  • Smoke cigarettes
  • Are in a car accident
  • Have high blood pressure
  • Are hit hard in the belly or fall on their belly
Symptoms
  • Pain in the belly
  • Pain in the back
  • Vaginal bleeding
  • Uterus tightening (contractions)

A baby’s heart rate may also not be normal in a pregnant woman with a placental abruption.

If you’re having vaginal bleeding or belly pain during your pregnancy, call your doctor immediately.

Testing
Usually, your doctor can tell if you have placental abruption by asking you some questions and conducting an exam.

You may also need an ultrasound. It uses sound waves to create pictures of the inside of your body and your baby.

Treatment
Once you’re at the hospital, you’ll have some blood drawn. Your nurse or doctor will check to see if you’re having contractions, and check your baby’s heart rate. They’ll also put an IV in your vein. This small tube helps get fluids into you, and possibly blood, if you need it.

Depending on how far along you are in your pregnancy, and how much of your placenta is affected, your doctor may want you to have your baby immediately. This may mean a vaginal delivery, or they may perform a C-section.

Prevention
To help decrease your chances of having placental abruption you can do several things. Don’t smoke, don’t use illegal drugs like cocaine, and don’t put yourself in a situation where you could be hit in the belly or fall.

If you’ve had a placental abruption before, you are at an increased risk of having one again with future pregnancies.

Understanding Postpartum Bleeding

When a woman loses a great deal of blood after having a baby, it’s called postpartum hemorrhage. This may happen after a vaginal delivery or after a C-section, a surgery to get your baby out.

Normally, postpartum hemorrhage occurs because the uterus isn’t tightening well enough after giving birth. Other causes include:

  • Small pieces of membranes or placenta remain stuck to the uterus after delivery. The placenta forms between mom and baby, bringing her child oxygen and nutrients. The organ also carries waste away.

  • Tears of the uterus, cervix or vagina.

Symptoms
Vaginal bleeding is the main symptom of postpartum hemorrhage. If a women ends up losing a lot of blood, she’ll also probably feel lightheaded and weak.

Treatment
If the uterus isn’t contracting well enough, causing a hemorrhage, treatments will include:

  • Using medicines to help the uterus contract

  • Checking for pieces of membranes and placenta stuck in the uterus. They’ll be removed by your doctor, possibly with some special tools.

  • Massaging your uterus by your doctor or nurse pressing down on your lower belly. This will help the uterus contract.

If the hemorrhage is due to tears or injuries, your doctor will suture them up. If you’re having severe bleeding, you may need a blood transfusion with donated blood through an IV. This tube goes into your vein.

If none of these treatments is able to stop the bleeding, your doctor may try other treatments. If nothing works, you may need your uterus removed, called a hysterectomy. This is rare.

Normally, your postpartum hemorrhage won’t happen again in a future pregnancy. Make sure your doctor knows about it, though. You are at an increased risk of having one again, over women who’ve never had one before.

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