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What causes bleeding during pregnancy?

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Posted on Fri, 25 Jul 2014
Question: I am 22 weeks pregnant and since the 18th week, I have been spotting on and off. It comes on the tissue after I go for a wee and then would subside by itself , I have gone atleast for three days without any spotting and then it comes back again. Had 2 scans in the last two weeks, the last one being the 16th XXXXXXX and baby is fine. Drs have been checking baby's heart with doppler and it seems absolutely fine, had a speculum inspection of the cervix as well and nothing found there either, cervix is closed. Don't know what to do and wondering where the blood is coming from. No UTI , no any other infections, had all swabs done.
Please advise
doctor
Answered by Dr. Manisha Jain (13 minutes later)
Brief Answer:
rest, precautions and medicines advised

Detailed Answer:
Hello mam, thanks for writing us your concern.
After reading your history the most probable cause for your bleeding is basically related to abnormal implantation of the placenta which is separating from its attachment time and again.

I have seen patients with similar history in my clinic and the best response is seen with HCG Injection every 5th day till 34 weeks of pregnancy and progesterone vaginal pessaries daily.
Along with these medicines-
- strict bed rest
- avoid intercourse
- avoid straining at stools
- keep a note of movements of the baby
- foot end elevation of bed by placing either wooden blocks below bed or pillows beneath your legs whichsoever is comfortable.

It will most probably stop in 2-4 weeks time with this treatment and in the meanwhile don't feel anxious as everything is fine till baby is growing properly with adequate daily movements.
Wish you best of luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Jain (4 minutes later)
I have no abnormal implantation of placenta, I have been checking my placenta on the sonograms, it is anterior and high. The doctors here have no concerns on the placenta.
doctor
Answered by Dr. Manisha Jain (14 minutes later)
Brief Answer:
abnormal implantation

Detailed Answer:
Hi dear, I know that by your history as your doctor did a per speculum examination which is never attempted in low lying placenta.
By abnormal implantation I didn't mean lower segment implantation.
Abnormal implantation is when placenta is not able to attach deep into the layers of uterus so that there is proper gluing of both of then in order to exchange nutrients and waste products via blood.

And when blood barrier is not able to form in a proper way it separates in times of stress or exertion to give rise to repeated bleeding till the detachment seals properly.
It is usually too small to be detected on ultrasound and thank god it is small.
In case precautions are not taken then it can cause a bigger bleed.
In case you have any other question, I will be happy to help. Take care and all the best

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Jain (10 minutes later)
I live in the Uk and the doctors here don't believe in HSG injections or progesterone, they say these things have no evidence as I had asked them earlier, they don't even believe in bed rest.
If what you are suggesting about placenta cannot be seen on ultrasound then how do you make the diagnosis. I am asking so that I can tell the doctors here.
Please could give a detailed explanation and investigations of the same so I could show what you say to my doctors here.
doctor
Answered by Dr. Manisha Jain (8 hours later)
Brief Answer:
HCG is must, bed rest empirical role

Detailed Answer:
Hello dear.
I know there are differences in management protocols between gynecologists of different countries.
Regarding bed rest many new studies say that there is no role of bed rest but we still recommend it because when already doctors ask normal pregnant ladies to take extra sleep then why not extra bed rest in high risk pregnancies.
But as far as HCG is concerned it is very important for the replenishment of placental support and should be given.
As regards evidence of abnormal placental attachment there is a book ' XXXXXXX obstetrics' which is the bible of obstetricians worldwide in which it is explained in the topic on 'etiopathogenesis of pregnancy induced hypertension'
I understand your anxiety and will be happy to answer your questions over this issue in future also.
All the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Manisha Jain (3 hours later)
Are you then suggesting for sure that it is the abnormal implantation of placenta?
Could there be any other reason? I am seeing my doctor today so I will show them what you are saying.
There seems to be a lot of difference in doctors opinions. I am surprised that you have been able to come up with a diagnosis only with my history giving and these uk doctors aren't able to figure out even after doing so many scans and blood tests
doctor
Answered by Dr. Manisha Jain (18 minutes later)
Brief Answer:
Discuss with your gynecologist

Detailed Answer:
Hi, don't be double minded as this abnormal implantation of placenta is a diagnosis of exclusion and then also management remains the same even after diagnosis has been delineated.
Regarding rest in high risk pregnancy difference will be seen even in XXXXXXX doctors so it is still an issue of debate so best is to follow a safe path.

Even for HCG, here in XXXXXXX everyone favours it as I have been in touch with many gynecologists in XXXXXXX Bombay and XXXXXXX but when I study on internet or research journals there are a few doctors across the world who deny the use of HCG anymore and favor progesterone in the form of pessaries or injections.

So i have given you my opinion which I follow with my patients and getting desirable results but you can discuss with your treating doctor and show our discussion to reach a final management plan.

I wish you all the best and hope to see you in good health soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Manisha Jain

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What causes bleeding during pregnancy?

Brief Answer: rest, precautions and medicines advised Detailed Answer: Hello mam, thanks for writing us your concern. After reading your history the most probable cause for your bleeding is basically related to abnormal implantation of the placenta which is separating from its attachment time and again. I have seen patients with similar history in my clinic and the best response is seen with HCG Injection every 5th day till 34 weeks of pregnancy and progesterone vaginal pessaries daily. Along with these medicines- - strict bed rest - avoid intercourse - avoid straining at stools - keep a note of movements of the baby - foot end elevation of bed by placing either wooden blocks below bed or pillows beneath your legs whichsoever is comfortable. It will most probably stop in 2-4 weeks time with this treatment and in the meanwhile don't feel anxious as everything is fine till baby is growing properly with adequate daily movements. Wish you best of luck.