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Early pregnancy bleeding (also called first trimester bleeding) is vaginal bleeding before 14 weeks of gestational age. [ 1 ] [ 2 ] If the bleeding is significant, hemorrhagic shock may occur. [ 1 ] Concern for shock is increased in those who have loss of consciousness , chest pain, shortness of breath , or shoulder pain.
Implantation bleeding may be confused with a regular period. [5] [6] 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. [7]
This commonly occurs around 32 weeks of gestation, but can be as early as late mid-trimester. [8] More than half of women affected by placenta praevia (51.6%) have bleeding before delivery. [9] This bleeding often starts mildly and may increase as the area of placental separation increases.
Retroplacental hematomas are entirely behind the placenta and not touching the gestational sac. Subamniotic or preplacental hematomas are contained within amnion and chorion. Rare. Most patients with a small subchorionic hematoma are asymptomatic. [5] Symptoms include vaginal bleeding, abdominal pain, premature labor and threatened miscarriage. [6]
What the cramps feel like: The uterine cramping connected with implantation bleeding is mild compared to the more severe cramping seen with a typical period, says Dr. Ross. 11. Ectopic pregnancy
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
In the early stages of placental abruption, there may be no symptoms. [1] When symptoms develop, they tend to develop suddenly. Common symptoms include: sudden-onset abdominal pain [5] [8] contractions that seem continuous and do not stop [5] vaginal bleeding [5] [8] enlarged uterus (disproportionate to the gestational age of the fetus) [5]
The heart rate increases, but generally not above 100 beats/ minute. Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to baseline in the second half of pregnancy. [6]
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