Bleeding during pregnancy is regarded as a normal experience by most women, especially when it occurs in the first trimester. However, as much as many women who experience this will go on to deliver healthy babies, the bleeding may be a sign of something more serious.

According to medics, vaginal bleeding can, in some instances, cause miscarriage. Here the fetus gets aborted and one may experience abdominal cramps along with bleeding, which may be mild or massive. Thus it’s always ideal to see a doctor in case of any bleeding while pregnant.

"Not all bleeding during the first trimester of the pregnancy ends up well. At times it can be a warning sign of a miscarriage or something that needs quick medical attention to prevent something worse occurring,” says Iba Mayale,a gynaecologist at Doctors Plaza in Kimironko, Kigali.

He adds that women should be able to differentiate between a normal and abnormal bleeding to prevent complications to their health and that of the child.

According to Rachna Pande, a medic at Ruhengeri Hospital, normal bleeding for pregnant women is supposed to be slight and that should be within 5 to 6 weeks after conception.

"Normally one out of six women may have slight bleeding during early pregnancy. It may be in form of slight spotting, noticed just as a stain on the undergarments. This happens due to slightly disturbed hormonal equilibrium and there is nothing to worry about,” she explains.

Causes of bleeding

Although it’s normal for any woman to experience vaginal bleeding, the case is more common in women who have had issues with fertility.

"It is said to be more common in women who have conceived after fertility treatments, particularly after in vitro fertilisation. Also, uterine fibroids may cause vaginal bleeding during pregnancy,” says Pande.

Dr Mayele says bleeding may also occur immediately after conception, a condition known as implantation bleeding, which may occur anywhere from 6-12 days.

"It depends on one’s hormones as every woman will experience implantation bleeding differently. For instance, some will experience light spots for a few hours, while others may have it for days,” he says.

Dr Mayele adds that infections in the pelvic cavity or urinary tract may also cause bleeding. Some women may also experience bleeding after sexual intercourse due to the tenderness of the cervix.

What to watch out for

Albert Ndata, a general practitioner in Kigali, cautions that depending on the time of the pregnancy, bleeding can pose a serious risk to the fetus.

"Virginal bleeding during pregnancy is not normal, and if it happens, one should immediately consult their doctor so that further tests can be done to determine the cause. Sometimes the bleeding could include a threatening abortion or placenta previa,” warns Ndata.

He further notes that the situation could be more threatening if the pregnancy is over four months.

According to Dr Francis Kazungu, a general practitioner in Kigali, bleeding can also be a sign of other abnormalities of the pregnancy.

For instance, in cases where a woman has a blighted ovum (embryonic pregnancy), which happens when a fertilised egg attaches itself to the uterine wall but the embryo does not develop, may experience bleeding during pregnancy.

"In such a situation, a woman may experience heavy virginal bleeding and severe cramps. When this happens, one should consult a doctor as it may be a sign of an embryonic pregnancy which should be terminated immediately,” advices Kazungu.

Pande also adds that it’s not necessarily that if one bleeds during pregnancy, it’s always a sign of miscarriage, but it could be an indication of a risky pregnancy.

"In case of an ectopic pregnancy, where the fetus grows at some other site and not on the uterine wall, one may have abdominal pain and bleeding. Vesicular mole, an abnormal form of pregnancy where an abnormal tissue growth occurs instead of a normal fetus may be associated with vaginal bleeding,” she says.

"Slight vaginal bleeding can also occur due to trauma as during sex. Cervical polyps can also cause vaginal bleeding. However, if there is associated abdominal cramps, severe pain, heavy bleeding or passing large clots, it is advised to seek medical care,” Pande advises.

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