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25% of women experience light or heavy bleeding during pregnancy. Expectant mothers should consider bleeding during pregnancy abnormal until proven otherwise by your doctor. Bleeding during pregnancy does not necessarily mean unhealthy pregnancy outcome. However, it is of great benefit if you speak with your doctor and possible signed of unfavourable outcome is ruled out.

Some of the causes of early pregnancy (first trimester that is, during first 13 weeks of pregnancy) bleeding include the following:

1. Implantation bleeding: implantation bleeding happens when fertilized ovum (egg) burrows into the wall of the uterus for implantation. It is defined as light bleeding that occurs about 10-14days after conception or fertilization has taken place. During this period, most women think they have light period or menstrual flow. This explains the reason why most women do not know they are pregnant until second month. If your doctor confirms implantation bleeding, you have nothing to worry about.

2. Miscarriage:- It is defined as loss of pregnancy before the age of viability (28weeks in Nigeria). It is often associated with heavy bleeding and abdominal cramping. The woman describes bleeding to be heavy with or without blood clot. Ultrasound exam is done to confirm the viability of the fetus. Causes of miscarriage in first trimester are: reduced level of human chorionic gonadotropin (hCG)- this chemical helps to maintain pregnancy until placental is well developed, chromosomal abnormality, smoking, alcohol, caffeine etc.

There are four types of miscarriage.

If a miscarriage has been threatened, there was bleeding before 28 weeks of pregnancy with no cervical dilatation and no expulsion of any of the fetal parts.

If a miscarriage is inevitable, there was bleeding through the vagina with dilated cervical os and no expulsion of any of the fetal parts.

If a miscarriage has been completed, there was complete expulsion of fetal parts from your body.

If a miscarriage has happened incompletely, there was partial expulsion of the fetal parts before 20 weeks. In the case of incomplete miscarriages, the next step may be to allow the remaining products of pregnancy to pass naturally or perform a dilation and curettage.

3. Ectopic pregnancy: This is when pregnancy is implanted somewhere other than the uterine wall eg fallopian tube, or in the abdomen. Your doctor will suspect ectopic pregnancy when you have missed your period, complained of abdominal pain and bleeding through vagina. Transvaginal ultrasound scan when combined with BhcG estimation provides best way to diagnosed an unruptured ectopic pregnancy.

4. Cervical incompetence: Click and read this:

5. Hydatidiform mole: It is a benign tumour composed of proliferating or rapidly growing placenta tissue. The woman appears to be pregnant but the uterus enlarges much more than rapidly than in normal pregnancy. The woman also bleed with abdominal pain, excessive vomiting and passage of vesicles.

6. Post-coital bleeding: Even in normal pregnancy, there could be bleeding after sexual intercourse due to hypervasculariasation (increased blood supply) to the cervix. Once your physician affirms this, you have nothing to worry about.

NOTE: All forms of bleeding in pregnancy should be considered abnormal until you speak with your doctor.