by kizzyv on Wed Mar 01, 2006 5:18 pm
Cervical Polyps
Harmless small polyps can also cause bleeding. These are overgrowths of benign tissue, probably owing their existence to estrogen levels that made them grow. Most often they can be gently and painlessly twisted off during a physical exam. If not, they're usually destroyed by the very act of delivering the baby. It’s worth getting them off at a checkup so that your doctor won't need to worry and feel obligated to force you into a lot of extra tests you don’t need every time there’s spotting.
Subchorionic Hemorrhage
This sounds disastrous, but it usually represents a small clot that causes bleeding and then dissolves away harmlessly. Rarely, the clot dissects between the placenta and the attachment to mother and causes a miscarriage.
Decidual Tissue
Sometimes a small piece of tissue becomes loose and disintegrates through some unknown cause, causing spotting. It's usually a hormonally stimulated collection of menstrual-like tissue that can often be confused with a miscarriage. If it's just tissue debris, it can mean nothing. If it's actual tissue of the pregnancy (fetal or placental), then there should be serious concern, because now this "threatened miscarriage" is re-labeled as "incomplete miscarriage." No one knows why such a phenomenon occurs, but it is harmless. It’s the passage of tissue for sure, so it’s very disturbing until the pathology report can ease everyone’s mind. Strangely enough, the pseudopregnancy of birth control pills can cause this type of tissue shedding, which is really upsetting to a woman who thought (correctly) that she had been using her contraceptive properly. The stabilization of the uterine lining depends on estrogen and progesterone. It’s possible that there are lags in the amounts of hormones so that lining not involved with implantation loses its grip and sheds. In my practice, such shedding of only decidual tissue has had no impact on whether a pregnancy will miscarry. The tissue is termed “decidualized,” because of the pregnancy-like effect on it at the hands of estrogen.
Implantation Bleeding
In the past it’s been thought that an egg eroding into the uterine lining would cause bleeding at the time because of a burrowing effect. It’s doubtful whether there’s any bleeding when this happens, and if so, it's too small an amount to notice. The myth persists because there are bleeding episodes in which no cause is ever identified and in which the pregnancy goes on successfully to term. Such a mystery that starts off so menacingly but ends so well begs for an explanation that must include a natural process. Implantation makes sense under these criteria but can’t be proven.
Periods During Pregnancy
Many women ask me about having regular periods during their pregnancies. They’re concerned because Grandma or a cousin had periods every month during pregnancy, and could that happen during this pregnancy, making the last menstrual period (whichever one that was) screw up the due date? They swear that these periods during pregnancy are true – that they really happened. It’s false, all the swearing notwithstanding. Shedding one’s layer of menstrual tissue is not compatible with life. The closest thing we have to this is shedding of decidual tissue (as described above). When Grandma swears that it happened, it’s certainly the polite thing to listen with an open mind – just be sure to slam it shut by thinking about what’s really going on in pregnancy. The cycling of hormones stops because a pregnancy causes the hormone levels to remain high. This is necessary for pregnancy to continue. There are no falls in the hormones, which is what causes a period, except right before labor. Most likely, Grandma experienced a subchorionic hemorrhage (as described above), bleeding intermittently, misinterpreted as cyclic. That would explain her first trimester “periods.” Just being Grandma might explain the rest of her pregnancy’s periods.
Although the above instances describe the causes of bleeding that do not indicate miscarriage, miscarriage should still be ruled out if you have any bleeding at all. And when one considers that the cramping of a threatened miscarriage can feel exactly like the growing pains of a normal uterus, it is fortunate that there are other tools to give you peace of mind.
Blood tests can prove that the pregnancy hormone is increasing as expected and confirms a healthy pregnancy; ultrasound can demonstrate the physical well-being of a growing baby by showing a healthy heart rate or by ruling out an ectopic (tubal) pregnancy.
It's true that miscarriage is a fact of life as we know it, and usually it's due to some sort of doomed genetic mismatch; but although most miscarriages begin with first trimester bleeding, first trimester bleeding isn't always indicative of a miscarriage. Doctors always approach first trimester bleeding as a possible miscarriage until a cause can be determined. Usually it has a good outcome. So, although it's understandable how first trimester bleeding can cause a lot of anxiety and worry, your doctor can usually find something unrelated to the pregnancy – and treatable – to blame it on.
About the Author
Dr. Gerard M. DiLeo is a board certified obstetrician-gynecologist who has been in private practice since 1981 and has served as Chief of the Medical Staff at Lakeview Regional Medical Center in greater New Orleans. As a member of our expert panel, Dr. DiLeo can be contacted regarding obstetric care questions on his BabyZone expert page. Dr. DiLeo's book The Anxious Parent's Guide
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