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Pregnancy, Bleeding (cont.)

Bleeding During Pregnancy Prognosis

The effects of bleeding during your pregnancy depend on many factors. The cause of the bleeding and whether it is treatable is the most important issue.

Early pregnancy bleeding

If a normal appearing pregnancy with a normal beating heart is seen by ultrasound inside the uterus and you are younger than 40 years, the pregnancy has a less than 3% chance of being a miscarriage. If you are older than 40 years, then there is an 8% chance of a miscarriage. If there is not a definite pregnancy seen within the uterus, then the likelihood of a miscarriage is really unknown but could be up to 50%.

Ectopic pregnancy: For bleeding in early pregnancy caused by ectopic pregnancy, the pregnancy will not survive. If you have such a pregnancy, the possibilities of future ectopic pregnancies depend on the location, timing, and management of the condition. About 50% of women with ectopic pregnancies later have successful pregnancies.

Threatened abortion: You will have an entirely normal pregnancy and birth 50% of the time. Alternatively, you may progress to have a spontaneous abortion or miscarriage. If you have an ultrasound at the time of your evaluation, which shows a fetus with a heartbeat in the uterus, there is a 75%-90% chance of having a normal pregnancy.

Complete abortion or miscarriage: For women with recurrent miscarriages, the possibility of having a successful pregnancy is still high. Even after two or more miscarriages, your chances for delivering a child are still high.

Molar pregnancy: After having a molar pregnancy, the risk of molar pregnancy in a later conception is about 1%. In addition, the overall risk of a certain form of cancer in women who have had a prior molar pregnancy has been estimated at 1,000 times higher than that of women who have not had a molar pregnancy.

Late pregnancy bleeding

Placenta Previa: The risk of maternal death is less than 1%, but other complications, such as massive hemorrhage requiring a blood transfusion or a hysterectomy, can also occur.

  • RRarely, the placenta attaches abnormally deep into the uterus. This is called a placenta accreta, increta, or percreta, depending on the depth. Many women who have this condition have such massive bleeding that a hysterectomy (removal of the uterus) is required to save the woman's life.
  • Up to 8 of every 100 babies with placenta previa die, usually because of premature delivery and lack of lung maturity. Other problems for the baby include size smaller than expected, birth defects, breathing difficulties, and anemia requiring blood transfusion.

Placental Abruption:The risk of maternal death is low, but major blood loss may require transfusions.

  • The risk of death for the baby with placental abruption is about 1 in 500. This accounts for 15% of all newborn deaths.
  • If the baby survives, about 15% have neurological and behavioral problems as a result of decreased oxygen to the brain. This occurs because placental blood vessels spasm and reduce the flow of oxygen to the baby before delivery.
  • As the placenta separates from the womb, amniotic fluid and some placental tissue may enter the woman's bloodstream and cause a reaction. Her blood may become very thin and not clot well, which worsens the hemorrhage. She may require additional blood products to help her clot.

Uterine Rupture: This is a very dangerous condition for both the woman and the baby.

  • The greatest risks to the woman are hemorrhage and shock.
  • An increased rate of transfusion occurs with uterine rupture, and 58% of women require more than 5 units of blood transfused.
  • TThe risk of death for the woman is less than 1%. However, if left untreated, the woman will die.
  • The risk to the fetus is extremely high. The death rate is about one in three.
  • Fetal bleeding is extremely dangerous for the baby. The risk of death for the baby is 50% and is increased to 75% if the membranes rupture (water breaks).

Congenital Bleeding Disorders: TThe risk of complications for the woman is quite low. The most concerning is hemorrhage. The risk to the infant is very low. The largest risk to the baby, especially if it is a male, is inheritance of the bleeding disorder.

Pictures of Ectopic and Intrauterine Pregnancies

Picture of an Ectopic Pregnancy

Media file 1: An early intrauterine pregnancy seen on ultrasound.


Media type: Ultrasound

Medical Author:

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