Signs of Internal Bleeding During Pregnancy

Internal bleeding during pregnancy is caused by ectopic pregnancy, which means that a fertilized egg has implanted outside the uterus, usually in one of the Fallopian tubes. For this reason, an ectopic pregnancy is often referred to as a "tubal pregnancy." More than 95% of all ectopic pregnancies occur in the Fallopian tubes. Although rare, the egg can also implant in the ovary, abdomen or cervix. As the fetus develops, severe bleeding may occur, posing a risk to the mother's life. An ectopic pregnancy in the Fallopian tube cannot be carried to full term.

Theories/Speculation

• Blockage of the Fallopian tube is a common cause of ectopic pregnancy. Pelvic inflammatory disease (PID) is an infection or inflammation that can block the tube. Endometriosis and scar tissue from previous abdominal or reproductive surgeries can also cause blockages. In rare cases, birth defects can change the shape of the tube, resulting in an ectopic pregnancy. Because the egg is unable to develop normally, the pregnancy must be treated.

Effects

• Since the symptoms of ectopic pregnancy are typically the same as those normal for early pregnancy, the condition can be difficult to diagnose. A woman may miss periods, have nausea and vomiting, need to urinate frequently, and experience tenderness in the breasts. Sharp pelvic or abdominal pain and vaginal bleeding are often the first warning signs that there may be problems. Many times the pain, which can vary in intensity, is located only on one side of the pelvis. In addition to vaginal spotting, other signs of ectopic pregnancy may include pain in the lower back, and low blood pressure and dizziness caused by blood loss.

Significance

• Internal bleeding is the most serious complication of an ectopic pregnancy, and may require immediate surgery. While approximately half of all ectopic pregnancies resolve spontaneously without treatment, heavy bleeding occurs if the Fallopian tube ruptures. This is frequently the case in undetected ectopic pregnancies where the fertilized egg has implanted in the tube, just before entering the uterus. Internal bleeding is caused by hemorrhage in the affected tube. As the embryo continues to develop, the Fallopian tube expands and eventually ruptures. This occurs in one out of every five cases. If the artery on the outside of the tube ruptures, severe internal bleeding can occur. Serious blood loss can lead to shock, and in rare instances, death. Any vaginal bleeding may be heavy and dark. If discovered early enough, an ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.

Misconceptions

• Despite the complications, ectopic pregnancy does not necessarily cause infertility. In many cases, a woman who has had an ectopic pregnancy can become pregnant again, but she is at increased risk for another ectopic pregnancy. Fortunately, increasing awareness about ectopic pregnancies has led to early diagnosis and treatment. Doctors recommend that a woman wait at least 3 to 6 months before trying to get pregnant again to allow time for scarring to heal.

Warning

• The risk of ectopic pregnancy is highest for women over the age of 35 who have had a previous ectopic pregnancy, surgery involving a Fallopian tube, scar tissue in the abdomen caused by pelvic inflammatory disease, a history of endometriosis, or infertility problems. Ectopic pregnancy can also occur in women without any of these risk factors.

Time Frame

• Symptoms last as long as the ectopic pregnancy continues. Without treatment, serious and even life-threatening complications can occur. If an ectopic pregnancy is diagnosed within the first six weeks, the pregnancy can be terminated with medication. An ectopic pregnancy that goes beyond that time will require surgery either through a laparoscope, or abdominal surgery if the Fallopian tube has already ruptured and there is a lot of bleeding in the abdomen. Depending on the extent of the damage, all or part of the Fallopian tube may need to be repaired or removed. A blood transfusion may also be required if there has been serious blood loss.

Prevention/Solution

• While there is not a lot that you can do to prevent an ectopic pregnancy, you can take steps to decrease the risk factors. Talk to your doctor before trying to conceive if you have had previous surgery involving the bowel, reproductive system or lower abdomen, as scar tissue may be present.
  Make sure your physician carefully reviews your medical history, including if you have had a cesarean section or your appendix removed. If you are diagnosed with PID, take the prescribed antibiotic medication as directed, and then follow up with your doctor. Use a condom to prevent infection associated with a sexually transmitted disease. Should pregnancy occur and you have some of the risk factors, ask your obstetrician to schedule an early ultrasound to locate the implanted embryo.