Sunday, November 18, 2007

Bleeding in pregnancy is a worrisome symptom

I REMEMBER being in complete awe in medical school learning about how embryos become fetuses, and fetuses babies. As we learned about each intricate step that had to occur in just the right way at just the right time, I was amazed that any of us ever made it to the point of being born.

Any number of problems can occur at any step in the process, yet most of the time, everything works out perfectly. Fortunately, this is true, because when everything doesn't happen perfectly, the results can be devastating.

Miscarriages, ectopic pregnancies and molar pregnancies are just three of the possible outcomes when things don't go just right.

Miscarriage (called abortion in medical terminology regardless of whether it's spontaneous or induced) is the most common of the three. It's estimated that up to 50 percent of all pregnancies end in miscarriage, most before the woman even knows she's pregnant.

The most common symptoms of a miscarriage are bleeding and sometimes cramping.

Most miscarriages occur before 12 weeks of pregnancy and usually don't result in a serious threat to the mother's health -- unless very heavy bleeding occurs. Even this is generally managed without too much difficulty nowadays.
The emotional toll, however, is another story. Losing a pregnancy often leads to thoughts about how it happened and feelings of guilt about every little perceived transgression that is believed to play a part.

But most miscarriages are no one's fault. Most occur due to random genetic abnormalities and have nothing to do with anything the mother or anyone else did wrong. They are just nature's way of dealing with abnormal pregnancies. This realization can ease a lot of unnecessary and debilitating guilt.

The good news is that most women go on to have a normal pregnancy after one and even two miscarriages.

The mother's health

More life-threatening for the mother are the other two pregnancies-gone-wrong: ectopics and molar pregnancies.

Most women know ectopics as tubal pregnancies. Most ectopics do, in fact, occur in the tubes. But they can also occur on the ovary, in the abdominal cavity and in the cervix, among other places.

The problem with these pregnancies is that they occur in places that can't increase in size as the pregnancy does. The result is a rupture or excessive bleeding of the organ in question, which can be life-threatening for the mother if not diagnosed and acted on quickly.

Like miscarriages, ectopics cause abnormal bleeding. But ectopics also cause severe pain as the pregnancy gets bigger and bigger. These symptoms should never be ignored.

With highly sensitive pregnancy tests and ultrasound capabilities, these abnormal pregnancies can be detected quite early and treatment -- whether surgery or with medication -- can mean the difference between life and death.

It is important to realize that ectopic pregnancies are not normal pregnancies and the pregnancy cannot be removed from the tube or wherever it has decided to implant and be placed into the uterus.

Get symptoms checked

Molar pregnancies are the least common of the three and many women have never heard of them. Molar pregnancies occur when the egg and sperm do not join as they are supposed to, creating a pregnancy with distinct chromosomal abnormalities.

The main symptom, again, is bleeding. Once a pelvic exam is performed, the uterus will be found to be larger than expected for a normal pregnancy at the same stage. Ultrasound and blood pregnancy tests confirm the diagnosis.

The reason these pregnancies are so dangerous is that they can become cancers. Surprisingly, they often occur after normal pregnancies.

In the past, the diagnosis of a molar pregnancy was a death sentence because if it turned cancerous, it could be very aggressive. Today, with the use of chemotherapy, the survival rate is very good.

I've heard many women say they thought bleeding a little in early pregnancy is normal. While this may be true, bleeding while pregnant should not be ignored. Chances are that everything will be OK, but the consequences if not are too devastating to take that chance.


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