Understanding Bleeding During Pregnancy
Vaginal bleeding during pregnancy is a common concern, affecting between 15% and 25% of all pregnancies [1.9.5]. While it can be alarming, it doesn't always signal a major problem. The causes vary significantly depending on the trimester. In the first trimester, common causes include implantation bleeding, infections, cervical changes, or more serious conditions like ectopic pregnancy or early pregnancy loss (miscarriage) [1.9.5]. Bleeding in the second and third trimesters can be linked to issues like placenta previa, placental abruption, or preterm labor [1.10.5]. Because the underlying cause dictates the treatment, any bleeding during pregnancy requires immediate medical evaluation.
Medications for Early Pregnancy Bleeding
For bleeding in the first trimester (up to 12-13 weeks), the primary medication considered is progesterone.
Progesterone
Progesterone is a vital hormone for maintaining the early stages of pregnancy by supporting the uterine lining [1.4.3]. For women who experience bleeding in early pregnancy and have a history of one or more previous miscarriages, progesterone supplements may be recommended [1.4.2]. After an ultrasound confirms the pregnancy is correctly located in the uterus, a doctor might prescribe progesterone [1.4.2]. It is typically administered as a vaginal pessary, often twice daily, until 16 weeks of gestation [1.4.1, 1.4.2]. Research has shown this can increase the live birth rate in this specific group of women [1.4.5]. However, for women with early pregnancy bleeding who do not have a history of miscarriage, progesterone has not been shown to provide a significant benefit compared to a placebo [1.4.4].
Medications for Antepartum and Postpartum Hemorrhage
Later in pregnancy and especially after delivery (postpartum), bleeding is often more significant and requires different interventions. This is known as antepartum hemorrhage (before birth) or postpartum hemorrhage (PPH) (after birth).
Tranexamic Acid (TXA)
Tranexamic acid is an antifibrinolytic agent, meaning it works by preventing the breakdown of blood clots, thereby reducing bleeding [1.3.4]. Its use has become a critical part of managing severe bleeding, particularly PPH. The World Health Organization (WHO) recommends administering 1g of intravenous (IV) tranexamic acid as soon as PPH is diagnosed [1.3.4]. Studies, like the significant WOMAN trial, have shown that giving TXA within three hours of birth reduces deaths due to bleeding by about a third [1.3.2, 1.3.4]. It is considered safe and effective for managing bleeding during pregnancy and postpartum, although it is used with caution and prescribed by a doctor [1.2.2, 1.3.3]. It can be used for both vaginal and caesarean section deliveries to reduce blood loss [1.2.2].
Uterotonic Agents
Postpartum hemorrhage is most commonly caused by uterine atony, where the uterus fails to contract sufficiently after childbirth. Uterotonic medications are the first-line treatment to stimulate uterine contractions and control bleeding [1.5.1].
- Oxytocin: This is the most common and first-line uterotonic agent used for both prevention and treatment of PPH [1.6.2]. It is typically given via IV infusion immediately after delivery [1.6.5].
- Methylergonovine (Methergine): If oxytocin is not effective, methylergonovine may be administered. It's a powerful smooth muscle constrictor but is contraindicated in patients with hypertension or preeclampsia [1.6.5].
- Carboprost (Hemabate): This is another second-line agent, a prostaglandin analogue that stimulates uterine contractions. It should be avoided in patients with asthma [1.6.5].
- Misoprostol (Cytotec): This medication can be administered orally, sublingually, or rectally and is another option when other uterotonics fail or are unavailable [1.6.2].
| Medication | Primary Use | Administration Route | Key Contraindication(s) |
|---|---|---|---|
| Progesterone | Early pregnancy bleeding with prior miscarriage | Vaginal pessary | Not typically used after 16 weeks for this purpose [1.4.2] |
| Tranexamic Acid | Postpartum hemorrhage, severe bleeding | Intravenous (IV) | Known thromboembolic event during pregnancy [1.3.4] |
| Oxytocin | Postpartum hemorrhage (prevention & treatment) | Intravenous (IV) or Intramuscular (IM) | Hypersensitivity [1.6.5] |
| Methylergonovine | Second-line for postpartum hemorrhage | Intramuscular (IM) | Hypertension, Preeclampsia, Cardiovascular Disease [1.6.5] |
| Carboprost | Second-line for postpartum hemorrhage | Intramuscular (IM) | Asthma [1.6.5] |
Important Considerations
While Ethamsylate is another medication that can be used to control bleeding from small blood vessels, its use during pregnancy is generally not recommended due to a lack of safety information [1.7.1, 1.7.2]. The management of bleeding during pregnancy is complex and must be handled by healthcare professionals. Self-treatment is dangerous. Any instance of bleeding should be reported to a doctor immediately for proper diagnosis and a tailored treatment plan.
Conclusion
The medicine used to stop bleeding during pregnancy is highly dependent on the cause, severity, and timing of the hemorrhage. For threatened miscarriages in early pregnancy among women with a history of loss, progesterone can be beneficial. For severe bleeding, especially postpartum, tranexamic acid and a suite of uterotonic drugs like oxytocin are the primary tools. The decision of which medication to use, if any, rests entirely with a qualified medical professional after a thorough evaluation.
