Q: What causes bleeding during pregnancy?
Dr. Michael Kim, OB-GYN, Hawaii Permanente Medical Group: Bleeding in pregnancy is more common than you might think, especially in the first trimester. In some cases it’s nothing to worry about, while in others it can be a sign of a problem.
Around 20 percent of women experience some bleeding or spotting in the first trimester. Common causes include implantation bleeding, which occurs as the fertilized egg implants itself in the lining of the uterus around 10 days after conception, and might look like a very light period. There can be some bleeding between seven to 10 weeks because of a shift in the production of the hormone progesterone from the ovary to the placenta and this is usually not serious. Because pregnancy causes extra blood to flow to the cervix, some women might notice light bleeding after sex or a Pap test. More serious causes of early pregnancy bleeding include infection, ectopic pregnancy or miscarriage.
Bleeding in the second and third trimester can be more cause for concern. Possible causes include miscarriage, a premature opening of the cervix, problems with the placenta or preterm labor. Near the end of pregnancy, it’s common to experience light bleeding, and this may be a sign that labor is about to begin.
In general, you should contact your doctor if you experience any bleeding during pregnancy. During the first trimester, you can wait until your next prenatal visit to report any spotting or light bleeding that lasts less than a day. Later on, you should call your doctor the same day if you notice even light bleeding, and you should call your doctor immediately if you experience heavy bleeding at any point in your pregnancy or if the bleeding is associated with any pain.
Q: What is a TIA?
Dr. Christopher Taleghani, neurosurgeon, Maui Brain and Spine: TIA stands for transient ischemic attack. Some people call it a “mini-stroke” because it’s caused when blood temporarily stops flowing to part of the brain. It can cause many of the same early symptoms of a stroke — like weakness or numbness in the face, arm or leg, severe headache, loss of balance, and confusion — but those symptoms may only last a few minutes or hours. Some people may have multiple TIAs.
Even though most TIAs do not cause any lasting damage, it’s important to seek medical attention right away. That’s because, about one-third of the time, a TIA will be followed by a real stroke, often occurring within a few hours or days.
TIAs are often caused by a buildup of plaque in a person’s arteries, temporarily blocking blood flow or lowering blood pressure to the brain or leading to the formation of a blood clot. You can lower your risk for TIA and stroke by making lifestyle changes like maintaining a healthy weight, quitting smoking, limiting alcohol, controlling your diabetes and getting regular exercise. If you have high blood pressure, it’s also important to limit your sodium.
While a TIA can be scary, it can also be an opportunity to get medical attention before a more serious stroke can occur.
* Physicians, providers and administrative staff who practice at Maui Health System hospitals and clinics answer questions from the public in “Healthwise Maui,” which appears on Thursdays. Maui Health System operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital & Clinic and Lana’i Community Hospital and accepts all patients. To submit a question, go to the website at mauihealthsystem.org/contact.