:By Angela Onwuzoo
Maternal health experts have called for proper sensitisation of women in the country on the process and signs of pregnancy, noting that some women who are unaware of these signs often mistake bleeding in early pregnancy for menses.
They stressed that due to this misconception, some pregnant women often go for weeks and even months, without knowing they are pregnant, thus putting the health of the foetus at risk.
According to the experts, pregnancy and menses do not co-exist, stressing that a woman is not expected to menstruate while pregnant.
Speaking with PUNCH HealthWise in exclusive interviews, the experts, an Obstetrician and Gynaecologist at the Family Health Department, Federal Ministry of Health, Abuja, Dr. Kamil Shoretire; and a Consultant Obstetrician and Gynaecologist at the Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Dr. HaleemahOlalere, noted that the blood that women see during pregnancy is not actually menses but bleeding caused by different factors.
The gynaecologists reiterated that menses does not come during pregnancy, pointing out that it is mostly ignorance that makes some women not know the difference between menses and bleeding in early pregnancy.
Shoretire emphasised that it is unusual and uncommon for a woman with a normal womb and normal pregnancy to menstruate.
He explained, “A woman can bleed during pregnancy but the bleeding is not menses and if she has never known any other bleeding other than menses, she will say is menses.
“What you call menses is the monthly shedding of the lining of the womb; that is what comes out as menses. When there is pregnancy, there can’t be the shedding of the lining of the womb. It is on the lining of the uterus that pregnancy is sited. Pregnancy and menses do not co-exist, except the woman has a double womb. A woman is not expected to menstruate while she is pregnant but she could bleed.
“That bleeding could be as a result of implantation; when a pregnancy is growing and is planting itself in the lining of the womb. The implantation causes bleeding but that bleeding is not supposed to be significant. But in some women, the bleeding could be significant.
“The woman could bleed if the egg goes and locates itself in a place where there is a rich blood supply. So, the implantation is like an invasion; it is trying to dig a hole into the lining of the womb.
“If it digs a place where there is so much blood supply, the bleeding becomes more than the spot bleeding. But some women who are unaware of this will be confused and mistake it for their menses.”
Continuing, the gynaecologist noted, “Normally, menstruation ceases when there is pregnancy. Menses doesn’t come during pregnancy. However, some women may bleed during pregnancy depending on the location of the growing embryo or the location of the placenta.
“The one that is common is when the woman is already pregnant and she has sex with her husband and then begins to experience bleeding. This usually occurs when the placenta is sited very close to the mouth of the womb. That is what is called abnormally sited placenta or placenta previa.
Shoretire also pointed out that it is possible for women to bleed early in pregnancy, middle of pregnancy, and late in pregnancy.
“The one that is early in pregnancy is the one that some of the women would claim they are still seeing their menses. It is highly unusual and uncommon for a woman with a normal womb and normal pregnancy to menstruate. A woman that has ectopic pregnancy can continue to bleed without knowing that she is pregnant. But that is not a normal pregnancy.
“Women need to understand the process of pregnancy and how a baby is formed,” he said.
According to the American College of Obstetricians and Gynecologists, 15 to 25 percent of pregnant women bleed during the first trimester.
“Bleeding in the first trimester happens in 15 to 25 in 100 pregnancies. Light bleeding or spotting can occur one to two weeks after fertilisation when the fertilised egg implants in the lining of the uterus.
“The cervix may bleed more easily during pregnancy because more blood vessels are developing in this area. It is not uncommon to have spotting or light bleeding after sexual intercourse or after a Pap test or pelvic exam,” ACOG said.
Also speaking with our correspondent, Dr. Olalere said that there is no scientific evidence to show that women who are pregnant menstruate.
The gynaecologist said women that are experiencing bleeding during pregnancy need to be evaluated to know the exact cause.
“Women that say that they see blood while they are still pregnant, need to be evaluated. There could be a pathology; a particular issue that is making them bleed.
“That bleeding may not be from the endometrium wall that we call menses. However, there is something we call “threatened miscarriage”. Some women may have bleeding during this time but it is not going to be every month.
“25 per cent of pregnant women have some degree of vaginal bleeding. That threatened miscarriage can happen in about 25 percent of pregnant women, while in about 50 percent it progresses to abortion – they lose that pregnancy.
“Another thing that could predispose women to see blood during pregnancy is placenta previa and hormones of pregnancy.
“Changes in the cervix as a result of a hormone can cause bleeding in pregnancy. Also, entopic pregnancy, that is pregnancy in which the fertilised egg implants outside the uterus, can cause bleeding.
“So, there is no menstruation during pregnancy. Any woman that experiences that should be evaluated to know the disease condition that is responsible”, the gynaecologist explained.
