Brown discharge in pregnancy: norm or pathology?

Expectant mothers are probably the most anxious people in the world. The changes that occur in their bodies can be both joyful and exciting, and frighteningly alarming. And pregnant women are very sensitive to all such changes and inexplicable manifestations of their delicate situation, because they are responsible for the birth of a new life, which must see the world on time and in full health. It is not surprising that brown discharge during pregnancy worries the expectant mother so much, because there should be no menstruation during this period, however, as well as its harbingers. Nevertheless, women encounter such a symptom quite often, so it is worth figuring out whether in this case there is a reason to worry or the fears of pregnant women are groundless.

Norm or pathology?

Before pregnancy, a woman regularly has menstruation once a month and brown discharge on the eve and in the last days of menstruation does not scare anyone, because it is a normal variant. But the appearance of such discharge in the period between menstruations can alarm any woman, since they usually indicate some hidden pathology of the female reproductive system.

During pregnancy, things are different. There should be no menstruation after conception, except perhaps in the first 4-5 weeks after conception, otherwise we are no longer talking about a normal pregnancy. But in the absence of menstruation, by analogy with non-pregnant women, there should be no spotting, which hints at possible problems with women's health. And if brown discharge appears during pregnancy, then everything is bad.

This is approximately how many expectant mothers reason when they encounter such a symptom for the first time, especially if previous pregnancies were without colored discharge. It is impossible to say unequivocally whether they are right or wrong, because even an experienced doctor cannot always determine by eye what brown discharge during pregnancy means - whether it is normal or pathological, until he conducts the necessary examination.

One thing is certain, that in the early stages of pregnancy and before childbirth, spotting brown discharge appears quite often. And there is usually nothing pathological in their appearance that would be worth serious worries for the expectant mother, for whom worries are no less dangerous. In the first case, they may indicate the onset of pregnancy, in the second - about the imminent joy associated with the birth of a new life.

But everything is always so rosy. The reasons for brown discharge during pregnancy can be different, and often we are talking about a serious disorder that carries the threat of premature termination of pregnancy. Still, despite the color, we are talking about bleeding, albeit minor. And how dangerous it is can be judged by the accompanying symptoms and the period of pregnancy.

The most dangerous are considered to be discharges that appear at the end of the first or in the second trimester of pregnancy. In this case, we are definitely talking about serious problems, because there are no physiological reasons that could provoke such a symptom. Here, everything depends on the woman herself and her desire to maintain the pregnancy, which will be facilitated by timely treatment at a medical institution.

Non-pathological causes of brown discharge

Let's first try to figure out when brown discharge during pregnancy is normal? But you need to realize that understanding the causes of an unusual symptom gives a woman hope that everything is fine with her and the baby, but still does not eliminate the need to get advice from a doctor at a women's clinic about this.

The first days and months of pregnancy are a period when a woman's body undergoes a rapid restructuring caused by changes in hormonal levels and the body's preparation for the long journey from conception to the birth of the baby. The main female hormones, estrogens and the hormone responsible for the normal course of pregnancy and called progesterone, can cause the appearance of unusual dark discharge. In addition, the processes occurring in a woman's body that are natural for the onset of pregnancy can provoke minor bleeding, which looks like brown spotting.

Hormonal changes can provoke regular spotting during the first, second, and sometimes third month of pregnancy. The discharge appears regularly on the days when a woman began menstruating before pregnancy. Their duration rarely exceeds two days.

Sometimes the discharge may even acquire a scarlet hue and resemble a normal period, although more scanty. However, in the absence of other suspicious symptoms (pulling or sharp pains in the lower abdomen, an unpleasant smell of discharge, nausea, unusual weakness, etc.), they do not cause harm to the expectant mother and the fetus in her womb.

A non-hormonal cause of brown discharge in the first couple of weeks of pregnancy is considered to be the transition of the fertilized egg to a new place of residence - the uterus. The implantation process in some cases is accompanied by damage to small vessels, the blood from which enters the vagina, where it mixes with natural physiological secretions and gets out together with them.

The bleeding is so slight that drops of blood only slightly tint the vaginal discharge, and it acquires a pink, beige or light brown tint. Such discharge, which has a creamy consistency, can continue for 24 hours and should not cause concern if it is scanty, does not have an unpleasant odor or foreign impurities (pus, white curdled lumps), does not cause itching in the genital and vaginal areas, and is not accompanied by pain.

Women have different attitudes towards unusual bleeding in the first weeks of pregnancy. Sometimes you can hear such a statement that there was brown discharge and it went away during pregnancy. In fact, this discharge only confirms the fact of pregnancy, which the woman did not suspect until she visited the gynecologist, and it quickly goes away, because hemorrhages from small capillaries are insignificant, and scarring of the vascular walls occurs in a short time on its own.

An identical situation can be observed in the last weeks of pregnancy, and although the cause of dark discharge will be somewhat different, namely the discharge of the mucus plug before childbirth, the pathogenesis of bleeding will be similar - rupture of small vessels in the cervix as a result of its shortening and smoothing. Drops of blood in this case get on the mucus plug and are excreted along with it.

A mucus plug is a lump of mucus that blocks the access of infection to the uterus. In this way, the mother's body provides additional protection to her offspring while it is in her womb. When the time comes for labor, the cervix begins to prepare for the passage of the already noticeably grown fetus. The expansion of its lumen (the uterus opens slightly) leads to the spontaneous passage of the plug. This process can be either one-time or prolonged, if the plug comes off in parts.

Most often, this happens either immediately before labor (in first-time mothers), or 3-5 days before it begins. But sometimes the mucus plug comes off a few weeks earlier. If we are talking about the 38th week or later, there should be no particular worries, you need to prepare for labor. Although it would not be a bad idea to notify your doctor.

But if brown discharge appears during pregnancy up to 37 weeks, you should not delay visiting a gynecologist, because even such scanty bleeding can be a harbinger of premature birth. Although in some cases, women successfully carry out their pregnancy for several more weeks.

Pathological causes of brown discharge

Of course, I would not like to move from pleasant to alarming, because any worries for expectant mothers are considered risk factors for spontaneous termination of pregnancy. But the reality is that in most cases, brown discharge during pregnancy indicates various complications that pose a danger to the woman and her unborn child. Therefore, their appearance cannot be ignored.

Frozen pregnancy. Embryo freezing can occur at any stage of pregnancy, but most often it occurs in the first trimester at 7-8 weeks. After all, it is during this period that the formation of most of the baby's organs and systems occurs, and its needs increase. According to statistics, the probability of such an outcome of pregnancy is about 0.7%, but this does not mean that the problem can be ignored due to the low risk of its occurrence.

A frozen pregnancy is most often a consequence of its incorrect course, as a result of which the embryo does not receive from the mother the nutrients necessary for its development, or is exposed to harmful factors. Risk factors for stopping the child's development include:

• hormonal imbalances, such as a deficiency of the pregnancy hormone progesterone, diseases of the thyroid gland and ovaries that produce hormones,
• the diet of the expectant mother is poor in vitamins and microelements,
• Rhesus conflict, caused by the difference in the Rhesus factor of the blood of the mother and child, due to which the pregnant woman's body reacts to the fetus as a foreign body, producing specific antibodies,
• some autoimmune disorders characterized by increased production of antibodies to blood components,
• various infectious diseases, regardless of the form they take (the most popular pests that can lead to the death of the fetus are considered to be herpes infection, mycoplasma, chlamydia, cytomegalovirus, papillomavirus, etc.),
• strong nervous experiences and stress,
• any bad habits,
• the impact of negative factors on a pregnant woman (vibration, radiation, inhalation of toxic substances, etc.),
• lifting weights,
• hereditary factor, etc.

In most cases, we are talking about health and nutritional disorders of the expectant mother, as well as the impact of harmful factors on her. But sometimes the cause of pregnancy fading is chromosomal pathologies of the fetus itself, preventing it from developing normally, as well as unknown reasons for which a healthy and normally nourished woman has a miscarriage. The symptom preceding this event is brown discharge.

The fact is that embryonic freezing is always accompanied by an inflammatory process in the woman's body, which reaches its peak 2-3 weeks after the onset of the pathological process. The appearance of brown discharge in this case already indicates the detachment of the ovum, and if there is pus in them - a necrotic process against the background of a long-frozen pregnancy.

Detachment of the fetal egg and the threat of miscarriage. All of the above factors can provoke detachment of the fetal bladder from the uterine wall in the early stages of pregnancy, even if the fetus developed normally. The rejection of the membrane surrounding the embryo and amniotic fluid from the chorion is accompanied by damage to the vessels and the formation of a hematoma.

At the same time, moderate scarlet discharge indicates the beginning of detachment, especially if they are accompanied by nagging pains in the lower abdomen, nausea and vomiting. An increase in the size of the hematoma contributes to further detachment of the fetal bladder, which can end in its complete rejection and death of the fetus. Outwardly, this looks like a spontaneous miscarriage.

Brown discharge during pregnancy in this case may indicate that bleeding has stopped and the hematoma has resolved, but the risk of repeated rupture of the junction of the chorion and the ovum remains, which means that the symptom should not be treated carelessly.

True, in some sources you can find a different opinion. Its adherents consider the detachment of the fertilized egg as a test of the embryo's strength, a kind of natural selection. A healthy, viable embryo is capable of surviving not one, but even several partial detachments. The fertilized egg can detach and grow back to the chorion. But only a strong fetus can survive.

According to this theory, the expectant mother can take a wait-and-see attitude, hoping that her baby will cope with adversity. By the way, there are many cases when women, when brown discharge and nagging pains appeared, either did not consult a doctor or simply did not respond to confirmation of the fact of detachment of the amniotic sac by ultrasound, but at the same time gave birth to healthy babies on time. But whether to take risks or not is already the choice of the expectant mother herself, which she makes both for herself and for her child, taking his fate into her own hands.

In any case, it is important to understand that the threat of miscarriage is not equivalent to a miscarriage that has occurred. If you contact your doctor in a timely manner, in most cases you can save your pregnancy with the help of hormonal therapy (achieving a normal level of progesterone to maintain pregnancy), normalizing the psycho-emotional state of the pregnant woman, and physical rest.

Chromosomal abnormalities in the fetus and hydatidiform mole. This is a very unpleasant condition during pregnancy, when either some part of the placenta or all of its tissues undergo pathological changes, while the villi of the chorion (the embryonic part of the placenta) take the form of bubbles, growing like a bunch of grapes. Oddly enough, the cause of this phenomenon most likely lies in the chromosome set of the fetus.

Since male chromosomes are mainly responsible for the structure and characteristics of the chorion of the placenta and the amniotic sac, their predominance is precisely what contributes to pathological measurements in these organs. When diagnosing a hydatidiform mole, studies of embryos showed that most of them had a triple set of chromosomes, where 2 sets were paternal. In another part of the children, as expected, only 2 sets of chromosomes were detected, but both of them turned out to be paternal.

The exact causes of this pathology have not yet been established, so we have to rely only on a hypothesis. However, a relatively small number of pregnant women are diagnosed with abnormal development of the placenta, characterized by dysplastic processes. In other words, small benign tumors are formed on the chorion villi - cystic formations with fluid inside.

This pathology is characterized by a less than favorable prognosis. In case of partial molar pregnancy with damage to individual tissues of the placenta, there is some chance of a healthy baby being born, but in most cases the fetus dies in the second trimester of pregnancy. If all tissues are damaged, they become unable to support the viability of the embryo and stimulate its development, so the fetus dies within the first months after conception.

Brown discharge in this pathology most often occurs with a complete hydatidiform mole, which caused the pregnancy to freeze. However, they are not the only symptom. The general condition of the patient worsens, so it will not be difficult to distinguish a problem pregnancy from a normal one.

Polyps in the uterus. Sometimes, when diagnosing brown discharge during pregnancy in its first trimester, small harmless neoplasms - polyps - can be found in the cervical canal of the cervix. These benign growths can provoke minor bleeding, which on underwear has the appearance and character of smearing discharge. In some cases, polyps disappear on their own (fall off and are removed from the vagina along with vaginal secretions) and do not require treatment. But their surgical removal is also possible, which does not involve scraping the uterus, and therefore is safe for the pregnant woman.

Ectopic pregnancy. Among all the above-described disorders, this pathology has the worst prognosis, since it always ends in termination of pregnancy, which poses a threat to the woman's life. There is no talk of saving the embryo growing and developing in the fertilized egg outside the uterus (in the fallopian tube); it is removed surgically.

The fact is that an ectopic pregnancy, as the fetus grows and develops, can be complicated by a rupture of the fallopian tube wall, which cannot be restored. But this is not the worst thing. Much worse for a pregnant woman is bleeding caused by a rupture of the fallopian tube, which is more intense and provokes a large blood loss.

Brown discharge in this case may be the first sign, followed by profuse bloody discharge, unpleasant constriction on the side where the fetus is located, or severe pain in the lower abdomen. And the sooner a woman seeks help, the greater the chance of saving her life and preserving her reproductive function.

Placental abruption. This pathology usually occurs in the middle and last stages of pregnancy, i.e. in the second and third trimesters, and is dangerous for both the pregnant woman and the baby in her womb. The placenta is a kind of intermediary between the mother's body and the child. It is the placenta that supplies the fetus with the necessary nutrients and oxygen, obtained from the blood of the expectant mother.

If the placenta detaches, the connection necessary to support the life of the organism forming inside it is lost. The baby dies from hypoxia and deficiency of vital substances. And the placenta detachment itself is accompanied by bleeding, the strength of which determines the woman's condition and, to some extent, the possibility of maintaining the pregnancy.

The cause of a problematic pregnancy in this case may be abdominal trauma during this period, previous abortions and cesarean sections accompanied by the formation of scar tissue, a shortened umbilical cord, hypertension in the expectant mother, and smoking during pregnancy.

Placental abruption occurs gradually, passing through several stages. At the first stage, a woman may experience brown discharge during pregnancy. But they will not be smeared for long, subsequently acquiring a more saturated scarlet color and moderate intensity. At the last, most severe stage of the pathology, the discharge may already be strong enough to be called full-fledged bleeding.

Regardless of whether there is a partial detachment, diagnosed in most cases, or a complete placental abruption, the pregnancy ends with a cesarean section. Another matter is at what stage it will be performed. With severe bleeding, everything is decided in the first minutes and hours after contacting a medical institution, and the child cannot be saved. With spotting, characteristic of the initial stage of detachment, doctors try to drag out time at least until 30-32 weeks, when the fetus is considered quite viable, after which they again resort to a cesarean section.

Placenta previa. This is another disorder in which brown discharge occurs due to damage to blood vessels, but in the placenta. Placenta previa is the location of the placenta close to the cervix. At an early stage, this does not cause any problems, but as the baby grows, it begins to press harder on the walls of the placenta, which in turn rests against the walls of the uterus. This pressure provokes the rupture of small vessels of the placenta, accompanied by a small discharge of blood.

In rare cases, strong pressure on the tissues of the placenta leads to placental abruption, but this only happens with prolonged bleeding. Usually, everything is limited to spotting and a feeling of pressure on the cervix, with which women go to the gynecologist to be subsequently monitored until the very birth.

The entire period from the onset of the first bleeding until the moment the baby is born, it is in danger, because by squeezing the placenta vessels, it disrupts the oxygen supply and can die from hypoxia. This danger does not decrease during natural childbirth, so doctors prefer to play it safe and practice cesarean section.

Late pathologies of pregnancy. In the last trimester of pregnancy, if we are not talking about the discharge of the mucus plug, among the possible causes of brown discharge we can consider such unpredictable violations of the structure and functions of the placenta as its stratification (detachment), making natural childbirth impossible.

A rupture of the uterus is considered an equally dangerous complication of pregnancy if its walls were previously weakened by inflammatory-degenerative processes or surgical interventions (abortion, cesarean section, curettage). In this case, bleeding of varying intensity is also possible, posing a danger to the expectant mother. But a violation of blood circulation in the uterus entails disruptions in the supply of oxygen to the child, who is not yet able to breathe independently and may die right in the womb on the eve of the date of his birth. The most effective solution to the problem is a cesarean section followed by an operation to suture the uterus.

Gynecological problems. It is wrong to think that a pregnant woman cannot have any gynecological diseases. Pregnancy usually does not cure, but provokes an exacerbation of already existing latent diseases. For example, cervical erosion can have such a latent course. Before the woman got to the gynecological chair, the erosive-inflammatory process could be sluggish and not give symptoms. But subsequently, the uterine tissue disturbed by the gynecological instrument can begin to bleed, which will be accompanied by the appearance of smearing brown discharge until the wound heals.

An identical situation can be observed after active sexual intercourse. The fact is that hormonal changes make a woman's tissues more sensitive to any aggressive impact, and damaging them is not difficult. It is not surprising that doctors diagnose cervical erosion in many women during pregnancy, although the possibilities for effective treatment of the pathology during this period are limited. Acceptable drug treatment does not give the desired effect, so after the birth of the baby, women still have to undergo the procedure of cauterization of the erosion.

Another danger is sexually transmitted infections (STIs) and inflammatory processes in the tissues of the internal female genital organs, which occur under the influence of infectious factors or mechanical damage. During pregnancy, which occurs against the background of such diseases, brown discharge is not uncommon. But usually they are accompanied by other symptoms, such as an unpleasant odor of vaginal discharge, itching, nagging pain in the lower abdomen, etc.

The causes of such diseases may be:

• unprotected sexual intercourse, because there is no longer any reason to protect yourself from possible conception, and few people think about infections,
• a decrease in the immunity of the expectant mother, which provokes the development and proliferation of opportunistic microflora in her body, which was previously in an inactive state,
• damage to the vaginal mucosa by all kinds of devices that enhance orgasm, gynecological instruments, and poor-quality intimate hygiene products.

It is important to understand that the presence of infectious diseases (and any inflammation will attract infection) is not just some discomfort for a pregnant woman, but also one of the main risk factors for a complicated pregnancy. Infections can provoke a miscarriage or death of the fetus, as well as cause various developmental disorders of the child, so you need to take care of their treatment in advance, because the possibilities of treating infectious and inflammatory diseases during pregnancy are limited by the fact that many antibiotics and antifungal drugs can have a toxic and teratogenic effect on the fetus.

Brown discharge during pregnancy, although often indicating various pathologies, is not a reason to panic. There are many reasons for their appearance, so it is simply impossible to determine the one that caused this symptom on your own. You should not make frightening diagnoses and unpleasant forecasts in advance, but you should not be careless about such a situation either. It is known that the majority of successfully resolved pregnancies, in which spotting appeared at one time or another, became so only due to timely seeking help from doctors. And even if the fears turned out to be in vain, can anyone blame the expectant mother for caring about her health and the health of her child? After all, the baby during its stay inside the mother's tummy depends only on her and her vigilance.