Bleeding during pregnancy: Why it happens, what to do

Vaginal bleeding during pregnancy has many causes. Some are serious, and some aren't. Know when to contact your health care provider.

Vaginal bleeding during pregnancy can be scary. It's not always a sign of trouble, however. In fact, most women who experience vaginal bleeding during pregnancy — particularly during the first trimester — go on to deliver healthy babies. By understanding the most common causes of vaginal bleeding during pregnancy, you'll know what to look for and when to contact your health care provider.

Bleeding during the first trimester

Many women experience light vaginal bleeding during the first 12 weeks of pregnancy. Possible causes of vaginal bleeding during early pregnancy include:

• Implantation. You may notice a small amount of vaginal bleeding very early in pregnancy, about 10 to 14 days after fertilization. This "implantation bleeding" happens when the fertilized egg attaches to the lining of your uterus. It's usually earlier, spottier and lighter in color than a normal menstrual period, and it doesn't last long. Some women mistake this light bleeding for a period and don't realize they're pregnant.
• Cervical changes. When you're pregnant, more blood flows to your cervix. You may experience harmless vaginal bleeding after contact to your cervix, such as after sex or a pelvic exam.
• Miscarriage. Up to 15 percent of known pregnancies end in miscarriage, according to the American College of Obstetricians and Gynecologists. Vaginal bleeding is the primary sign of miscarriage. But bleeding doesn't necessarily mean you're having a miscarriage. Remember, most women who experience vaginal bleeding during pregnancy go on to deliver healthy babies.
• Ectopic pregnancy. Sometimes an embryo implants somewhere outside the uterus, usually in a fallopian tube. This is known as an ectopic pregnancy. An embryo implanted outside the uterus can't survive. And without treatment, life-threatening blood loss is possible. In addition to vaginal bleeding, an ectopic pregnancy may cause abdominal or pelvic pain.
• Molar pregnancy. Rarely, an abnormal mass — instead of a baby — forms inside the uterus after fertilization. Vaginal bleeding is the most common sign of a molar pregnancy.
• Infection. Some cervical infections cause bleeding in early pregnancy.

When to contact your health care provider
During the first trimester, if you have slight vaginal bleeding that goes away within a day, tell your health care provider at your next visit. If you have any vaginal bleeding that lasts more than a day, contact your health care provider within the next 24 hours. Contact him or her immediately if you:

• Experience moderate to heavy vaginal bleeding
• Experience any amount of vaginal bleeding accompanied by abdominal pain, cramping, fever or chills
• Pass tissue from your vagina

What to expect next
Your health care provider will likely ask questions about the bleeding and do a physical exam, including a pelvic exam. Depending on the severity of your symptoms, your health care provider may do lab tests or an ultrasound to assess your baby's well-being.

Typically, vaginal bleeding during the first trimester doesn't require treatment. Sometimes, however, your health care provider may recommend resting until the bleeding subsides. If you have a cervical infection, you may be given antibiotics.

If your health care provider diagnoses a miscarriage, you may choose to let it progress naturally or speed the process with medication or a minor surgical procedure known as dilation and curettage (D and C). During this procedure, the doctor dilates your cervix and gently suctions the tissue out of your uterus. Sometimes a long metal instrument with a loop on the end (curet) is used after the suction to scrape the uterine walls.

If you have an ectopic or molar pregnancy, you'll need prompt treatment. Sometimes an ectopic pregnancy can be treated with medication. In other cases, surgery is needed. With a molar pregnancy, a D and C is needed to remove the tumor from the uterus.

Bleeding during the second or third trimester

As the cervix begins to thin out and relax in preparation for labor, the thick plug of mucus that seals the opening of the cervix is dislodged. When this happens, you may notice a thick or stringy discharge that may be tinged with blood. This "bloody show" is a normal sign of impending labor that may occur up to a week or two before delivery.

A bloody show near the end of pregnancy isn't cause for concern. But other causes of bleeding during the second or third trimester are more worrisome, including:

• Miscarriage. Vaginal bleeding is the primary sign of miscarriage. Although miscarriage is most common during the first trimester, a risk still exists in the second trimester.
• Preterm labor. Light bleeding in the second or third trimester may be a sign of preterm labor, especially when accompanied by regular contractions, dull backache or pelvic pressure.
• Problems with the cervix. A cervical infection, inflamed cervix or growths on the cervix may cause vaginal bleeding in the second or third trimester. Occasionally, light bleeding may be a sign that the cervix is opening prematurely (cervical incompetence). This can lead to preterm birth.
• Placenta previa. Painless, bright red vaginal bleeding in the second or third trimester may indicate placenta previa — a serious problem in which the placenta partly or completely covers the opening to the birth canal. The bleeding may stop at some point, but it nearly always recurs days or weeks later.
• Placental abruption. Rarely, the placenta begins to separate from the inner wall of the uterus before birth. This may cause bleeding that's scant, heavy or somewhere in between. The bleeding is usually accompanied by abdominal pain.
• Uterine rupture. Rarely, the uterus tears open along the scar line from a prior C-section. This may cause vaginal bleeding, intense abdominal pain and abdominal tenderness. If your uterus ruptures — either before or during labor — an emergency C-section is needed to prevent life-threatening complications.

When to contact your health care provider
Contact your health care provider if you have any amount of vaginal bleeding in the second or third trimester. You'll likely need an exam in the doctor's office or hospital. Seek immediate care if you have vaginal bleeding accompanied by:

• Pain
• Cramping
• Fever
• Chills
• Contractions

What to expect next
To determine what's causing the bleeding, your health care provider will likely do an ultrasound and a vaginal exam. Monitors may be used to detect contractions and track your baby's heart rate. If you've lost a significant amount of blood, you may need intravenous fluids or a blood transfusion. Your health care provider will closely monitor your baby for signs of distress.

Depending on the cause of the bleeding and various other factors, treatment may include bed rest or medication. If you have a cervical infection, you may be given antibiotics. In some cases, an emergency C-section may be recommended.

Details are key to diagnosis

If you experience vaginal bleeding during pregnancy, don't be shy about explaining your symptoms. Describe how much blood you passed, what it looked like, and whether it included any clots or tissue. If you use pads to soak up the blood, keep track of how many. All this information can help your health care provider determine if the bleeding is a normal part of pregnancy or something more serious — and what to do next.

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By Mayo Clinic Staff
May 2, 2007

Artificial sweeteners: A safe alternative to sugar

More than ever, people are consuming large amounts of sugar as part of their daily diet. But in excess, sugar can take its toll. Eating large amounts of sugar adds extra calories, which can cause weight gain. Hence many people opt for artificial sweeteners — also referred to as sugar substitutes or low-calorie sweeteners — as a way to enjoy their favorite foods without as many calories.

What are artificial sweeteners?

Artificial sweeteners are chemicals that offer the sweetness of sugar without the calories. Because the substitutes are much sweeter than sugar, it takes a much smaller quantity of them to create the same sweetness. Therefore, products made with artificial sweeteners have a much lower calorie count than do those made with sugar. Artificial sweeteners are often used as part of a weight-loss plan or as a means to control weight gain.

People with diabetes may use artificial sweeteners because they make food taste sweet without raising blood sugar levels. But keep in mind that if you do have diabetes, some foods containing artificial sweeteners, such as sugar-free yogurt, can still affect your blood sugar level due to other carbohydrates or protein in the food. In addition, some foods labeled "sugar-free" — such as sugar-free cookies and chocolates — may contain sweeteners such as sorbitol or mannitol that contain calories and can affect your blood sugar level. Some sugar-free products may also contain flour, which will raise blood sugar levels.

Sweet choices

The Food and Drug Administration (FDA) has approved five low-calorie sweeteners for use in a variety of foods. The FDA has established an "acceptable daily intake" (ADI) for each sweetener. This is the maximum amount considered safe to consume each day over a lifetime. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.

Artificial sweetener	ADI*	Estimated ADI equivalent**	OK for cooking?
Aspartame (NutraSweet, Equal)	50 milligrams (mg) per kilogram (kg)	18 to 19 cans of diet cola	No
Saccharin (Sweet'N Low, SugarTwin)	5 mg per kg	9 to 12 packets of sweetener	Yes
Acesulfame K (Sunett, Sweet One)	15 mg per kg	30 to 32 cans of diet lemon-lime soda***	Yes
Sucralose (Splenda)	5 mg per kg	6 cans of diet cola***	Yes
Neotame	18 mg a day	No consumer products available yet in the U.S.	Yes

*FDA-established acceptable daily intake (ADI) limit per kilogram (2.2 pounds) of body weight.
**Product-consumption equivalent for a 150-pound person.
***These products usually contain more than one type of sweetener.

Safety of artificial sweeteners

Artificial sweeteners are often the subject of stories in the popular press and on the Internet, claiming that they cause a variety of health problems, including cancer. According to the National Cancer Institute, however, there's no scientific evidence that any of the artificial sweeteners approved for use in the United States cause cancer. And numerous studies confirm that artificial sweeteners are safe for the general population.

Aspartame does carry a cautionary note, however. It isn't safe for people who have the rare hereditary disease phenylketonuria (PKU). Products that contain aspartame must carry a PKU warning on the label.

Still empty calories

Just removing sugar from cookies and chocolates doesn't make them low-calorie, low-fat foods. If you eat too many, you'll still get more calories than you need, and you may not get enough nutritious foods. Unlike fruits, vegetables and whole grains, sugar-free soft drinks, candy and desserts often provide few — if any — beneficial nutrients.

Use artificial sweeteners sensibly. It's OK to substitute a diet soda for a regular soda, for example, but diet soda shouldn't be the only beverage you drink.

By Mayo Clinic Staff
July 3, 2007

20 ways to revive your healthy-eating plan

Make healthy eating interesting and enjoyable. These quick tips are certain to invigorate your healthy-eating efforts.

Whether you're just starting or have been following a healthy diet for years, sticking to the plan can be challenging. But healthy eating doesn't need to be boring or tiresome. Flavorful food combinations, new cooking ideas and an inventive spirit can enliven your meals and snacks.

Here are 20 ideas to keep you on course.

1. Experiment with new foods and combinations. Try mango or peach slices on whole-wheat toast with a little peanut butter and honey. Toss some mandarin orange and peach slices into a salad.
2. Add chickpeas, black beans or garbanzos to your lunch or dinner salad. If you typically buy a salad at work and no beans are available, bring beans from home in a small container.
3. Try something new for breakfast. Munch on leftover vegetable pizza or make a smoothie blended from exotic fruits, low-fat yogurt and a spoonful of wheat germ.
4. Stir-fry extra-firm or firm tofu rather than meat in oriental dishes. Freezing and then thawing tofu before use gives it a firmer, chewier texture.
5. Make a nutritious snack rather than a full meal when time is tight. For example, spread a brown rice cake with ricotta cheese and fresh strawberries or low-sugar, spreadable fruit. Or try corn muffins with apple and cheese slices, or fat-free refried beans mixed with salsa, a small amount of low-fat sour cream and baked tortilla chips.
6. Add crushed bran cereal or unprocessed wheat bran to baked products, such as meatloaf, breads, muffins, casseroles, cakes and cookies. Also, use bran products as a crunchy topping for casseroles, salads or cooked vegetables.
7. Grill fresh vegetables for a quick and healthy side dish. Cut vegetables into 1/2-inch slices or large chunks and baste with a light salad dressing or brush them with canola or olive oil. Grill until tender, turning only once.
8. Take advantage of ready-to-use foods. Fresh bagged salads, frozen vegetables, low-fat deli meats, whole-wheat pasta, whole-grain breads, and fresh and canned unsweetened fruits take only minutes to prepare.
9. Vary your salad greens and enjoy the multitude of flavors and textures. Choices include arugula, chicory, collard greens, dandelion greens, kale, mustard greens, spinach or watercress. Purchase a different variety each week.
10. For breakfast on the go, munch dry, ready-to-eat cereal with a banana and drink a small carton of low-fat or skim milk.
11. Choose a dish that serves as a full meal for quick and simple cooking. Healthy examples include beef, barley and vegetable stew; chicken, vegetable and rice casserole; turkey and bean casserole (made with turkey breast, white beans and tomatoes); or vegetarian chili with diced vegetables.
12. Take advantage of healthy side dishes offered at fast-food restaurants. Instead of french fries, choose a side salad with low-fat dressing or a baked potato. Or add a fruit bowl or a fruit and yogurt option to your meal.
13. Stock your shelves with good-for-you snacks. Low-fat pudding cups, dry roasted soy nuts, low-fat popcorn and whole-grain crispbread crackers are good choices.
14. Decrease the meat portion on your plate and increase the serving size of vegetables. Use three times as many vegetables on pizzas or in casseroles, soups and stews.
15. Plan meals so that you can use the extra food in other dishes. For example, bake chicken breasts for a meal and use what's left in sandwiches, soup or a stir-fry.
16. Use salsa for more than just chips. Whether it's mild, fruity, scorching, smooth or chunky, salsa is a great companion for potatoes, vegetables, fish, chicken or meats.
17. Marinate meat, chicken, fish before cooking to tenderize and add flavor to foods. Try mixtures of herbs or spices with wine, olive oil, soy sauce, cider vinegar or lemon juice.
18. Expand your grain repertoire with whole-grain complements, such as kasha, brown rice, wild rice, barley or whole-wheat tortillas.
19. Use herbs and spices to add color, savory taste and sensational aroma. Add cilantro to rice or bean dishes. Sprinkle rosemary on roasted potatoes or grilled meats. Add freshly chopped chives to omelets or pasta salads.
20. Explore world cuisines. Discover and enjoy foods from around the world: Mexican, Latin American, Indian, Greek, French and Asian cuisines, just to name a few. Some of the world's most intriguing ingredients — quinoa, edamame, bok choy, bulgur — are as healthy as they are delicious.

Fast food: 6 ways to healthier meals

These six tips can help you make wise meal choices when going to a fast-food restaurant.

Can fast food be part of a weight-loss or healthy diet plan? You might not think so. In fact, you might even think that you can't have a meal that's both quick and healthy.

But this isn't necessarily so. An occasional stop at a fast-food restaurant can fit into a healthy diet plan. The key is to choose wisely.

1. Keep portion sizes small. If the fast-food restaurant offers several sandwich sizes, pick the smallest or order half a sandwich, if available. Bypass hamburgers with two or three beef patties, which can pack more than 1,000 calories and 70 grams of fat. Instead, choose a regular- or children's-sized hamburger, which has about 250 to 300 calories. Also, skip the large serving of french fries or onion rings and ask for a small serving instead. This switch alone saves 200 to 300 calories. Or better yet, select a lower calorie option.
2. Choose a healthier side dish. Take advantage of healthy side dishes offered at many fast-food restaurants. For example, instead of french fries choose a side salad with low-fat dressing or a baked potato. Or add a fruit bowl or a fruit and yogurt option to your meal. Other healthy choices include apple or orange slices, corn on the cob, steamed rice, or baked potato chips.
3. Go for the greens. Choose a large entree salad with grilled chicken, shrimp or garden vegetables with fat-free or low-fat dressing on the side, rather than regular salad dressing, which can have 100 to 200 calories per packet. Watch out for high-calorie salads, such as those with deep-fried shells or those topped with breaded chicken or other fried toppings. Also skip salad extras, such as cheese, bacon bits, croutons and fried chips, which quickly increase your calorie count.
4. Opt for grilled items. Fried and breaded foods, such as crispy chicken sandwiches and breaded fish fillets, are high in fat and calories. Select grilled or roasted lean meats — such as turkey or chicken breast, lean ham, or lean roast beef.
5. Have it your way. Don't settle for what comes with your sandwich or meal. Ask for healthier options and substitutions. For example, ask for reduced-fat mayonnaise or mustard on your sandwich. Or at a fast-food Mexican restaurant, request salsa with your meal instead of shredded cheese and nacho cheese sauce. Try to avoid special dressings, tartar sauce, sour cream and other high-calorie condiments.
6. Watch what you drink. Many beverages contain a large number of calories. For example, a large regular soda (32 ounces) has about 300 calories. Instead, order diet soda, water, unsweetened iced tea, sparkling water or mineral water. Also, skip the shakes and other ice-cream drinks. Large shakes can contain more than 800 calories and all of your saturated fat allotment for the day.

You can eat healthy away from home, even at fast-food restaurants. The bottom line: Be choosy. Make wise menu choices and focus on portion control.

By Mayo Clinic Staff
May 30, 2008

Red wine and resveratrol: Good for your heart?

Red wine and something in red wine called resveratrol might be heart healthy. Learn the facts, and hype, regarding red wine and its impact on your heart.

Red wine has long been touted as heart healthy. Some have suggested that the apparent health benefits of red wine, namely reducing your risk of heart disease, are behind the so-called French paradox. The French are regular drinkers of red wine and have relatively high amounts of saturated fat in their diet. Despite this fat intake, the French have lower rates of heart disease.

While the news about red wine might sound great if you enjoy a glass of red wine with your evening meal, doctors are wary of encouraging anyone to drink alcohol because too much alcohol can have a host of harmful effects on your body.

But despite the caution, doctors do agree that something in red wine appears to help your heart, though it's unclear just exactly what that "something" is. Recent research has indicated a substance called resveratrol, which is found in the skin and seeds of grapes used to make wine, has promising heart-healthy benefits.

Resveratrol isn't the only substance in red wine that looks promising. The alcohol in red wine also appears to be heart healthy. Understand what's known — and not known — about red wine and its possible heart-health benefits.

How does alcohol help the heart?

Various studies have indicated that moderate amounts of all types of alcohol benefit your heart, not just alcohol found in red wine. Some heart-healthy benefits of alcohol include:

• Raises high-density lipoprotein (HDL) cholesterol, the "good" cholesterol
• Inhibits the formation of blood clots
• Helps prevent artery damage caused by high levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol

Is red wine better?

Red wine in particular seems to have even more heart-health benefits than other types of alcohol, according to a large Danish study from 2000. The study, known as the Copenhagen City Heart Study, found that those who drank red wine had about half the risk of dying of heart disease as those who didn't.

Additional studies have given mixed results — some confirming the Danish finding, others showing red wine isn't any better than beer, white wine or liquor for heart health. As a result, the American Heart Association says there's no clear evidence yet that red wine is superior to other forms of alcohol when it comes to possible heart-health benefits.

The pro-red wine studies suggest antioxidants in red wine called polyphenols help protect the lining of blood vessels in your heart. These antioxidants come in two main forms: flavonoids and nonflavonoids.

• Flavonoids. These antioxidants are found in a variety of foods, including oranges, apples, onions, tea and cocoa. Other types of alcohol, such as white wine and beer, contain small amounts, too, but red wine has higher levels.
• Nonflavonoids. These antioxidants found in red wine have recently been of particular interest because they appear to help prevent arteries from becoming clogged with fatty blockages. However, these studies mostly involved mice — not humans. Resveratrol is the nonflavonoid that researchers are most interested in.

Resveratrol in red wine

Some researchers believe that resveratrol might be the key ingredient in red wine that helps prevent damage to blood vessels, reduces "bad" cholesterol and prevents blood clots.

Research in mice given resveratrol has indicated that the antioxidant might also help protect them from obesity and diabetes, both of which are strong risk factors for heart disease. However, those findings were reported only in mice, not in people. In addition, to achieve the dose of resveratrol used in the mice studies, a person would have to consume 100 to 1,000 bottles of red wine a day.

Some companies sell supplements containing resveratrol. However, doctors caution that not enough is known about resveratrol's effects to endorse resveratrol supplements. Research into the potential heart-health benefits of resveratrol is continuing.

Resveratrol in grapes and other foods

The resveratrol in red wine comes from the skin of grapes used to make wine. Because red wine is fermented with grape skins longer than is white wine, red wine contains more resveratrol. Simply eating grapes, or drinking grape juice, has been suggested as one way to get resveratrol without drinking alcohol. Some studies have suggested that red and purple grape juices have some of the same heart-healthy benefits of red wine.

Other foods that contain some resveratrol include peanuts, blueberries and cranberries. It's not yet known how beneficial eating grapes or other foods might be compared with drinking red wine when it comes to promoting heart health. The amount of resveratrol in food and red wine can vary widely.

Drink in moderation — or not at all

Red wine's potential heart-health benefits look promising. Those who drink moderate amounts of alcohol, including red wine, seem to have a lower risk of heart disease. However, more research is needed before we know whether red wine is better for your heart than are other forms of alcohol, such as beer or spirits.

The American Heart Association doesn't recommend that you start drinking alcohol just to prevent heart disease. Alcohol can be addictive. Too much increases your risk of high blood pressure, high triglycerides, liver damage, obesity, certain types of cancer, accidents and other problems. In addition, even small amounts of alcohol can cause cardiomyopathy — weakened heart muscle — and heart failure in some people. If you have heart failure or a weak heart you should avoid alcohol completely.

If you already drink red wine, do so in moderation. Moderate drinking is defined as an average of two drinks a day for men and one drink a day for women.

• A drink is defined as 12 ounces (oz.) of beer, 5 oz. of wine or 1.5 oz. of 80-proof distilled spirits.

The limit for men is higher because men generally weigh more and have more of an enzyme that metabolizes alcohol than women do.