Nosebleeds In Pregnancy: Causes, Prevention And Treatment

During pregnancy, you may experience symptoms such as mood swings, morning sickness, and body ache. One common pregnancy symptom is bleeding from the nose or epistaxis, which affects one in five women. Though it does not pose any perinatal risk (risk to the mother and baby), be cautious that you do not bleed too much and get self-treatment or hospital care, depending on the severity (1).

This post discusses the various causes of nosebleeds during pregnancy and how they can be treated and prevented.

What Causes Nosebleeds During Pregnancy?

During pregnancy, your body goes through the following changes, increasing the risk of occasional minor nosebleeding (1) (2):

1. Your blood volume increases by 50% (especially during the first trimester), which means that the blood flow in the body is doubled. This causes your blood vessels to dilate. Since nostrils have tiny blood vessels, the extra blood pressure can sometimes cause the nasal blood vessels to rupture and bleed (3).

2. Changes in the hormonal levels of estrogen and progesterone (3) (4)

3. Placental growth hormone, which regulates systemic effects such as vasodilation (widening of blood vessels)

4. Various immunological changes that could lead to nasal hypersensitivity

Besides physiological changes, the following conditions and diseases can also result in nosebleeds during pregnancy (1):

1. Contracting colds, sinusitis, infections, or allergies can make your nasal mucous membranes dry and irritated and cause your nasal blood vessels to disrupt and bleed.

2. Pregnancy rhinitis affects about 20% of all pregnancies and causes nasal congestion (blocked nose), postnasal drip, and runny nose. Thus, constantly blowing your nose makes you more likely to have a nosebleed.

3. Certain medical conditions, such as high blood pressure (hypertension), preeclampsia, or clotting disorders. If so, you should immediately refer to your doctor

4. Cold weather conditions, dry air, or intense air conditioning, which causes the mucous membranes to dry

5. Rarely (less than 5% of all pregnancies), a pregnancy tumor (pyogenic granuloma) may also cause nosebleeds. This non-carcinogenic condition typically forms in the gums due to hormonal fluctuations in pregnancy but may also form in the nose.

Sometimes, nosebleeds in pregnancy may also occur due to (5)

• An increased risk of postpartum hemorrhage

• Nasal hemangioma (a small, noncancerous growth in the nose)

• Pregnancy-related coagulopathies (blood clotting disorders)

• Taking aspirin or other anticoagulants (blood thinners)

• Nasal steroid therapies (6)

When Do Nosebleeds Generally Start During Pregnancy?

Throughout your pregnancy, nosebleeds can occur multiple times (7). It can occur in one or both nostrils and be light or severe, lasting between a few seconds and more than 10 minutes.

While epistaxis can occur at any time during the day, you may also have one while asleep. For example, when you’re lying down, you may feel the blood in the back of your throat, which flows out of your nose when you sit up (3) (4).

How To Stop A Nosebleed During Pregnancy?

You can stop a nosebleed with these steps (1) (5) (8):

• Tilt your head forward while sitting or standing upright

• Lean forward and pinch both nostrils under the bony ridge of your nose

• Apply constant pressure on your nostrils for 10 to 15 minutes while breathing through your mouth

• Gently release your nostrils to see if the bleeding has stopped. If your nose continues to bleed, hold the nostrils shut for another 10 minutes

• Avoid blowing your nose for at least 12–24 hours after a nosebleed

• Lie down on your side if you feel lightheaded or dizzy

Before pinching your nostrils together, applying a cold pack or ice cubes to the bridge of your nose, sucking ice chips, or using a nasal spray may help constrict the blood vessels and decrease bleeding.

When Should You Seek Medical Care For Nosebleeds During Pregnancy?

Mostly, frequent nosebleeds during pregnancy are minor and unharmful. However, you should contact your doctor if (1) (3)

• Your nosebleeds are heavy and recurrent

• The bleeding continues even after 30 minutes of following the technique mentioned above, and you begin to feel ill

• You have difficulty breathing

• You are experiencing dizziness or faintness

• You have a fever or chills with the nosebleed

• You have clotting disorders of preeclampsia

Are Nosebleeds During Pregnancy A Cause For Concern?

According to the National Health Services (NHS) Choices, severe nosebleeds are rare in otherwise healthy pregnant women. Further, nosebleeds won’t usually affect you or your unborn child (4).

However, if your nosebleeds are severe and persistent, especially in the third trimester, they can cause acute loss of blood and adverse obstetrical outcomes. These conditions may include preterm birth, postpartum hemorrhage, and antepartum fetal distress (3) (5) (9) (10).

What Is The Treatment For Severe Nosebleeds During Pregnancy?

Generally, you can manage minor nosebleeds at home with the above procedure without requiring any specific treatment. However, in case of heavy recurrent nose bleeding that may have underlying causes (especially in the third trimester), various treatments are followed, including (2) (5)

• Cauterization, a burning treatment that shuts bleeding blood vessels

• Nasal packing, where a gauze is stuffed into the nose

• Hemostatic foam/sponge

• Diathermy (deep heating below the surface of the skin)

• Ligation of the sphenopalatine artery, an endoscopic transnasal approach (especially employed to remove nasal pregnancy tumors)

• Blood transfusion and tranexamic acid intravenous therapy in case of acute blood loss

During the third trimester, severe epistaxis may necessitate an evaluable delivery inducement or an elective cesarean procedure. This is because the strains of vaginal birth and the Valsalva maneuver (pushing in the late second stage of labor) can cause nosebleeding to recur (2).

How To Prevent Nosebleeds During Pregnancy?

Nosebleeding during pregnancy is a natural phenomenon and may not always be preventable. However, epistaxis due to underlying causes, such as dry and irritated nasal and mucous membranes, may be prevented with the following methods (1) (3):

• Use a humidifier in your room, especially during the winter months, to moisten the air

• Moisturize your nostrils using a saline nasal gel or petroleum jelly

• Drink plenty of fluids and water

• Treat your symptoms or get medical attention if you have an infection, cold, or allergies; however, avoid using nonprescription nasal decongestants, such as allergy pills or nasal sprays

• If you must blow and wipe your nose, do it gently (7).

If you recently had an episode of nosebleed (3) (5):

• Sneeze with your mouth open

• Avoid bending down, lying flat, or doing strenuous exercises for at least 12–24 hours

• Avoid rubbing your nose

• Avoid blowing or picking your nose

• Avoid drinking alcohol or hot beverages

Can Stress Cause Nosebleeds In Pregnancy?

Some studies show an association between stress and nosebleeding (11). However, stress during pregnancy is quite common, with research showing that around three of four women experience at least one stressful event in the 12 months before delivery (12).

References

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