Q: I am 28 years old and into my eighth month of my pregnancy. I had blood spotting twice in my fourth and seventh month without abdominal pain or any other symptom. After sonography, it was found that I had a retro-placental blood clot. I have been given Susten injections to prevent bleeding. I have also been asked to take complete bed rest. Why did I have a retro-placental blood clot?

A:Retroplacental clot means having bleeding behind the placenta. This happens when the placenta starts separating prematurely. This bleeding can trickle down from behind the placenta and present itself vaginally and or can collect behind the placenta and form a clot. In medical terms it is called Placental Abruption or Abruptio Placentae. It can occur in women who develop pre-eclampsia (high blood pressure in pregnancy) or in women who have blunt trauma over the abdomen. There are other associations noted with abruption. However unfortunately, it is not always possible to identify the cause. It most often presents with abdominal pain and bleeding from the vagina. It is a clinical diagnosis in the sense, that apart from the above mentioned symptoms there are other signs which a doctor has to identify by carrying out clinical examination and put the overall picture into context before making this diagnosis as it has significant implications for managing rest of the pregnancy / labour, depending on when the diagnosis is made. Ultrasound scan can contribute towards making the diagnosis but may not always pick it up especially if there is no clot behind the placenta and the bleeding is presenting vaginally or for example, if the woman has fibroids in the uterus it may not be easy to differentiate it from a blood clot, especially in labour. If one has abruption, it cannot be stopped by any medication. Therefore, I do not believe that Susten is helping at all. Your symptoms do not sound like those of abruption because you seem to have spotting (as opposed to bleeding). Spotting in pregnancy is most often due to bleeding from the cervix (neck of the womb), especially if it occurred after sexual intercourse. You also do not have any abdominal pain. If the baby is moving well and the bleeding is settled, feel assured that it is highly unlikely that it could be abruption. If there is no further bleeding or even if it is spotting, bed rest is not needed. You can carry out routine activities.