Nosebleeds in pregnancy

Nosebleeds during pregnancy also called epistaxis, are fairly common. Nosebleeds are quite common in pregnancy because of hormonal changes. Although nosebleeds can be frightening, in most cases there’s no need to worry about as long as you don’t lose a lot of blood and you should be able to treat a bleeding nose yourself at home. However, see your doctor if you’re worried about your nosebleeds. During pregnancy, you may also find that your nose gets more blocked up than usual.

Nosebleeds can give you a fright or be a nuisance, but as long as you don’t lose a lot of blood, they are generally nothing to be worried about. In most cases, a nosebleed won’t harm you or your baby.

While the odd nosebleed may be annoying, serious nosebleeds in otherwise healthy pregnant women are very rare.

During a nosebleed, blood flows from one or both nostrils. Nosebleed can be heavy or light and last from a few seconds to more than 10 minutes. The blood flow can be light or quite heavy.

Nosebleeds can happen at night, while you’re sleeping. You might feel liquid in the back of your throat before blood comes out of your nose if you’re lying down. You may wake up feeling the blood going down the back of your throat before you sit up. It will then come out of your nose.

But if your nosebleeds are heavy, recurrent or occur alongside other symptoms, speak to your doctor. Nosebleeds in pregnancy are sometimes associated with:

• a higher incidence of postpartum hemorrhage
• hypertension and pre-eclampsia
• nasal aemangioma (a small harmless growth in the nose)
• pregnancy-related coagulopathies (blood-clotting disorders)
• taking aspirin or other anti-coagulant treatments.

If nosebleed are serious, your doctor may use various treatments and will check whether any underlying issues are causing your nosebleeds. The doctor may offer cauterization, which is a burning treatment that seals bleeding blood vessels, or nasal packing, where gauze is packed into the nose .

Figure 1. Nose external anatomy

Figure 2. Nasal septum

Figure 3. Arteries involve in nose bleeds (nasal septum)

Figure 4. Arterial supply of the nasal cavity

Footnote: The different territories supplied by the internal carotid artery (green) and the external carotid artery (yellow) are indicated in a). The Kiesselbach area (blue) is supplied by branches of both the main arteries (red).

a) Arteries supplying the nasal septum and b) the lateral walls of the nasal cavity.

Are nosebleeds in pregnancy common?

Yes, absolutely. Around one in five pregnant women get nosebleeds, so you aren’t alone if you’re suffering from nosebleeds while pregnant.

Nosebleeds in pregnancy causes

During your first trimester the amount of blood circulating in your body increases and your heart works harder. This means that the lining of your nasal passage (inside your nose) also receives more blood. You have tiny blood vessels inside your nose so the increased blood volume can sometimes damage those blood vessels and cause them to burst, resulting in a nosebleed.

Changes in your hormones during pregnancy can also contribute to nosebleeds.

These changes can make your nose feel congested (stuffy) and it might get more blocked up than usual. Your gums may also feel swollen and may bleed.

Nose bleeds can often occur if you:

• Have allergies, infections, or dryness that cause itching and lead to picking of the nose.
• Pick your nose
• Blow your nose too hard that ruptures superficial blood vessels
• Strain too hard on the toilet
• Have an infection in the nose, throat or sinuses
• Low humidity or irritating fumes: If your house is very dry, or if you live in a dry climate, the lining of your child’s nose may dry out, making it more likely to bleed. If he is frequently exposed to toxic fumes (fortunately, an unusual occurrence), they may cause nosebleeds, too.
• Receive a bump, knock or blow to the head or face
• Have a cold
• Have a bunged-up or stuffy nose from an allergy.
• Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding (e.g., deviated septum)
• Are taking some types of medicines, such as anticoagulants (e.g., warfarin) or anti-inflammatories (e.g., aspirin) or nose sprays
• Clotting disorders that run in families or are due to medications.
• •Fractures of the nose or the base of the skull. Head injuries that cause nosebleeds should be regarded seriously.
• •Hereditary hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
• Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.

In general, nose bleeds are not a symptom or result of high blood pressure. It is possible, but rare, that severe high blood pressure may worsen or prolong bleeding if you have a nosebleed.

How can you prevent a nose bleed?

Your nose contains many small blood vessels. Due to the increase in blood circulation during your pregnancy, these blood vessels are more prone to burst, causing a nosebleed. If you are blowing your nose, do so gently and try to avoid large sneezes. This will help reduce your possibility of having a nosebleed during pregnancy.

You should also avoid picking your nose. You could be more likely to get nosebleeds in winter months when the air is drier, so you may like to use a dehumidifier in your home to moisten the air. The moistened air will help decrease your chances of a nosebleed while pregnant.

If you’ve recently had a nosebleed:

• Sneeze with your mouth open.
• Try to avoid bending down or vigorously exercising for at least 12 hours afterwards.
• Avoid hitting your nose on anything.

Nosebleeds in pregnancy treatment

How to stop a nosebleed:

1. Sit down and keep your head upright. This reduces the pressure in the blood vessels inside your nose and will help to slow down the bleeding.
2. Firmly pinch the soft part of your nose, just above your nostrils (underneath the bony ridge), for 10 to 15 minutes without releasing the pressure.
3. Lean forward and breathe through your mouth. This will drain blood down your nose instead of down the back of your throat.
4. Sit or stand upright, rather than lying down, as this reduces the blood pressure in the veins of your nose and will discourage further bleeding.
5. Spit out any blood that is in your mouth.
6. Place a covered ice pack, or a packet of frozen peas wrapped in a tea towel, on the bridge of your nose. You may also want to suck an ice cube.
7. After 10 to 15 minutes, gently release your pinch to see if the bleeding has stopped.

If the bleeding doesn’t stop, try this procedure again for another 10 minutes or seek medical advice – see your doctor urgently.

For the next 24 hours, you should try to avoid:

• Avoid blowing or picking your nose your nose, bending down and strenuous activity for at least 12 hours after a nosebleed.
• Avoid heavy lifting
• Avoid strenuous exercise
• Avoid drinking alcohol or hot drinks.

It’s a good idea to swallow lots of water, as dryness in your nose can make nosebleeds worse. Other ideas to reduce dryness include using a humidifier in your house or dabbing some petroleum jelly in each nostril.