Nosebleeds While Pregnant

Introduction

A nosebleed is a loss of blood from the lining of the nose. They often occur in pregnancy, in about one in five pregnant women and are majorly caused by hormonal changes and an increase in blood volume.¹ They are usually harmless and do not require any medical intervention if the blood loss is minimal. Blood supply increases by as much as 50 percent in pregnancy, to support the growing foetus. For this reason, pregnant women are more susceptible to nosebleeds due to the expansion and rupture of the fragile blood vessels in the nose because of the pressure of the new blood moving throughout the body. 

Understanding the Physiology

Nosebleeds, also known as epistaxis, are caused by the drying out of the tiny blood vessels in the nose which can lead to breakage and bleeding. they can also be caused by the overfilling of these vessels which can lead to rupture and bleeding. They are often treatable and rarely cause complications during pregnancy. Many conditions increase the chances of getting nosebleeds in pregnancy including. 

• Elevated oestrogen levels increase blood flow to the tissue lining the nose.
• Increased progesterone level increases the volume of blood.
• Placental growth hormone affects the whole system including dilation of blood vessels in the nose.
• Other indirect hormonal effects may increase nasal sensitivity and congest the nose.² The hormones that thicken the lining of the uterus may also impact the lining of the nose and cause a nosebleed.

There are two types of nosebleeds, anterior and posterior nosebleeds. Anterior nosebleeds are most common and account for approximately 90 percent of nosebleeds.³ They occur in the blood vessels that lie in the front part of the nose. Posterior nosebleeds are far less common but more severe and occur when there is damage to an artery at the back of the nose. Nosebleeds can start in the first trimester and last until childbirth and can be impacted by lifestyle or medical history and several other factors.

Common triggers for nosebleeds

Pregnant women are prone to nosebleeds if they have a cold, a sinus infection, allergies, dry lining of the nose because of dehydration or cold water, injury in the nose, high blood pressure or a clotting disorder. A swelling of the mucus membrane of the nose, a condition called pregnancy rhinitis causes congestion that may also lead to nosebleeds, especially in the first trimester. 

Preventive measures

Nosebleeds in pregnancy can be triggered by factors that cannot be controlled, so it is difficult to prevent. However, the risks can be lowered to keep the pressure in the nose down and to limit irritation of the sensitive blood vessels in the nose by doing the following:

• Keep the inner lining of your nose moist with saline nasal gel or any water-based nasal lubricant
• Avoid pinching or rubbing the nose
• If you have a stuffy or runny nose, blow it gently
• Avoid picking your nose
• Use a dehumidifier to keep the air in the home moist 
• Intense workouts that require bending or jumping should be avoided
• Keep hydrated by drinking plenty of fluids to keep the lining of the nose well hydrated

Home remedies for relief

Under most circumstances, nosebleeds pose no threat to either the mother or her baby. However, there are simple steps that can be followed at home if a nosebleed occurs and there are no underlying health conditions

• Sit or stand with your head upright to reduce the pressure in the veins of the nose
• Apply a cool compress to the nose to constrict the blood vessels and reduce the bleeding
• Lightly squeeze your nostrils and let go, till the bleeding stops
• If there is heavy bleeding, to prevent ingesting blood, slightly lean forward 
• Do not tilt your head backwards as this might lead to ingestion of blood or inhaling it into the lungs

When to Seek Medical Attention

If the nosebleed continues after following the steps above, the blood flow is substantial or follows an injury to the head, you should consult your healthcare provider. If you also get frequent nosebleeds during pregnancy, contact your doctor so the possibility of a bigger problem like high blood pressure or a bleeding disorder can be ruled out. The following cases should also be treated as an emergency and immediate medical attention should be sought.

• Bleeding does not seize after 30 minutes of applying pressure
• Blood flow is very heavy
• The bleeding interferes with normal breathing
• The bleeding causes dizziness, fatigue, or disorientation
• The bleeding causes chest pain
• The bleeding causes you to turn pale 
• You are on blood thinners and you have a nosebleed

Other symptoms that should not be ignored if accompanied by nosebleeds include blurred vision, severe headaches, vomiting, sudden swelling in the legs, stomach pain, severe bloating, fever, sudden weight loss, yellowing of skin or eyes, dark urine, or light-coloured stools. In the 24 hours after a nosebleed, it is advisable to avoid the following:

• Blowing the nose
• Bending down
• Any form of vigorous exercise
• Picking the nose
• Drinking hot drinks or alcohol

Medical interventions

In a few cases, medical interventions might be required for nosebleeds. In this instance, nasal sprays can be used short-term to ease congestion and minor bleeding if the pregnant woman has no history of high blood pressure. However, the recommended dosages of these sprays should be strictly adhered to and should not be used for more than a few days at a time, as they can make congestion and nosebleeds worse.

Life-threatening epistaxis during pregnancy is very rare and there are no specific guidelines to follow in managing pregnant women who present this condition. However, if such patients are encountered, conservative measures like intravenous tranexamic acid administration, anterior packing and bipolar cautery should always be considered as first-line treatments. If these treatment methods fail, other invasive treatments like surgical vessel ligation or in extreme circumstances, termination of the pregnancy might be required.⁴ A study conducted in 2016 showed that artery ligation performed on a patient in her second trimester who presented with severe nosebleeds did not affect her baby. A healthy baby was delivered at 40 weeks, and there was no recurrence of epistaxis 18 months after the procedure.⁵

Lifestyle adjustments

Lifestyle changes like a healthy diet and regular exercise can promote healthy blood pressure and improve general blood circulation thereby reducing the chances of nosebleeds. Foods rich in vitamin C are known to improve blood clotting and will therefore stop nosebleeds faster. Research also shows that smoking can increase the occurrence of nosebleeds so should therefore be completely avoided during pregnancy. Stress levels should also be managed as an increase may trigger the body to release hormones that increase the heart rate and blood pressure, risk factors for nosebleeds. Increased stress levels may also contribute to behaviours like nose-picking that can increase the risk of bleeding. 

Summary

To summarize, understanding the dynamics of nosebleeds during pregnancy sheds light on their predominantly harmless nature, primarily stemming from hormonal fluctuations and increased blood volume. While these occurrences are generally harmless, it is crucial for expectant mothers to be aware of potential triggers and preventive measures to minimize the risk of nosebleeds. The differentiation between anterior and posterior nosebleeds, coupled with insights into common triggers like infections, allergies, and high blood pressure, equips pregnant women with the knowledge to adopt proactive measures.

Preventive strategies, such as maintaining nasal moisture, avoiding nose-picking, and staying hydrated, offer practical approaches to mitigate the impact of nosebleeds. In cases where home remedies are insufficient, recognising the signs that warrant medical attention is vital. Timely consultation with healthcare providers is emphasized, especially in instances of prolonged bleeding, substantial blood flow, or the presence of alarming symptoms.

Furthermore, this overview underscores the importance of lifestyle adjustments, including a healthy diet, regular exercise, and stress management, in promoting overall well-being and minimizing the likelihood of nosebleeds. While medical interventions may be necessary in severe cases, the emphasis remains on conservative measures and cautious use of nasal sprays.

In essence, a comprehensive approach to nosebleeds during pregnancy involves a balance between self-care, awareness of potential complications, and collaboration with medical professionals. By navigating these considerations, expectant mothers can enhance their well-being and ensure a healthier pregnancy experience.

Sekinat Amoo

Masters of Public Health – MPH, University of Sheffield, England

Sekinat is a highly skilled and dedicated health writer, complemented by her invaluable experience as a Public Health Consultant. With an academic background in Life Sciences and Healthcare and a profound passion for women empowerment, Sekinat has seamlessly merged the worlds of healthcare and communication to advocate for improved women's health, well-being, and empowerment through her writing. She has many years of experience in healthcare management consulting, programme and project management and execution. Her work is driven by a desire to educate, inspire, and empower women to take charge of their health and lives. She is proficient in crafting clear, concise, and informative health content and has a knack for translating complex health information into easily digestible articles, reports, and publications.

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