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Why am I having nosebleeds?Nosebleeds are common in pregnancy, especially from the second trimester onwards. About one in five pregnant women have nosebleeds, compared with only one in 16 women who aren't pregnant (Dugan-Kim et al 2009).
Nosebleeds are so common because the pregnancy hormones progesterone and oestrogen (Goldstein and Govindaraj 2012, Kumar et al 2011) make your blood vessels open wider (dilate). At the same time, your increased blood supply puts pressure on the delicate veins in your nose.
The moist linings (mucous membranes) inside your nose may also swell and dry out. This may be worse in winter, a time when colds happen, and our homes tend to be warm and dry because of central heating. All this can make it quite easy for the vessels in your nose to break open, causing you to have minor bleeds (NHS Choices 2011).
How can I stop a nosebleed?Most nosebleeds start from the many small blood vessels that lie in the front part of your nose (Bamimore and Silverberg 2011, PRODIGY 2010), and are fairly easy to stop yourself. Nosebleeds that start in back part of your nose come from bigger vessels, and tend to be heavier, and harder to stop (NHS Choices 2011, PRODIGY 2010).
Here's what to do when you have a nosebleed:
- Sit down and firmly pinch your nose just above your nostrils, where your nose is soft. Breathe through your mouth.
- Keep pinching for about 10 minutes to 15 minutes, without releasing the pressure.
- Lean forward, with your mouth open, so the blood either drips out of your nose, or you spit it into a bowl or basin. This will reduce the amount of blood that goes down the back of your throat and into your stomach, which can make you feel queasy.
- Only lie down on your side if you feel faint (Bamimore and Silverberg 2011, PRODIGY 2010).
- Time how long your nose has been bleeding. Most nosebleeds will stop within 20 minutes if you press continuously on the soft part of your nose (NHS Choices 2011). This sort of firm pressure helps the blood to clot properly.
To prevent the bleeding from starting again, for the next 24 hours, try not to:
- lie down flat
- do anything strenuous, such as exercise, or heavy lifting
- blow or pick your nose
- drink alcohol or hot drinks, as these can cause the blood vessels in your nose to dilate (PRODIGY 2010)
What can I do to avoid nosebleeds?
- Try not to let your nose dry out, especially in the winter. Soften the inside of your nose with petroleum jelly (Bamimore and Silverberg 2011, NHS Choices 2011). If the air in your house becomes dry because of central heating, you could use a humidifier or vaporiser indoors (Bamimore and Silverberg 2011).
- Be gentle with your nose. Don't pick it, and only blow it gently if you really have to (NHS Choices 2011). Forcefully blowing your nose can cause nosebleeds.
- Try drinking extra fluids to prevent the mucous membranes and other tissues in your nose from getting dehydrated.
Can nosebleeds affect my pregnancy?Nosebleeds in pregnancy may be linked to an increased risk of heavy bleeding after the birth. One large study found that the risk of heavy bleeding was about one in ten for women who had nosebleeds in pregnancy, compared with one in 17 for women who didn't (Dugan-Kim et al 2009). Though more research is needed to be sure that nosebleeds increase your risk of this complication.
It's very rare for nosebleeds to affect how you give birth. However, if you have very severe nosebleeds which are ongoing in your last trimester, you may be advised to have your baby by caesarean.
When should I seek help for a nosebleed?Go to your nearest accident and emergency (A&E) if:
- Your nosebleed hasn't stopped after you've kept pressure on your nose for 20 minutes.
- You are bleeding very heavily from the back of your nose, and blood is pouring out of your mouth. This is much harder to stop by self-help methods, so getting medical help quickly is important (PRODIGY 2010).
Once you're at the hospital, a doctor will probably use a nasal tampon, an inflatable pack, or a special gauze to pack your nose (PRODIGY 2010). This puts pressure on the blood vessels and stops the bleeding (NHS Choices 2011).
The packing will need to stay in for a while, so you may be admitted to an ear, nose and throat ward for observation (PRODIGY 2010). If you're discharged, you may need to go back again to have it removed.
Your doctor may cauterise (burn) the blood vessel that is the source of the bleed. Sealing the vessels using silver nitrate on the end of a swab (chemical cautery) is the usual option, while heavier bleeds may need to be sealed using an electric current (electrocautery) (Bamimore and Silverberg 2011, NHS Choices 2011). This won't pose any risks to you or your baby.
If you have a severe nosebleed, you may need to be admitted to hospital for surgery (NHS Choices 2011).
See your GP if you have frequent nosebleeds. You may be prescribed an antiseptic cream, or your doctor may cauterise the problem blood vessel and then prescribe the cream (Kumar et al 2011, PRODIGY 2010). Or she may refer you on to hospital for treatment.
Be reassured that even though nosebleeds are a nuisance, they're a temporary problem. Once your baby is born it's very likely that your nosebleeds will stop (Goldstein and Govindaraj 2012).
ReferencesBamimore O, Silverberg MA. 2011. Management of acute epistaxis. eMedicine. [Accessed October 2012]
Dugan-Kim M, Connell S, Stika C, et al. 2009. Epistaxis of Pregnancy and Association With Postpartum Hemorrhage. Obstet Gynecol 114(6):1322-5
Goldstein G, Govindaraj S. 2012. Rhinologic issues in pregnancy. Allergy Rhinol (Providence) 3(1):e13-5 www.ncbi.nlm.nih.gov [pdf file, accessed October 2012]
Kumar R, Hayhurst KL, Robson AK. 2011. Ear, nose and throat manifestations during pregnancy. Otolaryngol Head Neck Surg 145(2):188-98 NHS Choices. 2011. Nosebleed. NHS Choices, Health A-Z. www.nhs.uk [Accessed October 2012]
PRODIGY. 2010. Epistaxis. PRODIGY Clarity, Clinical topic. prodigy.clarity.co.uk [Accessed October 2012]