Coughing up blood (hemoptysis) is concerning at any time, especially during pregnancy. While alarming, it doesn’t always indicate a severe problem. However, any instance warrants prompt medical evaluation.
Immediate Steps and When to Seek Medical Care
If you experience coughing up blood during pregnancy, contact your healthcare provider without delay. Even small amounts or streaks of blood should prompt a call. They can provide initial guidance and determine the urgency of an in-person evaluation.
Certain signs indicate a medical emergency requiring immediate attention. Seek emergency care if you cough up a significant amount of blood, such as more than a teaspoon, or if the blood is bright red or contains large clots. Other concerning symptoms accompanying hemoptysis include difficulty breathing, shortness of breath, chest pain, dizziness, or lightheadedness.
Common Reasons for Coughing Up Blood
Many instances of coughing up blood during pregnancy stem from less severe, common conditions. Upper respiratory infections (colds, bronchitis, sinusitis) can inflame and irritate airway linings. Persistent coughing from these infections can damage small blood vessels, leading to streaks of blood in mucus. This bleeding is typically minimal and resolves as the infection clears.
Nosebleeds, more common in pregnancy due to increased blood volume and hormone-induced vascular changes, can also mimic hemoptysis. Blood from a nosebleed may drain down the back of the throat and then be coughed up, leading to the mistaken impression it originated in the lungs. Similarly, severe coughing fits from allergies or asthma can irritate the bronchial tubes, resulting in minor bleeding. This irritation can be exacerbated by the increased sensitivity of mucous membranes during pregnancy.
More Serious Underlying Conditions
While less common, certain serious medical conditions can cause coughing up blood during pregnancy and require careful evaluation. Pneumonia, a lung infection, often presents with a productive cough that may include blood-tinged sputum, along with fever, chills, and difficulty breathing. Another significant concern is pulmonary embolism, a blockage in a lung artery, which carries an increased risk during pregnancy due to the body’s hypercoagulable state. Symptoms can include sudden shortness of breath, chest pain, and coughing up blood.
Pre-existing lung conditions, like bronchiectasis or cystic fibrosis, can lead to hemoptysis, especially with an exacerbation or infection. Bronchiectasis involves damaged, widened airways prone to infection and bleeding. Tuberculosis, though less prevalent, is another infectious disease causing chronic cough and hemoptysis. Certain heart conditions, such as severe mitral stenosis leading to pulmonary hypertension, can cause blood to be coughed up due to increased pressure in lung blood vessels.
How Healthcare Providers Diagnose and Treat
When evaluating coughing up blood during pregnancy, healthcare providers begin with a detailed medical history and physical examination. They will ask about the amount and appearance of the blood, associated symptoms like fever or shortness of breath, and relevant past medical conditions. The physical exam focuses on listening to the lungs and assessing respiratory and cardiovascular function.
Diagnostic tests are often necessary to pinpoint the cause, selected carefully to ensure the safety of both the pregnant person and the baby. Blood tests may check for infection or clotting abnormalities. A chest X-ray, typically with abdominal shielding, can help identify lung infections, fluid, or other abnormalities. In some cases, a computed tomography (CT) scan of the chest, also with appropriate shielding, may be used for a more detailed view of the lungs and blood vessels.
Treatment is highly individualized and depends entirely on the underlying diagnosis. For instance, bacterial infections are treated with antibiotics, while a pulmonary embolism may require anticoagulant medication. Supportive care, such as oxygen therapy, is provided as needed to manage symptoms.