Nosebleeds, medically termed epistaxis, are a common and usually harmless occurrence during pregnancy, affecting approximately one in five expectant individuals. While a nosebleed can be alarming, the vast majority are minor events originating from the front part of the nose. This high frequency is due to the underlying physiological changes of pregnancy.
The Physiological Causes
Pregnancy induces profound changes in the body’s circulatory system. The total blood volume circulating through the body expands by up to 50% to support both the pregnant person and the developing fetus. This substantial increase in volume places additional pressure on blood vessels throughout the body.
Hormonal shifts, particularly the increased levels of estrogen and progesterone, cause generalized vasodilation, which is the widening of blood vessels. This effect makes the tiny, delicate capillaries lining the nasal passages more congested and fragile. The combination of greater blood flow and vessel expansion makes the small blood vessels, especially those in the area known as Kiesselbach’s plexus, more prone to rupture and bleeding.
Furthermore, many pregnant individuals experience rhinitis of pregnancy, characterized by nasal congestion and swelling of the mucous membranes. This swelling, combined with the drying effects of increased air exposure or dry climates, causes the nasal lining to become irritated and cracked. The fragile, swollen blood vessels beneath this compromised lining can then break more easily, triggering a nosebleed.
Immediate First Aid for an Active Nosebleed
When a nosebleed begins, the immediate goal is to stop the flow and encourage clotting. The first step is to sit upright and lean slightly forward, which helps reduce blood pressure in the nasal veins and prevents blood from draining down the throat. Swallowing blood can lead to nausea or vomiting, which may restart or worsen the bleeding.
Next, use the thumb and index finger to firmly pinch the soft, lower part of the nose, just above the nostrils. Breathe through the mouth while maintaining this continuous pressure for a minimum of 10 to 15 minutes without checking if the bleeding has stopped. Applying a cold compress or ice pack to the bridge of the nose can also help constrict the blood vessels. If the bleeding continues after the initial pressure, repeat the process for another 10 to 15 minutes.
Prevention and Management Strategies
Keeping the nasal passages moist is a primary strategy. This is often achieved by using a cool-mist humidifier, especially in the bedroom or during colder months. Using a saline nasal spray or drops several times a day can also help lubricate the mucous membranes without the side effects of medicated sprays.
Applying a small amount of water-based nasal gel or petroleum jelly just inside the nostrils can provide a protective moisture barrier. Systemic hydration is also beneficial, as drinking sufficient fluids helps keep all mucous membranes, including those in the nose, well-hydrated and less susceptible to cracking. Additionally, individuals should avoid forceful nose blowing or picking, and sneeze with the mouth open to distribute pressure away from the nasal capillaries.
Warning Signs Requiring Medical Attention
While most nosebleeds resolve quickly with first aid, certain situations warrant immediate medical evaluation to rule out a more serious issue. Seek prompt attention if the bleeding is excessively heavy or if it does not stop after 20 minutes of continuous, firm pressure on the nose. Bleeding that is accompanied by symptoms such as dizziness, weakness, or feeling faint could indicate significant blood loss.
A healthcare provider should also be consulted if frequent nosebleeds occur alongside other concerning symptoms like severe headaches, changes in vision, or elevated blood pressure readings. High blood pressure, particularly in the later stages of pregnancy, can be a sign of preeclampsia, and nosebleeds may occasionally be a related symptom. Any nosebleed that occurs following a head injury also requires immediate medical assessment.