Coughing Up Blood During Pregnancy: Causes & Urgent Action Required
Hemoptysis (coughing up blood) in pregnancy is NEVER normal. It requires **immediate medical evaluation** — do not wait.
Potential Causes (Pregnancy-Specific & General)
| Category | Conditions |
|---|
| Pregnancy-Related | Pulmonary embolism (↑ risk 5x), peripartum cardiomyopathy, amniotic fluid embolism (labor), severe preeclampsia/HELLP (pulmonary edema), gestational trophoblastic disease (choriocarcinoma) |
| Respiratory | Pneumonia, TB, bronchitis, bronchiectasis, lung cancer (rare), fungal infection |
| Cardiovascular | Mitral stenosis (worsens in pregnancy), pulmonary hypertension, Eisenmenger syndrome |
| Coagulation | Antiphospholipid syndrome, DIC, thrombocytopenia |
| Upper Airway | Epistaxis (posterior) draining to pharynx — common in pregnancy (vascular engorgement) |
Immediate Steps
- Call 911 / Go to ER if: >30 mL blood, shortness of breath, chest pain, dizziness, palpitations, fever.
- Contact OB/GYN immediately for any amount — they coordinate with pulmonology/ER.
- Do NOT lie flat — sit upright, lean slightly forward.
- Spit out blood — do not swallow (causes nausea/vomiting).
- Bring sample if possible (tissue/towel).
Diagnostic Workup (Pregnancy-Safe)
- Vitals, O2 sat, ECG, D-dimer (↑ in pregnancy — interpret with caution).
- Chest X-ray **with abdominal shielding** (radiation <0.01 mGy — safe).
- CT Pulmonary Angiography (CTPA) if PE suspected — fetal dose ~0.1–0.5 mGy (safe per ACR).
- Bronchoscopy if source unclear.
- Coagulation panel, CBC, type & screen, BNP, echo.
Treatment Priorities
- Maternal stabilization (airway, breathing, circulation).
- Treat underlying cause (anticoagulation for PE, antibiotics for pneumonia, etc.).
- Fetal monitoring (continuous if >24 wks).
- Multidisciplinary: OB, MFM, Pulm, Cardiology, Heme, ICU.
Never assume it's "just a nosebleed." Hemoptysis in pregnancy = high-risk until proven otherwise.
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