Vaginal bleeding

Vaginal bleeding during pregnancy is any discharge of blood through the vagina from the time of conception to the end of pregnancy.

Between 20% and 30% of women experience some vaginal bleeding during their first 20 weeks of pregnancy. Up to 10% of women have it in their third trimester. While it is often a normal part of the process of gestation, it may indicate complications. You should report vaginal bleeding to your health-care provider right away.

What Could It Be?

figure 1

First-trimester bleeding may be caused by:

• Implantation of the fertilized egg in the uterus.
• Hormonal changes.
• Undetermined factors that cause no harm to the mother or baby.

More serious causes of first-trimester bleeding may include:

• Miscarriage. Almost all women who miscarry will have vaginal bleeding prior to the loss of the pregnancy (fig. 1).
• Ectopic pregnancy. This is when the fertilized egg develops outside of the uterus.
• Molar pregnancy. Also known as a hydatidiform mole or trophoblastic disease, this is a condition in which the placenta does not form properly.
• Luteal phase deficiency. This is when the ovary does not produce enough progesterone.
• Bacterial vaginosis. Women with this reproductive tract infection are twice as likely to experience first-trimester bleeding than those without it.

Mid- or late-term bleeding may be caused by:

• Trauma to the sensitized cervix, such as sexual intercourse or an internal exam.
• Diseases of the vagina or cervix, including infections.
• Unknown causes that pose no threat to the mother or baby.
• Uterine fibroids.

More serious causes of late-term bleeding may include:

• Placenta previa. The placenta moves down the side of the uterus and covers the cervix (fig 1).
• Placenta abruptio. The placenta becomes detached, either partially or fully, from the uterine wall.
• Late miscarriage.
• Preterm labor. Dilatation of the cervix in preterm labor that occurs between 20 and 37 weeks of pregnancy.

What Should I Do?

Contact your health-care provider any time you experience vaginal bleeding. You will be asked very specific questions during your visit. Try to be as precise as possible since the variations in bleeding may signal different complications. If the bleeding is heavy or accompanied by other symptoms, and you can't reach your health-care provider, go to the emergency room.

Questions your health-care provider may ask:

• How far along is the pregnancy?
• Has bleeding occurred before or during this pregnancy? Has it been constant since the beginning of the pregnancy?
• When did the bleeding begin? Is it intermittent or constant?
• How much bleeding is present?
• What is the color of the blood?
• Is there an odor to the blood?
• Is cramping present? Is there other abdominal pain, weakness, or increased fatigue? Is there fainting, dizziness, nausea, vomiting, or diarrhea? Is there a fever?
• Are there changes in urination or bowel movements?
• Has there been an injury, such as a fall?
• Have there been changes in physical activity?
• Has there been additional stress?
• Did the bleeding occur during or after sexual intercourse?
• Does rest reduce or stop the bleeding?

Your health-care provider will most likely perform a pelvic exam, with careful inspection of the cervix.

Other diagnostic tests may include:

• Blood tests.
• Ultrasound of the abdomen or pregnancy ultrasound.
• Pap smear.
• Cervical cultures or tests for infections.

Frequently Asked Questions

Early-term bleeding is generally treated with bed rest. Your doctor may also advise you to take time off work, stay off your feet, and avoid sexual intercourse. Bed rest is often enough to stabilize the pregnancy. If the bleeding is severe, you may be hospitalized and given pain medication.

Miscarriage, ectopic pregnancy, molar pregnancy, complications of the placenta, and premature labor all require medical attention. Your health-care provider will diagnose the problem and suggest treatment options.

Q: I am spotting just a bit, not even enough to cover my panty liner. Do I need to panic?

A: No. A little bit of spotting is common for women who have already had a normal viable pregnancy established by ultrasound. You should contact your health-care provider the same day you notice the spotting, just to let him know it is happening. At an early visit, have your health-care provider explain the difference between spotting and bleeding. (Spotting is periodic drops of blood. Bleeding is a light-to-heavy flow of blood.)

Q: What should I do if I'm bleeding heavily?

A: Contact your health-care provider immediately. If you pass material that you think is tissue, place it in a clean jar and bring it to your health-care provider for analysis.

Q: If I have vaginal bleeding, what are the chances that it is a serious complication?

A: Of the women who experience vaginal bleeding in the first trimester, half will have a miscarriage. But the odds of other problems are lower: ectopic pregnancy occurs in seven out of 1,000 pregnancies; molar pregnancy occurs in one out of 1,500 to 2,000 births; placenta previa happens in one of 200 births; and placenta abruptio happens in one of 150 births.

Q: I had some mild spotting during my first trimester. The doctor said it was nothing to worry about. Now I am in my third trimester and I am spotting again. Do I need to call the doctor this time?

A: Absolutely. Bleeding at any time during the third trimester is considered a potentially serious problem, whether or not it is accompanied by pain. Conditions such as placenta abruptio often do not develop until the end of the pregnancy; therefore, a health-care provider needs to be consulted as soon as you notice the bleeding.

Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of Pennsylvania School of Medicine. Review provided by VeriMed Healthcare Network.

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