Vaginal Bleeding During Pregnancy

Bleeding in early pregnancy

About 2 to 3 out of 10 women will have vaginal bleeding in the first 20 weeks of pregnancy. It does not always mean there is a serious problem. But call your healthcare provider if you have bleeding at any time during your pregnancy.

Common problems

Common causes of vaginal bleeding during early pregnancy include:

• An infection. An infection in your pelvis or urinary tract can cause bleeding and some abnormal discharge.

• Cervical changes. Pregnancy hormones can make the cervix softer and more likely to bleed. A noncancer growth (polyp) may also form and may cause bleeding.

• Having sex. You may have some bleeding after sex if your cervix is sore and sensitive. See your healthcare provider before having sex again.

• Implantation bleeding. Implantation is when the fertilized egg attaches to the uterine lining, about 6 to 12 days after conception. You may have some light spotting or bleeding just before you would expect your next period. This is often mistaken for a light period. But the bleeding is often a lighter color, and not heavy.

Serious problems

Serious problems that can cause vaginal bleeding in early pregnancy include:

Early pregnancy loss (miscarriage)

This is a pregnancy loss that occurs before 20 weeks of pregnancy. About 1 out of 10 pregnancies end this way. Symptoms can include bleeding and cramping. But half of all women who have a miscarriage don’t have any bleeding. Some pregnancy tissue may still be in your uterus. It may pass naturally from your vagina. Or you can choose to have it removed with medicine or surgery.

Ectopic pregnancy

This is when the fertilized egg implants outside of the uterus. In most cases, it implants in one of the fallopian tubes. This is very serious and must be treated. If the fallopian tube bursts (ruptures), there may be internal bleeding. This may lead to fainting, shock, or even death. Symptoms of ectopic pregnancy include:

• Vaginal bleeding (sometimes this is the only symptom)

• Belly, pelvic, or shoulder pain

Molar pregnancy

In rare cases, early bleeding is caused by a molar pregnancy. This occurs when you have an abnormal tissue growth, not an embryo. Symptoms include:

• Vaginal bleeding

• No fetal heartbeat

• Ultrasound shows small round clusters in the uterus

Subchorionic bleeding

This is caused by a blood clot (subchorionic hematoma) that forms when blood collects between the uterine lining and the placenta. In most cases, this goes away on its own with no problems. But in some cases, it may cause the placenta to separate from the uterine wall. And it may be linked to a higher risk of preterm labor and miscarriage. There is no treatment for these blood clots. But your healthcare provider may want you to have regular follow-up exams. You may also be advised not to do any strenuous activity or heavy lifting.

Bleeding later in pregnancy

Vaginal bleeding in the second and third trimesters is often a sign of a more serious problem. If you have any bleeding later in your pregnancy, call your healthcare provider right away.

Common problems that can cause light bleeding later in pregnancy are cervical growths or inflammation.

Heavy bleeding later in pregnancy is serious. It may mean there is a problem with the placenta.

Placental abruption

This is when the placenta separates from the uterine wall too soon. Symptoms include bleeding and back or belly pain. If this is not found early, it can cause serious problems. You may lose a lot of blood, and your baby may not get enough oxygen.

Placenta previa

This condition is most common in the third trimester. It occurs when the placenta is attached to the lower part of the uterus, instead of the upper part. This can partly or fully block the cervix. Bleeding may happen suddenly without any pain. In some cases placenta previa goes away on its own. But if that doesn’t happen, you may need to have an early C-section.

Placenta accreta

This is a condition where part or all of the placenta stays attached to the uterine wall. It can cause vaginal bleeding in the third trimester. And it can cause life-threatening blood loss during delivery. In some cases, placenta accreta is found during a routine ultrasound. But it may not be found until after delivery. If this condition is found before you deliver, you will likely have an early C-section. In many cases the uterus is also removed (hysterectomy) right after delivery. This is done to prevent severe blood loss.

Preterm labor

Vaginal bleeding that occurs later in pregnancy may also mean you are going into labor.

Bleeding that occurs before 37 weeks may be a sign of preterm labor. You may be given medicine to delay contractions. But if labor can’t be stopped, or there are other specific concerns, you may have to deliver your baby. Symptoms of preterm labor also include:

• Vaginal discharge (may be bloody, watery, or a mucus)

• Feeling of pressure in pelvis or lower belly

• Low back pain

• Cramps (may occur with diarrhea)

• Contractions

• Your water breaks (ruptured membranes)

If you have abnormal bleeding during pregnancy

• Call your healthcare provider right away

• Wear a pad or panty liner, so you can tell how much you are bleeding

• Keep a record of your bleeding. Is it heavy or light? Is it a red or brown color? Is it smooth or are there any clots?

• Don’t use a tampon or have sex when you are bleeding

When to call your healthcare provider

Call your healthcare provider right away if you have vaginal bleeding at any stage of pregnancy.