Vaginal bleeding during pregnancy: What causes it, and what should you do?

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Bleeding during pregnancy: Why it happens, what to do

Bleeding during pregnancy has many causes. Know when to contact your health care provider.

Vaginal bleeding during pregnancy can be scary. It's not always a sign of trouble, however. In fact, most women who experience vaginal bleeding during pregnancy — particularly during the first trimester — go on to deliver healthy babies. By understanding the most common causes of vaginal bleeding during pregnancy, you'll know what to look for and when to contact your health care provider.

Bleeding during the second or third trimester

As the cervix begins to thin out and relax in preparation for labor, the thick plug of mucus that seals the opening of the cervix is dislodged. When this happens, you may notice a thick or stringy discharge that may be tinged with blood. This "bloody show" is a normal sign of impending labor that may occur up to a week or two before delivery.

A bloody show near the end of pregnancy isn't cause for concern. But other causes of bleeding during the second or third trimester are more worrisome, including:

  • Miscarriage. Vaginal bleeding is the primary sign of miscarriage. Although miscarriage is most common during the first trimester, a risk still exists in the second trimester.
  • Preterm labor. Light bleeding in the second or third trimester may be a sign of preterm labor, especially when accompanied by regular contractions, dull backache or pelvic pressure.
  • Problems with the cervix. A cervical infection, inflamed cervix or growths on the cervix may cause vaginal bleeding in the second or third trimester. Occasionally, light bleeding may be a sign that the cervix is opening prematurely (cervical incompetence). This can lead to preterm birth.
  • Placenta previa. Painless, bright red vaginal bleeding in the second or third trimester may indicate placenta previa — a serious problem in which the placenta partly or completely covers the opening to the birth canal. The bleeding may stop at some point, but it nearly always recurs days or weeks later.
  • Placental abruption. Rarely, the placenta begins to separate from the inner wall of the uterus before birth. This may cause bleeding that's scant, heavy or somewhere in between. The bleeding is usually accompanied by abdominal pain.
  • Uterine rupture. Rarely, the uterus tears open along the scar line from a prior C-section. This may cause vaginal bleeding, intense abdominal pain and abdominal tenderness. If your uterus ruptures — either before or during labor — an emergency C-section is needed to prevent life-threatening complications.

When to contact your health care provider
Contact your health care provider if you have any amount of vaginal bleeding in the second or third trimester. You'll likely need an exam in the doctor's office or hospital. Seek immediate care if you have vaginal bleeding accompanied by:

  • Pain
  • Cramping
  • Fever
  • Chills
  • Contractions

What to expect next
To determine what's causing the bleeding, your health care provider will likely do an ultrasound and a vaginal exam. Monitors may be used to detect contractions and track your baby's heart rate. If you've lost a significant amount of blood, you may need intravenous fluids or a blood transfusion. Your health care provider will closely monitor your baby for signs of distress.

Depending on the cause of the bleeding and various other factors, treatment may include bed rest or medication. If you have a cervical infection, you may be given antibiotics. In some cases, an emergency C-section may be recommended.

Last Updated: 05/02/2007
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