Bleeding and spotting from the vagina during pregnancy

Bleeding and spotting from the vagina during pregnancy are common. Up to half of
all pregnant women have some bleeding or spotting during their pregnancy.

Bleeding and spotting in pregnancy dont always mean theres a problem, but they
can be a sign of miscarriage or other serious complications. Miscarriage is when a
baby dies in the womb before 20 weeks of pregnancy.

Call your health care provider if you have any bleeding or spotting, even if it stops.
It may not be caused by anything serious, but your provider needs to find out
whats causing it.

Whats the difference between bleeding and spotting?

Bleeding or spotting can happen anytime, from the time you get pregnant to right
before you give birth. Spotting is light bleeding. It happens when you have a few
drops of blood on your underwear. Spotting is so light that the blood wouldnt cover
a panty liner. Bleeding is when the blood flow is heavier, enough that you need a
panty liner or pad to keep the blood from soaking your underwear and clothes.

What should you do if you have bleeding or spotting during pregnancy?

Call your health care provider and do these things:

Keep track of how heavy your bleeding is, if it gets heavier or lighter, and how many
pads you are using.
Check the color of the blood. Your provider may want to know. It can be different
colors, like brown, dark or bright red.
Dont use a tampon, douche or have sex when youre bleeding.
Call your health care provider right away or go to the emergency room if you have:

Heavy bleeding

Bleeding with pain or cramping

Dizziness and bleeding
Pain in your belly or pelvis
What causes bleeding or spotting early in pregnancy?
Its normal to have some spotting or bleeding early in pregnancy. Bleeding or
spotting in the first trimester may not be a problem. It can be caused by:

Having sex
An infection
Implantation. When a fertilized egg (embryo) attaches to the lining of the uterus
(womb) and begins to grow.
Hormone changes. Hormones are chemicals made by the body.
Changes in your cervix. The cervix is opening to the uterus that sits at the top of the
vagina.
Sometimes bleeding or spotting in the first trimester is a sign of a serious problem,
like:

Miscarriage. Almost all women who miscarry have bleeding or spotting before the
miscarriage.
Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus
and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can
cause serious, dangerous problems for the pregnant woman.
Molar pregnancy. This is when a mass of tissue forms inside the womb, instead of a
baby. Molar pregnancy is rare.
What causes bleeding or spotting later in pregnancy?
Bleeding or spotting later in pregnancy may be caused by:

Labor
Having sex

An internal exam by your health care provider

Problems with the cervix, like an infection or cervical insufficiency. This is when a
womans cervix opens too early.
Bleeding or spotting later in pregnancy may be a sign of a serious problem, like:

Preterm labor. This is labor that happens too early, before 37 weeks of pregnancy.
Placenta previa. This is when the placenta lies very low in the uterus and covers all
or part of the cervix.
Placental abruption. This is when the placenta separates from the wall of the uterus
before birth.
Uterine rupture. This is when the uterus tears during labor. This happens very rarely.
It can happen if you have a scar in the uterus from a prior cesarean birth (also
called c-section) or another kind of surgery on the uterus. A c-section is surgery in
which your baby is born through a cut that your doctor makes in your belly and
uterus.
How are bleeding and spotting treated?
Your treatment depends on what caused your bleeding. You may need a medical
exam and tests.

Most of the time, treatment for bleeding or spotting is rest. You may need to take
time off from work and stay off your feet for a little while. You may need medicine to
help protect your baby from Rh disease. Rh disease is when your blood and babys
blood are incompatible (cant be together). This disease can cause serious problems
even death for your baby.

See also: Miscarriage, Ectopic and molar pregnancy

Vaginal bleeding in early pregnancy

Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can
happen any time from conception (when the egg is fertilized) to the end of pregnancy.
Some women have vaginal bleeding during their first 20 weeks of pregnancy.

The Difference Between Spotting and Bleeding

Spotting is when you notice a few drops of blood every now and then on your
underwear. It is not even enough to cover a panty liner.
Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep
the blood from soaking your clothes.
Ask your health care provider more about the difference between spotting and bleeding
at one of your first prenatal visits.

Should I Worry about Spotting?

Some spotting is normal very early in pregnancy. Still, it is a good idea to tell your
provider about it.
If you have had an ultrasound that confirms you have a normal pregnancy, call your
provider the day you first see the spotting.
If you have spotting and have not yet had an ultrasound, contact your provider right
away. Spotting can be a sign of a pregnancy where the fertilized egg develops outside
the uterus (ectopic pregnancy). An untreated ectopic pregnancy can be life-threatening
for the woman.

What Causes Vaginal Bleeding?

Bleeding in the first trimester is not always a problem. It may be caused by:

Having sex

An infection

The fertilized egg implanting in the uterus

Hormone changes

Other factors that will not harm the woman or baby

More serious causes of first-trimester bleeding include:

A miscarriage, which is the loss of the pregnancy before the embryo or fetus can
live on its own outside the uterus. Almost all women who miscarry will have bleeding
before a miscarriage.
An ectopic pregnancy, which may cause bleeding and cramping.
A molar pregnancy, in which a fertilized egg implants in the uterus that will not
come to term.

When to Contact a Medical Professional

Call or go to your health care provider right away if you have:

Heavy bleeding

Bleeding with pain or cramping

Dizziness and bleeding

Pain in your belly or pelvis

If you cannot reach your provider, go to the emergency room.
If your bleeding has stopped, you still need to call your provider. Your provider will need
to find out what caused your bleeding.

What Will My Provider Need to Know?

Your provider may need to know these things to find the cause of your vaginal bleeding:

How far along is your pregnancy?

Have you had vaginal bleeding during this or an earlier pregnancy?

When did your bleeding begin?

Does it stop and start, or is it a steady flow?

How much blood is there?

What is the color of the blood?

Does the blood have an odor?

Do you have cramps or pain?

Do you feel weak or tired?

Have you fainted or felt dizzy?

Do you have nausea, vomiting, or diarrhea?

Do you have a fever?

Have you been injured, such as in a fall?

Have you changed your physical activity?

Do you have any extra stress?

When did you last have sex? Did you bleed afterward?

What is your blood type? Your provider can test your blood type. If it is Rh
negative, you will need treatment with a medicine called Rho(D) immune globulin to
prevent complications with future pregnancies.

Treatment for Vaginal Bleeding

Most of the time, the treatment for bleeding is rest. It is important to see your provider
and have testing done to find the cause of your bleeding. Your provider may advise you
to:

Take time off work

Stay off your feet

Not have sex

Not douche (NEVER do this during pregnancy, and also avoid it when you are not
pregnant)

Not use tampons

Very heavy bleeding may require a hospital stay or surgical procedure.

What if I Discharge More than Blood?

If something other than blood comes out, call your provider right away. Put the
discharge in a jar or a plastic bag and bring it with you to your appointment.
Your provider will check to see if you are still pregnant. You will be closely watched with
blood tests to see if you are still pregnant.
If you are no longer pregnant, you may need more care from your health care provider,
such as medicine or possibly surgery.

References
Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG, Niebyl
JR, Simpson JL, et al, eds.Obstetrics: Normal and Problem Pregnancies
Gregory KD, Niebyl JR, Johnson TRB. Preconception and prenatal care: part of the
continuum. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds.Obstetrics: Normal and
Problem Pregnancies

Update Date 11/19/2014

Updated by: Cynthia D. White, MD, Fellow American College of Obstetricians and
Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve,
MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

First Trimester Bleeding Causes

Vaginal bleeding in the first trimester of pregnancy can be caused by several different
factors. Bleeding affects 20% to 30% of all pregnancies. Bleeding increases the risk of
having miscarriage (lose the baby). Of even more concern, however, is that about 2% of
all pregnancies are ectopic in location (the fetus is not inside the uterus), and vaginal
bleeding can be a sign of an ectopic pregnancy. An ectopic pregnancy may be lifethreatening. All bleeding associated with early pregnancy should prompt a call to your
health care professional for immediate evaluation.

Implantation bleeding: There can be a small amount of spotting associated with the normal
implantation of the embryo into the uterine wall, called implantation bleeding. This is usually very
minimal, but frequently occurs on or about the same day as your period was due. This can be very
confusing if you mistake it for simply a mild period and don't realize you are pregnant. This is a normal
part of pregnancy and no cause for concern.

Threatened miscarriage: You may be told you have a threatened miscarriage (sometimes also
referred to as threatened abortion) if you are having some bleeding or cramping. The fetus is definitely
still inside the uterus (based usually on an exam using ultrasound), but the outcome of your pregnancy
is still in question. This may occur if you have an infection, such as a urinary tract infection, become
dehydrated, use certain drugs or medications, have been involved in physical trauma, if the developing
fetus is abnormal in some way, or for no apparent reason at all. Other than these reasons, threatened
miscarriages are generally not caused by things you do, such as heavy lifting, having sex, or by
emotional stress.

Completed miscarriage: You may have a completed miscarriage (also called a spontaneous
abortion) if your bleeding and cramping have slowed down and the uterus appears to be empty based
on ultrasound evaluation. This means you have lost the pregnancy. The causes of this are the same as
those for a threatened miscarriage. This is the most common cause of first trimester bleeding.

Incomplete miscarriage: You may have an incomplete miscarriage (or a miscarriage in

progress) if the pelvic exam shows your cervix is open and you are still passing blood, clots, or tissue.
The cervix should not remain open for very long. If it does, it indicates the miscarriage is not
completed. This may occur if the uterus begins to clamp down before all the tissue has passed, or if
there is infection.

Blighted ovum: You may have a blighted ovum (also called embryonic failure). An ultrasound
would show evidence of an intrauterine pregnancy, but the embryo has failed to develop as it should in
the proper location. This may occur if the fetus were abnormal in some way and not generally due to
anything you did or didn't do.

Intrauterine fetal demise: You may have an intrauterine fetal demise (also called IUFD, missed
abortion, or embryonic demise) if the developing baby dies inside the uterus. This diagnosis would be
based on ultrasound results and can occur at any time during pregnancy. This may occur for any of the
same reasons a threatened miscarriage occurs during the early stages of pregnancy; however it is
very uncommon for this to occur during the second and third trimesters of pregnancy.

Ectopic pregnancy: You may have an ectopic pregnancy (also called tubal pregnancy). This
would be based on your medical history and ultrasound, and in some cases laboratory results.
Bleeding from an ectopic pregnancy is the most dangerous cause of first trimester bleeding. An ectopic
pregnancy occurs when the fertilized egg implants outside of the uterus, most often in the Fallopian
tube. As the fertilized egg grows, it can rupture the Fallopian tube and cause life-threatening bleeding.
Symptoms are often variable and may include pain, bleeding, or lightheadedness. Most ectopic
pregnancies will cause pain before the tenth week of pregnancy. The fetus is not going to develop and
will die because of lack of supply of nutrients. This condition occurs in about 3% of all pregnancies.

There are risk factors for ectopic pregnancy. These include a history of prior ectopic
pregnancy, history of pelvic inflammatory disease, history of Fallopian tube surgery or ligation,
history ofinfertility for more than two years, having an IUD (birth control device placed in the uterus)
in place, smoking, or frequent (daily) douching. Only about 50% of women who have an ectopic
pregnancy have any risk factors, however.

Molar pregnancy: You may have a molar pregnancy (technically called gestational trophoblastic
disease). Your ultrasound results may show the presence of abnormal tissue inside the uterus rather
than a developing fetus. This is actually a type of tumor that occurs as a result of the hormones of
pregnancy, and is usually not life-threatening to you. However, in rare cases the abnormal tissue is
cancerous. If it is cancerous it can invade the uterine wall and spread throughout the body. The cause
of this is generally unknown.

Postcoital bleeding is vaginal bleeding after sexual intercourse. It may be normal during
pregnancy.

Bleeding may also be caused by reasons unrelated to pregnancy. For example, trauma or
tears to the vaginal wall may bleed, and some infections may cause bleeding

The most common cause of late-pregnancy bleeding is a problem with the placenta.
Some bleeding can also be due to an abnormal cervix or vagina.
Placenta previa: The placenta, which is a structure that connects the baby to the wall
of your womb, can partially or completely cover the cervical opening (the opening of the
womb to the vagina). When you bleed because of this, it is called placenta previa. Late
in pregnancy as the opening of your womb, called the cervix, thins and dilates (widens)
in preparation for labor, some blood vessels of the placenta stretch and rupture. This
causes about 20% of third-trimester bleeding and happens in about 1 in 200
pregnancies. Risk factors for placenta previa include these conditions:

Multiple pregnancies

Prior placenta previa

Prior Cesarean delivery

Placental abruption: This condition occurs when a normal placenta separates from the
wall of the womb (uterus) prematurely and blood collects between the placenta and the
uterus. Such separation occurs in 1 in 200 of all pregnancies. The cause is unknown.
Risk factors for placental abruption include these conditions:

High blood pressure (140/90 or greater)

Trauma (usually a car accident or maternal battering)

Cocaine use

Tobacco use

Abruption in prior pregnancies (you have a 10% risk it will happen again)

Uterine rupture: This is an abnormal splitting open of the uterus, causing the baby to
be partially or completely expelled into the abdomen. Uterine rupture is rare, but very
dangerous for both mother and baby. About 40% of women who have uterine rupture
had prior surgery on their uterus, including Cesarean delivery. The rupture may occur
before or during labor or at the time of delivery. Other risk factors for uterine rupture are
these conditions:

More than four pregnancies

Trauma

Excessive use of oxytocin (Pitocin), a medicine that helps strengthen contractions

A baby in any position other than head down

Having the baby's shoulder get caught on the pubic bone during labor

Certain types of forceps deliveries

Fetal vessel rupture: The baby's blood vessels from the umbilical cord may attach to
the membranes instead of the placenta. The baby's blood vessels pass over the
entrance to the birth canal. This is called vasa previa and occurs in 1 in 5,000
pregnancies.
Less common causes of late-pregnancy bleeding include injuries or lesions of the cervix
and vagina, including polyps, cancer, and varicose veins.
Inherited bleeding problems, such as hemophilia, are very rare, occurring in 1 in 10,000
women. If you have one of these conditions, such as von Willebrand disease, tell your
doctor.
It is helpful for your health care professional to know the amount and the quality of the
bleeding that you have. Keep track of the number of pads used and passage of clots
and tissue. If you pass a clump of tissue and are going to see your doctor, bring the
tissue with you for examination.
Other symptoms you may experience are increased fatigue, excessive thirst, dizziness,
or fainting. Any of these may be signs of significant blood loss. You may notice a fast
pulse rate that increases when you stand up from lying down or sitting. Dizziness may
worsen when you stand up as well.

With late-pregnancy bleeding, you may have these specific symptoms:

Placenta previa: About 70% of women have painless bright red blood from the vagina. Another
20% have some cramping with the bleeding, and 10% have no symptoms.

Placental abruption: About 80% of women have dark blood or clots from the vagina, but 20%
have no external bleeding. More than one-third have a tender uterus. About two-thirds of women with
placental abruption have the classic "pain and bleeding." Over half of the time the baby shows signs of
distress. Most abruptions occur before labor begins.

Uterine rupture: Symptoms are highly variable. Classic uterine rupture is described as intense
abdominal pain, heavy vaginal bleeding, and a "pulling back" from the birth canal of the baby's head.
The pain may initially be intense, then get better with rupture, only to worsen as the lining of the
abdomen is irritated. Bleeding can range from spotting to severe hemorrhage.

Fetal bleeding: This condition may show up as vaginal bleeding. The baby's heart rate on the
monitor will first be very fast, then slow, as the baby loses blood.

When to Seek Medical Care

Bleeding is not normal at any time during pregnancy. Report any vaginal bleeding
during pregnancy to your health care professional. Be prepared to give information
about the amount of blood lost and a description of how you are feeling overall. If your
bleeding is light and you have no pain, your evaluation may be in the doctor's office.
Go to a hospital's emergency department if the following conditions develop:

If you have severe bleeding or cramps and contractions (call 911)

If vaginal bleeding in pregnancy lasts for more than 24 hours and you are unable to get in touch
with your health care professional or you don't have one

If you faint (pass out) or feel very dizzy

If you are bleeding and develop a feverover 100.5 F (38.05 C)

If you have pain worse than a normal period, or severe localized pain in your abdomen, pelvis, or
back

If you have undergone an abortion and develop a fever, abdominal or pelvic pain, or increased
bleeding

If you have been given medical treatment for ectopic pregnancy withmethotrexate (Rheumatrex,
Trexall), and you develop increased abdominal or pelvic pain within the first week after the injection

The medical evaluation begins with a thorough history and physical exam. Depending on the setting
(medical office or hospital) and the seriousness of your symptoms, laboratory and ultrasound tests
may be performed. For bleeding in the early part of pregnancy, the doctor's main goal will be to
make sure you don't have an ectopic pregnancy. That is what the evaluation will focus on. For latepregnancy bleeding, the doctor first will make sure you are stable.
Medical History and Physical Exam

Medical history: Your health care professional will ask you a lot of questions:

If early in pregnancy, your pregnancy history will be reviewed regarding the certainty of the dates
of your pregnancy. If you think you are pregnant, you usually are.

You may be asked about recent trauma or sexual intercourse and whether you have abdominal
pain or contractions.

Your medical history will be reviewed, with emphasis on bleeding disorders, liver problems, and
drug or tobacco use.

You will be asked about prior pregnancies, Cesarean deliveries, preterm labor, placenta previa,
or placental abruptions.

Physical exam: Regardless of where you are being treated, the first thing that should
be established is how sick you are as a result of the bleeding. This is done by
evaluating vital signs (pulse and blood pressure), and by a quick physical assessment
of volume of blood loss by looking to see if you are pale or if you have abdominal
tenderness. If you have lost a significant amount of blood, you will be treated with IV
fluids and you may need surgery.

Your abdomen will be examined to see if you are tender and to check the size of your uterus.

You will be checked for bleeding from other sites, such as the nose or rectum.

The results of the pelvic exam may or may not be very helpful in differentiating between ectopic
pregnancy and threatened miscarriage: 10% of women with an ectopic pregnancy will have a
completely normal pelvic exam. How enlarged the uterus is on examination may help, because in less
than 3% of ectopic pregnancies is the uterus enlarged to greater than 10 cm. In some cases,
especially late in the pregnancy, the pelvic examination might not be performed until an ultrasound is
available.

Quantity and quality of abdominal pain and vaginal bleeding is important for the doctor to know.
Pain is seen in most women with ectopic pregnancy (up to 90%) and vaginal bleeding (50% to 80%).

Late in pregnancy, you will have an abdominal ultrasound prior to a vaginal exam to see if you
have a placenta previa. If ultrasound does not show previa, you will have a sterile speculum vaginal

exam to evaluate you for injury to the lower genital tract. If the vaginal exam is normal, you will have a
digital exam to check for cervical dilation. You will have monitors attached to your abdomen to check
for contractions and for the baby's heart rate.

Symptoms and physical examination diagnose uterine rupture. The symptoms that suggest
rupture are sudden onset of severe abdominal pain, abnormality of the size and shape of the uterine
contour, and regression of the baby's head up the birth canal.

Laboratory Tests and Imaging

Lab tests: Several lab tests are routinely obtained. They include a urine pregnancy test,
a urinalysis, a blood type and Rh, and a complete blood count (CBC). Serum
quantitative bhCG, which is a blood hormone marker of pregnancy, is also frequently
obtained.

The urine pregnancy test is extremely sensitive for diagnosing pregnancy at or about the same
time you miss your period, or possibly a few days before. A urinalysis can diagnose urinary tract
infections, regardless of whether you have symptoms of this type of infection. This is because
infections, specifically of the urinary tract, are a cause of miscarriage. Also, a urinary tract infection with
no symptoms is relatively common in pregnancy, occurring in 2% to 11% of pregnant women. Up to a
fourth of these women will go on to have kidney infections.

Your blood type will be checked. You are being screened for whether your type is Rh negative or
positive. If you are negative and the father of the baby is positive, your body may make antibodies
against the baby's blood cells. If this occurs without treatment, the next time you are pregnant, these
antibodies will appear again and harm that baby. If this is discovered during the first pregnancy and
treatment with an injection called RhoGAM is given, this prevents the antibodies from forming.

A blood count is routinely obtained to have an estimate of how much bleeding has already
occurred.

The bhCG level is a measure of the volume of living tissue associated with the developing
pregnancy. Both ectopic and intrauterine pregnancies (IUP) produce bhCG, although there is usually a
difference in the rate at which the quantitative bhCG level increases. Although a single value of bhCG
isn't useful for differentiating between a normal or abnormal pregnancy or an ectopic pregnancy, a
variation in the expected rate of rise of the bhCG level can be helpful. The real value of the quantitative
bhCG for diagnosis of ectopic pregnancy is when it is used in correlation with the results of a pelvic
ultrasound.

Ultrasound: Ultrasound can often determine if the fetus is healthy and growing inside
the uterus. Ultrasound is a form of imaging using sound waves, not X-rays. It is a test
that is often able to identify a pregnancy and estimate the age of the fetus. However, a
pregnancy may be too early to be seen on ultrasound.

Ultrasound may be able to identify an ectopic pregnancy growing outside of the uterus. It also
may be used to look for blood in the pelvis, a very serious complication that can occur when the
ectopic pregnancy has ruptured the Fallopian tube.

Late in pregnancy, placenta previa is diagnosed almost exclusively by abdominal ultrasound,

which can detect it 95% of the time.

Placental abruption is diagnosed by excluding other causes. It often cannot be confirmed until
after delivery when the placenta is found to have a blood clot attached to it. An ultrasound is performed
to make certain that the bleeding is not from a placenta previa. Ultrasound at best is only able to detect
about half of placental abruptions.

Fetal bleeding can be distinguished from maternal bleeding by performing a special test on the
blood present in the vagina. Also, a special type of ultrasound (Doppler) may be used to see the blood
flow within the blood vessels.

Lower genital tract problems can easily be diagnosed with a speculum examination. It is
important that an ultrasound rule out placenta previa prior to any vaginal exam.

Bleeding During Pregnancy Self-Care at Home

If you begin to bleed during early pregnancy, until your doctor has seen you and given
different instructions, you should take it easy. Rest and relax, do not undertake heavy
lifting or strenuousexercise, and abstain from sex, tampon use, or douching. Drink
plenty of water and try to avoid against dehydration. Remember to keep track of the
number of pads used and if the bleeding is increasing or decreasing.
There is no home care for late-pregnancy bleeding. You must see a health care
professional immediately.

Bleeding During Pregnancy Treatment

Early pregnancy bleeding

Ectopic pregnancy: If you have been diagnosed with an ectopic pregnancy by

ultrasound, you may be given medication or taken into surgery.

Medical management is with methotrexate (Rheumatrex, Trexall), a drug that kills rapidly
developing tissue.

Surgery is reserved for those women who do not meet certain criteria for receiving medical
treatment with methotrexate, and for those who are too sick to wait for the methotrexate to work. Also,

if you choose not to have methotrexate therapy, then surgery would be the only other option. Surgery
is usually a laparoscopic procedure (small incisions in your abdomen for tiny instruments) into the
Fallopian tube and removal of the ectopic pregnancy, while attempting to save as much of the tube as
possible. This may not be possible; however, if there has been much damage to the tube by the
ectopic pregnancy itself or from significant bleeding.

Threatened miscarriage: If you are diagnosed with a threatened miscarriage, your

health care practitioner will give you instructions about activities, what to watch for, and
when to return for follow-up. Home care for threatened miscarriages includes resting
until any pain or bleeding stops. Avoid sexual intercourse for 3 weeks. You should not
douche or use tampons.
Incomplete/inevitable abortion: You will be admitted to the hospital for a procedure to
remove any remaining fetal tissue in your uterus. This is calleddilation and
curettage (uterine evacuation or D&C) to prevent any further complications such as
hemorrhage or infection.
Missed abortion: In this case, you may either be admitted to the hospital for a D&C or
monitored at home with the possibility of passing the tissue without surgery. This
decision is made by you and your doctor after a discussion of the risks and benefits of
both choices. The age and size of the fetus may be important when deciding which
course of action to pursue.
Complete abortion: You may be sent home after complete passage of fetal tissue is
ensured or if an ultrasound shows no remaining tissue.
Molar pregnancy: Immediate D&C is necessary. Follow-up blood B-hCG levels should
be obtained to check for chorionic carcinoma (a type of cancer).
Late pregnancy bleeding

With late-pregnancy bleeding, you will be monitored for blood loss and signs of shock.
You will receive IV fluids and possibly blood transfusions. Your baby will be monitored
closely for signs of distress. Your treatment will be guided by the cause of your bleeding,
your condition, and the age of the baby (weeks' gestation).
Placenta Previa

Cesarean delivery (the baby is delivered surgically) is the preferred route of delivery.
If you or your baby is in danger from severe bleeding, you will have an emergency Cesarean
delivery.
If you are having contractions, you may get IV medicine to slow them or stop them.

If your pregnancy is fewer than 36 weeks and your bleeding is not severe, you will be admitted to
the hospital for observation, monitoring of your baby's heart rate, and repeated blood counts to check
foranemia. You will get a medicine to help your baby's lungs mature. When you are 36 weeks
pregnant, the doctor will check your baby's lungs, and, if they are mature, you will have a Cesarean
delivery.

Almost all deliveries will be Cesarean deliveries because of the high risk of severe bleeding and
danger to the baby by a vaginal delivery. In very rare cases, when the placenta is next to but not
covering the cervix, a vaginal delivery may be attempted.

Even with a Cesarean delivery, you can lose up to 3 pints of blood.

Placental Abruption

Vaginal delivery is the preferred delivery. Cesarean delivery is reserved for emergencies.

If you have massive bleeding and you or your baby are in danger, then an emergency Cesarean
delivery will be performed.

If your baby is more than 36 weeks, you will have a rapid but controlled vaginal delivery. You
may be given some IV medication to make your contractions more effective.

If your pregnancy is fewer than 36 weeks and your bleeding is not severe, you will be admitted to
the hospital for observation, monitoring of your baby's heart rate, and repeated blood counts to check
for anemia. You will get a medicine to help your baby's lungs mature. When you are 36 weeks
pregnant, the doctor will check your baby's lungs, and, if they are mature, you will have a Cesarean
delivery.

Uterine Rupture

If there is a high suspicion for rupture of the uterus, you will have an immediate Cesarean
delivery.

Your uterus may have to be removed.

If you are stable and want to have more children, the surgeon may be able to repair your uterus.

You will probably need to have blood transfusions with several units of blood.

Fetal bleeding is treated by performing an immediate Cesarean delivery.

Bleeding During Pregnancy Follow-up

If you have any complications including bleeding, abdominal pain, or fever, you should
return to the doctor for reexamination.

If you have been treated for ectopic pregnancy and have increased pain or any
weakness or dizziness, you should call an ambulance or have someone take you to a
hospital's emergency department immediately.

You may be placed on bed rest with instructions to place nothing into the vagina.

Do not douche, use tampons, or have sexual intercourse until the bleeding stops.

Follow-up care with your gynecologist should be arranged within 1-2 days.

Women who have had a molar pregnancy need regular, long-term follow-up and repeat
measurements of beta-hCG to ensure that no cancer will develop.

The best way to prevent any complication in pregnancy is to have a good

relationship with your health care professional and to maintain close contact
throughout your pregnancy. This is especially important if you have had prior
pregnancies complicated by third-trimester bleeding.

Avoid bleeding in pregnancy by controlling your risk factors, especially the use of
tobacco and cocaine. If you have high blood pressure, work closely with your
health care professional to keep it under control.

Bleeding During Pregnancy Prognosis

The effects of bleeding during your pregnancy depend on many factors. The cause of
the bleeding and whether it is treatable is the most important issue.
Early pregnancy bleeding

The definite rate of miscarriages after vaginal bleeding in early pregnancies are difficult
to estimate as a significant percentage of pregnancies miscarriage without any specific
symptoms prior to the miscarriage.
Ectopic pregnancy: For bleeding in early pregnancy caused by ectopic pregnancy, the
pregnancy will not survive. If you have such a pregnancy, the possibilities of future
ectopic pregnancies depend on the location, timing, and management of the condition.

Most women with ectopic pregnancies who had no prior fertility issues later have
successful pregnancies (about 70%).
Threatened abortion: You will have an entirely normal pregnancy and birth 50% of the
time. Alternatively, you may progress to have a spontaneous abortion or miscarriage. If
you have an ultrasound at the time of your evaluation, which shows a fetus with a
heartbeat in the uterus, there is a 75%-90% chance of having a normal pregnancy.
Complete abortion or miscarriage: For women with recurrent miscarriages, the
possibility of having a successful pregnancy is still high. Even after two or more
miscarriages, your chances for delivering a child are still high.
Molar pregnancy: After having a molar pregnancy, the risk of molar pregnancy in a
later conception is about 1%. In addition, the overall risk of a certain form of cancer in
women who have had a prior molar pregnancy has been estimated at 1,000 times
higher than that of women who have not had a molar pregnancy.
Late pregnancy bleeding

Placenta Previa: The risk of maternal death is less than 1%, but other complications,
such as massive hemorrhage requiring a blood transfusion or a hysterectomy, can also
occur.

Rarely, the placenta attaches abnormally deep into the uterus. This is called a placenta accreta,
increta, or percreta, depending on the depth. Many women who have this condition have such massive
bleeding that a hysterectomy (removal of the uterus) is required to save the woman's life.

Up to 8 of every 100 babies with placenta previa die, usually because of premature delivery and
lack of lung maturity. Other problems for the baby include size smaller than expected, birth defects,
breathing difficulties, and anemia requiring blood transfusion.

Placental Abruption: The risk of maternal death is low, but major blood loss may
require transfusions.

The risk of death for the baby with placental abruption is about 1 in 500. This accounts for 15%
of all newborn deaths.

If the baby survives, about 15% have neurological and behavioral problems as a result of
decreased oxygen to the brain. This occurs because placental blood vessels spasm and reduce the
flow of oxygen to the baby before delivery.

As the placenta separates from the womb, amniotic fluid and some placental tissue may enter
the woman's bloodstream and cause a reaction. Her blood may become very thin and not clot well,
which worsens the hemorrhage. She may require additional blood products to help her clot.

Uterine Rupture: This is a very dangerous condition for both the woman and the baby.

The greatest risks to the woman are hemorrhage and shock.

An increased rate of transfusion occurs with uterine rupture, and 58% of women require more
than 5 units of blood transfused.

The risk of death for the woman is less than 1%. However, if left untreated, the woman will die.

The risk to the fetus is extremely high. The death rate is about one in three.

Fetal bleeding is extremely dangerous for the baby. The risk of death for the baby is 50% and is
increased to 75% if the membranes rupture (water breaks).

Congenital Bleeding Disorders: The risk of complications for the woman is quite low.
The most concerning is hemorrhage. The risk to the infant is very low. The largest risk to
the baby, especially if it is a male, is inheritance of the bleeding disorder.
Pictures of Ectopic and Intrauterine Pregnancies

Picture of an Ectopic Pregnancy

Media file 1: An early intrauterine pregnancy seen on ultrasound.

An early intrauterine pregnancy seen on ultrasound

Bleeding During Pregnancy

Bleeding during pregnancy is common, especially during the first trimester, and usually it's no cause for
alarm. But because bleeding can sometimes be a sign of something serious, it's important to know the
possible causes, and get checked out by your doctor to make sure you and your baby are healthy.
Bleeding in the First Trimester
About 20% of women have some bleeding during the first 12 weeks of pregnancy. Possible causes of first
trimester bleeding include:
Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you
conceive as the fertilized egg implants itself in the lining of the uterus. Some women don't realize they are
pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts
from a few hours to a few days.
Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be
one of the biggest concerns with first trimester bleeding. About half of women who bleed in pregnancy
eventually miscarry, but that doesn't necessarily mean that if you're bleeding you've lost the baby,
especially if you don't have any other symptoms.
Other symptoms of miscarriage are strong cramps in the lower abdomen and tissue passing through
the vagina.

Ectopic pregnancy. In an ectopic pregnancy, the fertilized embryo implants outside of the uterus, usually
in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be
life-threatening to the mother. Although ectopic pregnancy is potentially dangerous, it only occurs in about
2% of pregnancies.
Other symptoms of ectopic pregnancy are strong cramps or pain in the lower abdomen, and
lightheadedness.
Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which
abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can
spread to other parts of the body.
Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the
uterus.
Additional causes of bleeding in early pregnancy include:

Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test,
which cause contact with the cervix, can trigger bleeding. This type of bleeding isn't cause for concern.

Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such
as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Bleeding During Pregnancy

(continued)
Bleeding in the Second and Third Trimesters
Abnormal bleeding in late pregnancy may be more serious, because it can signal a problem with the
mother or baby. Call your doctor as soon as possible if you experience any bleeding in your second
or third trimester.
Possible causes of bleeding in late pregnancy include:
Placenta previa. This condition occurs when the placenta sits low in the uterus and partially or
completely covers the opening of the birth canal. Placenta previa is very rare in the late third trimester,
occurring in only one in 200 pregnancies. A bleeding placenta previa, which can be painless, is an
emergency requiring immediate medical attention.
Placental abruption. In about 1% of pregnancies, the placenta detaches from the wall of the uterus
before or during labor and blood pools between the placenta and uterus. Placental abruption can be very
dangerous to both the mother and baby.
Other signs and symptoms of placental abruption are abdominal pain, clots from the vagina, tender
uterus, and back pain.

Uterine rupture. In rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine
rupture can be life-threatening, and requires an emergency C-section.
Other symptoms of uterine rupture are pain and tenderness in the abdomen.
Vasa previa. In this very rare condition, the developing baby's blood vessels in the umbilical cord or
placenta cross the opening to the birth canal. Vasa previa can be very dangerous to the baby because the
blood vessels can tear open, causing the baby to bleed severely and lose oxygen.
Other signs of vasa previa include abnormal fetal heart rate and excessive bleeding.
Premature labor.Vaginal bleeding late in pregnancy may just be a sign that your body is getting ready to
deliver. A few days or weeks before labor begins, the mucus plug that covers the opening of the uterus
will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as "bloody
show"). If bleeding and symptoms of labor begin before the 37th week of pregnancy, contact your doctor
right away because you might be in preterm labor.
Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and ache
in the lower back.
Additional causes of bleeding in late pregnancy are:

Injury to the cervix or vagina

Polyps

Cancer

Bleeding During Pregnancy

(continued)
What to Do If You Have Abnormal Bleeding During Pregnancy
Because vaginal bleeding in any trimester can be a sign of a problem, call your doctor. Wear a pad so
that you can keep track of how much you're bleeding, and record the type of blood (for example, pink,
brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for
testing. Don't use a tampon or have sex while you are still bleeding.
You should expect to receive an ultrasound to identify what the underlying cause of your bleeding may be.
Vaginal and abdominal ultrasounds are often performed together as part of a full evaluation.
Go to the emergency room or call 911 right away if you are experiencing any of the following symptoms,
which could be signs of a miscarriage or other serious problem:

Severe pain or intense cramps low in the abdomen

Severe bleeding, whether or not there is pain

Discharge from the vagina that contains tissue

Dizziness or fainting

A fever of more than 100.4 or more degrees Fahrenheit and/or chills