Vaginal bleeding in late pregnancy: MedlinePlus Medical Encyclopedia

One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away.

You should understand 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 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.

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus.

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

• Having sex (most often just spotting)
• An internal exam by your provider (most often just spotting)
• Diseases or infections of the vagina or cervix
• Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

• Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
• Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

To find the cause of your vaginal bleeding, your provider may need to know:

• If you have cramping, pain, or contractions
• If you have had any other bleeding during this pregnancy
• When the bleeding began and whether it comes and goes or is constant
• How much bleeding is present, and whether it is spotting or a heavier flow
• The color of the blood (dark or bright red)
• If there is an odor to the blood
• If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
• If you have had recent injuries or falls
• When you last had sex and if you bled afterward
• If you’re feeling the baby move
• If you’ve had other complications during the pregnancy

A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:

• Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
• If spotting or bleeding continues, call your provider.
• If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.

For any other bleeding, call your provider right away.

• You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
• Your provider will also tell you whether you can drive yourself or you should call an ambulance.

Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn’s Current Therapy 2023. Philadelphia, PA: Elsevier 2023:1273-1276.

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 173.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae.  In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 43.

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Pregnancy – bleeding problems – Better Health Channel

Bleeding from the vagina in early pregnancy is very common. In fact, it is thought to happen in almost one in four pregnancies – many of which will result in a healthy baby. About a third to half of all women who have bleeding will go on to miscarry.

Bleeding later in your pregnancy is less common and can be a sign of a serious problem, such as placenta previa (when the placenta covers the cervix) or placental abruption (separation of the placenta).

You should go to your nearest hospital emergency department if you are experiencing:

• heavy bleeding, for instance soaking two pads per hour or passing golf ball sized clots
• severe abdominal pain or shoulder pain
• fever or chills
• dizziness or fainting
• unusual smelling vaginal discharge
• bleeding in the second half of your pregnancy.

Causes of bleeding problems during pregnancy

It is not always possible to pinpoint why a woman is bleeding during pregnancy. Some of the many reasons may include:

• Miscarriage
• Ectopic pregnancy
• Implantation bleeding
• Placenta previa
• Placental abruption.

Miscarriage

A miscarriage is the loss of a pregnancy before the fetus (unborn baby) can survive outside the uterus (womb).

Miscarriage usually occurs in the first 12 weeks of a pregnancy (the first trimester), and most miscarriages occur without a clear cause.

Vaginal bleeding is the most common sign of miscarriage. Some women may experience period-like cramping pain in the lower pelvis. Others may experience no symptoms at all.

Ectopic pregnancy

During the first trimester, vaginal bleeding can be a sign of ectopic pregnancy. This is when the fetus starts to grow outside of the uterus, often in one of the fallopian tubes.

Symptoms of ectopic pregnancy can include cramping, vaginal bleeding and abdominal pain. Pain might be caused by a ruptured fallopian tube. This is a medical emergency and needs immediate surgery.

Implantation bleeding

One cause for bleeding in early pregnancy is ‘implantation bleeding’. This usually occurs as light bleeding or ‘spotting’ and happens when the fetus implants (buries) itself into the lining of your womb (around the time that your first period after conception would have been due). This bleeding will often last a few days then stop.

Placenta previa

Placenta previa occurs where the placenta is (either wholly or in part) inserted into the lower part of the uterus and covering the cervix. One of the signs of placenta previa is bleeding after 28 weeks.

Diagnosis of placenta previa is by ultrasound. If you are diagnosed with placenta previa, your baby will usually be born by caesarean section.

Placental abruption

This is when part or all of the placenta separates from the wall of the uterus before the birth of your baby. The amount of bleeding varies, as does the impact on your baby. Treatment may involve monitoring you and your baby, bed rest, or, in more serious cases, the early birth of your baby.

Tests for bleeding problems during early pregnancy

It can take some time for your doctor to be sure of what the bleeding means. You may need a number of tests, which could include:

• Vaginal examination – to check the size of your uterus and the amount of bleeding. This examination lasts a few minutes and may be a bit uncomfortable.
• Blood tests – to check your blood type and, sometimes, the levels of pregnancy hormones in your blood.
• Ultrasound scan – gel is rubbed on your abdomen. A hand-held scanner uses sound waves to provide pictures of the pregnancy. In very early pregnancy, more information is gained by placing a small, slender scanner in the vagina. You will need to have a full bladder before the scan. An ultrasound scan takes around 15 to 20 minutes. If an ultrasound is needed, it can be arranged through the emergency department of your nearest hospital or your local doctor.

Tests for bleeding problems during later pregnancy

Both placenta previa and placental abruption can cause heavy bleeding of bright red blood from the vagina.

A vaginal examination is often used to help diagnose placental abruption, but could trigger heavier bleeding in the case of placenta previa. Therefore, an ultrasound scan should always be taken first, and digital (finger) vaginal examinations should be strictly avoided in the case of placenta previa.

Tests used to diagnose placenta previa include:

• medical history
• ultrasound scan
• feeling the mother’s belly to establish the baby’s position (the baby is sideways or presenting bottom-first in around one in three cases of placenta previa)
• very gentle speculum vaginal examination (to make sure the bleeding is not coming from the cervix or vagina).

Having ruled out placenta previa using the tests above, a digital vaginal examination may be used to identify placental abruption.

Treatment of bleeding problems during early pregnancy

The bleeding may be light and stop in a day or two. Many people go on to have a healthy baby at full term after such a bleed.

However, sometimes the bleeding becomes heavy and a miscarriage is likely to happen. While you still need to see a doctor, in such circumstances there is no emergency care that will save your pregnancy.

Sometimes, during a miscarriage, some of the pregnancy tissue may remain inside the uterus. This can lead to very heavy bleeding if it is not treated. Your doctor will tell you if you need further treatment.

If you are Rhesus (Rh) negative (if you have a negative blood type), you may require an injection of anti-D immunoglobulin to prevent problems related to possible blood incompatibility in future pregnancies.

Bleeding during early pregnancy and taking care of yourself at home

You may feel a range of emotions over this time. Guilt is a normal feeling, but don’t blame yourself, as you have done nothing wrong. Your body will be going through changes in hormone levels and this can make you feel very emotional. It may help to talk to family or friends.

While there is no specific treatment to prevent a miscarriage, things you can do that may help include:

• Getting plenty of rest.
• Using pads rather than tampons while you are bleeding.
• Avoiding sex while you are bleeding. Sex can resume once the bleeding has stopped.
• Taking mild pain relief medication, such as paracetamol, if needed.
• Reporting any changes in your condition to your doctor.

If you are finding your mood remains low for an extended period of time, you may be experiencing depression and require the assistance of a professional.

Where to get help

• Your GP (doctor)
• Obstetrician
• Midwife
• Sexual Health Victoria (SHV)External Link. To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Post and Antenatal Depression Association (PANDA) Helpline Tel. 1300 726 306

causes and treatment by an obstetrician-gynecologist at the Proxima Medical Center (Sochi)

Bleeding during pregnancy is an obstetric symptom characterized by discharge from the vagina of various volumes of bloody discharge, the cause of which can act as pathological conditions, and natural physiological changes in the female body. Every fifth pregnant woman faces this symptom. Bleeding occurs predominantly in the first and third trimesters of pregnancy. Bloody discharge from the vagina should be a reason for urgent medical attention, as in some cases this condition can pose a threat to the mother and fetus.

Causes of bleeding during pregnancy

In the first trimester of pregnancy the most common cause of bleeding is spontaneous miscarriage. Approximately at 6 obstetric weeks, spotting is characteristic of ectopic attachment of the fetal egg, fetal fading, or an Rhesus conflict between the fetus and mother.

In the second trimester of pregnancy bleeding is observed much less frequently, in no more than 10% of cases. In most cases, it is due to pathological causes, including isthmic-cervical insufficiency, intrauterine fetal death, late spontaneous abortion.

In the third trimester of pregnancy bleeding is always indicative of pathology of gestation. Usually spotting is a consequence of placenta previa, its premature detachment. In the latter case, there is a real danger to the life of the fetus. The most rare, but the most dangerous cause of bleeding in late pregnancy is uterine rupture (usually occurs with multiple pregnancies, large fetuses, polyhydramnios, and if there is a scar on the myometrium).

In the presence of benign neoplasms (polyps, mimoma), bleeding can occur at any stage of embryogenesis. Blood discharge is often observed in women suffering from cervical erosion. The likelihood of developing this pathological symptom increases with high physical exertion, too active sexual intercourse, the presence of cardiovascular pathologies, accompanied by a weakening of the endothelium.

Symptoms

Symptoms of bleeding during pregnancy may vary depending on the cause of bleeding. So, if bleeding is due to spontaneous miscarriage, then the pregnant woman may also be disturbed by pain in the lower abdomen, manifested in the form of spasms, deterioration in well-being and increased weakness. Dizziness, nausea, and a slight rise in body temperature may also occur. In this case, bleeding can have different intensity, and the discharge itself can be of a different color, from bright scarlet to crimson.

With placenta previa, a pregnant woman usually does not have any symptoms other than bleeding. Pain in most cases is not observed, and the tone of the myometrium is within the normal range. With placental abruption, a woman experiences severe pain, and there is also an increase in myometrial tone.

Methods of treatment

Treatment tactics for bleeding during pregnancy depends on the cause of bleeding from the genital tract, the amount of blood lost, the general condition of the patient and the fetus. If the bleeding is due to the natural physiological state of the woman, in the absence of pathological changes, then, as a rule, medical assistance in such cases is not required. It is recommended to comply with all previous doctor’s prescriptions, refrain from active sex life and increased physical activity. In some cases, hemostatic therapy may be indicated.

Similar recommendations are given in the presence of polyps, fibroids and erosion of the cervix, which caused bleeding during pregnancy. In such cases, expectant tactics are preferred. Cauterization of erosion is carried out after the birth of the child. In rare, exceptional cases, qualified gynecologists recommend removing polyps during pregnancy.

Bleeding during pregnancy, which occurred against the background of placenta previa or due to the threat of spontaneous abortion, requires emergency hospitalization of the woman in an obstetric hospital and further drug therapy under the constant supervision of doctors. In order to reduce uterine tone, tocolytics, sedative drugs are prescribed. With threatening abortions in obstetric practice, antispasmodics, coagulants and progesterone preparations are used. Physiotherapeutic treatment methods are also successfully used: electroanalgesia, endonasal galvanization. After normalization of the condition, the patient goes home and must observe the prescribed bed rest and complete sexual rest for a certain time. The introduction of pregnancy in such cases takes place under the close supervision of specialists.

In some cases, bleeding during pregnancy requires surgical procedures. We are talking about the following situations:

• miscarriage , completed spontaneous abortion – in this case, surgical removal of the remnants of fetal tissues is indicated.
• attachment of the ovum outside the uterine cavity . An emergency removal of the fetal egg is carried out. The method used to stop bleeding can be different, which depends primarily on the woman’s well-being and the intensity of bloody discharge. In case of massive blood loss, ligation of the uterine arteries is indicated.
• placental abruption . In moderate and severe forms of pathology, operative delivery (caesarean section) is indicated. After extraction of the fetus and subsequent separation of the placenta, clots are removed and, if necessary, in the presence of pronounced changes in the uterus, a hysterectomy is performed.
• isthymic-cervical insufficiency . During surgery, sutures are placed on the cervix to prevent its premature opening. Surgery is performed at less than 28 weeks’ gestation, and stitches are removed at 37 weeks. After surgical treatment, drug therapy based on hormonal drugs is indicated.

After the operation, the woman is prescribed a course of antibiotics to prevent the development of an infectious process. Also obligatory for compliance with the condition of postoperative rehabilitation is the observance of sexual rest and the requirements of personal hygiene.

Prognosis and prevention

Bleeding during pregnancy in most cases is characterized by a favorable prognosis. Timely qualified medical care ensures the preservation of the life of a pregnant woman and her fetus. Lethal outcome is extremely rare.

Preventive measures come down, first of all, to carrying out preconception preparation for conception. So, a woman should undergo a comprehensive examination, which allows timely identification and treatment of pathologies that can negatively affect the course of pregnancy. This is especially true of benign neoplasms, which can cause bleeding.

Along with this, a woman is recommended to register in the early stages of pregnancy and undergo all examinations and tests prescribed by a gynecologist. In the event of complications in early pregnancy (for example, bloody spotting, uterine tone), complex treatment is necessary, including hormone therapy, sedatives, bed rest, sexual rest and a special diet. It also follows:

• avoid stressful situations, emotional overstrain;
• exclude high physical activity;
• to eat properly and in a balanced way;
• give up bad habits;
• take vitamin complexes prescribed by a doctor;
• avoid violent sexual intercourse.

In severe pregnancy, bed rest and minimal physical activity are recommended to prevent bleeding.

Premature placental abruption: what expectant mothers need to know and how not to miss its signs | Blog

First, let’s talk about what is the placenta?

The placenta is the embryonic organ that connects the body of mother and child. Its uniqueness lies in the fact that it is the only “disposable” organ. The placenta begins to develop from the 2nd week of pregnancy, forms up to 15-16 weeks and reaches full functional maturity by 36 weeks. And after the birth of the fetus (in the third stage of childbirth), it separates and leaves the mother’s body, starting the process of lactation at the endocrinological level.

The placenta performs important functions such as gas exchange, nutrient exchange between the mother and the child, provides immunological protection and works as an endocrine gland, producing hormones necessary for the development of the fetus and the normal course of pregnancy. Every minute, about 500 ml of blood enters the placenta, but at the same time it is a kind of barrier that does not allow the blood of the mother and child to mix, and also prevents many toxic substances from entering the bloodstream of the baby.

In this article we will talk about placental abruption.

This condition is quite rare (up to 1.5% of all pregnancies), but causes such threatening complications as massive bleeding and hemorrhagic shock, fetal distress, which in some cases can cause fetal death. Normally, the detachment of the placenta from the inner wall of the uterus occurs only after the birth of the fetus. If this happens before the onset of labor, as well as in the first or second stage of labor, this is the premature detachment of a normally located placenta. This condition is a very dangerous pathology that requires immediate diagnosis and decision of further medical tactics in the near future.

Causes of premature placental abruption

The only cause of premature placental abruption, unfortunately, has not been established to date. There are many theories, but in general, the occurrence of this condition is associated with many provoking factors.

Major risk factors include:

• arterial hypertension,
• diabetes mellitus
• pregnant age over 40
• multiple pregnancy
• polyhydramnios
• postterm pregnancy and large fetus
• past uterine surgery
• blood clotting disorder,
• autoimmune diseases
• kidney disease
• bad habits such as smoking and drug use
• inflammatory diseases of the uterus and placenta, anomalies in the development of the uterus.

Causes that can provoke placental abruption: physical trauma of a pregnant woman (accident, fall, blow to the stomach), disruption of the contractile activity of the uterus, stress, gross obstetric manipulations.

Types of placental abruption

There are the following types of placental abruption: partial and complete.

Partial detachment, in turn, can be central and marginal.

Why is this classification so important? And because both the clinical picture and medical tactics depend on the place and volume of the detachment. Partial detachment can be progressive or non-progressive.

Non-progressive detachment has a significantly better prognosis for a pregnant woman, because in this case, conservative treatment is possible with preservation of pregnancy.

Symptoms of placental abruption:

Here is a triad of main symptoms that may be a sign of placental abruption:

1. abdominal pain, feeling of increased uterine tone;
2. bleeding from the genital tract;
3. violation of the fetal heartbeat, indicating fetal distress.

Also, a woman can feel the baby’s reaction to a decrease in the amount of oxygen supplied to him due to placental abruption – he begins to move more actively, reacting to hypoxia.

These symptoms do not always appear at the same time! For example, with marginal abruption of the placenta, blood flows into the vagina, which means that the woman sees signs of bleeding. With central detachment, a retroplacental hematoma is formed. Bleeding is internal, which means that a pregnant woman may not notice its signs. The appearance of an accelerated heartbeat in a woman, a decrease in blood pressure, nausea, dizziness, and severe weakness may indicate internal bleeding.

However, with central placental abruption, blood accumulates in front of the placenta and begins to “press” on nearby tissues. As a result, a pronounced pain syndrome occurs.

It must be emphasized that if at least one of the symptoms appears, it is necessary to immediately inform the doctor about this! This condition can be very dangerous for you and your baby, so it is important to diagnose it in a timely manner.

Diagnosis of placental abruption

Diagnosis of placental abruption is based not only on clinical symptoms and gynecological examination. Ultrasound diagnostics is the main method that allows you to accurately assess the location and area of ​​​​the exfoliated area of ​​the placenta and see the presence or absence of a hematoma. Also, ultrasound can distinguish premature detachment from placenta previa (its abnormal location, in which it overlaps the internal pharynx of the cervix). This condition can have similar symptoms, as it is often accompanied by bleeding. The condition of the fetus and the degree of its hypoxia will be determined using cardiotocography, and Dopplerography, in turn, assesses violations of the uteroplacental circulation. Based on these examination results, the obstetrician-gynecologist, and more often a council of doctors, decides on the type of further medical tactics.

Treatment of placental abruption

Treatment of placental abruption always requires hospitalization of the pregnant woman in the maternity hospital for constant monitoring of her condition. In cases of non-progressive mild placental abruption with a stable state of the mother and fetus, conservative tactics with drug therapy and preservation of pregnancy are possible. Progressive detachment, as well as severe detachment, certainly requires an emergency caesarean section.

In case of complete detachment of the placenta, with the rapid progression of this condition, massive bleeding occurs, which threatens the life of both the pregnant woman and the child. In such a situation, surgeons always prioritize the life of a woman and do everything necessary to save her. Some cases may, unfortunately, require even such radical surgical tactics as removal of the uterus. However, at the current level of development of medicine, more and more technologies are emerging that, with timely assistance, can save not only the life of the mother and child, but also the reproductive functions of a woman. In particular, our obstetrician-gynecologists and anesthesiologists use up-to-date international medical protocols to ensure the safest possible delivery.