What are the common causes of vaginal bleeding during late pregnancy? How should it be managed? Get the answers to these questions and more in this comprehensive article.

Vaginal Bleeding in Late Pregnancy: Causes and Management

Vaginal bleeding during the third trimester of pregnancy is a relatively common occurrence, affecting approximately one out of every ten pregnant women. While it may sometimes be a harmless sign, such as the cervix dilating during labor, it can also be a symptom of a more serious underlying condition that requires prompt medical attention.

Understanding the Difference Between Spotting and Bleeding

It is important to differentiate between spotting and bleeding, as they can have different implications:

• Spotting: Spotting refers to a few drops of blood that may appear on the underwear, but is not enough to warrant the use of a panty liner.
• Bleeding: Bleeding is a heavier flow of blood that requires the use of a liner or pad to prevent it from soaking through clothing.

Potential Causes of Late-Term Bleeding

There are several potential causes of vaginal bleeding during the third trimester of pregnancy, including:

1. Cervical Changes During Labor

As labor begins, the cervix starts to dilate, which can cause a small amount of blood to mix with the normal vaginal discharge or mucus.

2. Intercourse or Pelvic Exams

Sexual intercourse or pelvic examinations performed by a healthcare provider can sometimes cause a small amount of spotting, usually just a few drops.

3. Vaginal or Cervical Infections or Growths

Certain diseases or infections affecting the vagina or cervix, as well as uterine fibroids or cervical growths or polyps, can also lead to late-term bleeding.

4. Placental Issues

More serious causes of late-term bleeding may include placenta previa, where the placenta partially or completely covers the cervix, and placental abruption, where the placenta separates from the uterine wall before delivery.

Evaluating the Cause of Bleeding

To determine the cause of the vaginal bleeding, your healthcare provider will likely ask you a series of questions, such as:

• Do you have any cramping, pain, or contractions?
• Have you had any other bleeding during this pregnancy?
• When did the bleeding begin, and is it constant or intermittent?
• How much bleeding is present, and is it spotting or a heavier flow?
• What is the color of the blood (dark or bright red)?
• Do you have any other symptoms, such as dizziness, nausea, or fever?
• Have you had any recent injuries or falls?
• When was the last time you had sexual intercourse, and did you bleed afterward?
• Have you had any other complications during this pregnancy?

Depending on the answers to these questions, your healthcare provider may recommend further tests or examinations to determine the cause of the bleeding and the appropriate course of action.

Managing Vaginal Bleeding in Late Pregnancy

The management of vaginal bleeding in late pregnancy will depend on the underlying cause and the severity of the bleeding:

1. Mild Spotting

If the bleeding is light and you have no other symptoms, your healthcare provider may recommend monitoring the situation at home. This involves putting on a clean pad and checking it every 30 to 60 minutes for a few hours. If the spotting or bleeding continues, you should call your provider.

2. Heavy or Persistent Bleeding

If the bleeding is heavy, your belly feels stiff and painful, or you are experiencing strong and frequent contractions, you may need to call 911 or your local emergency number. For any other persistent or heavy bleeding, you should call your healthcare provider right away, as you may need to go to the emergency room or the labor and delivery area of the hospital.

3. Further Evaluation and Treatment

Your healthcare provider will determine whether you need to go to the emergency room or the labor and delivery area, and whether you can drive yourself or if you need to call an ambulance. They may also order additional tests or examinations to identify the underlying cause of the bleeding and provide appropriate treatment.

In summary, while a small amount of spotting during late pregnancy can be relatively common, any vaginal bleeding should be reported to your healthcare provider immediately, as it may be a sign of a more serious condition that requires prompt medical attention.

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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Bleeding during pregnancy: When to worry about spotting in pregnancy

A little light bleeding or spotting during pregnancy is common, especially during the first trimester. Heavier or more consistent bleeding could signal a problem with the pregnancy. Early pregnancy bleeding can happen when the fertilized egg implants, or it could be from something more serious like a miscarriage or ectopic pregnancy. Common causes of bleeding later in pregnancy include placental problems or preterm labor. Any bleeding is worth letting your doctor know about as soon as possible, especially if it’s heavy or it doesn’t stop.

Is it normal to have spotting during pregnancy?

A little light bleeding or spotting during pregnancy is common, especially in early pregnancy. Up to one in four pregnant women have some light bleeding in their first trimester. But even if the bleeding seems to have stopped, call your doctor, just to make sure everything is okay.

Spotting or light bleeding in pregnancy is probably from something minor. But it could also be a sign of a serious problem, such as an ectopic pregnancy, a miscarriage, or an infection.

Your doctor may want to do some tests, which can include a physical exam, an ultrasound, and blood tests, to check how well you and your baby are doing and to rule out any complications.

If you’re actively bleeding or you have severe pain and can’t reach your doctor, head to the emergency room right away.

What’s the difference between spotting and bleeding during pregnancy?

Spotting is very light bleeding, similar to what you may have at the very beginning or end of your period. It will look like small drops of blood on your underwear, varying in color from pink to red to brown (the color of dried blood). Pregnancy spotting is common, especially during the first three months.

Bleeding means that you need to wear a panty liner or pad to avoid soaking your underwear. And heavy bleeding will soak through one or more pads. Continued or heavy bleeding could signal a problem with your pregnancy, which is why it’s important to share with your doctor right away.

Early pregnancy bleeding: What causes it?

The most common causes of light spotting or bleeding during early pregnancy include:

Implantation. Some women have spotting even before they know they’re pregnant, about a week or so after they ovulate. It’s called “implantation bleeding” because it happens when the fertilized egg burrows (or implants) into the blood-rich lining of the uterus, a process that starts just six days after fertilization.

If you have a day or two of spotting in the week before your period is due, take a home pregnancy test. If the result is negative, wait a few days or a week. If your period doesn’t start when you expect it, try testing again.

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Subchorionic hematoma. Also called a subchorionic hemorrhage, this kind of bleeding can happen when the outer layer of the amniotic sac (chorion) separates from the wall of the uterus. It’s usually harmless and stops on its own. Small collections of blood like this early on are typically harmless. But if the collection of blood is larger, it will take longer to reabsorb, or go away. This can raise the risk of miscarriage or preterm labor, so your doctor may want to check on it regularly with ultrasound.

Miscarriage. Spotting or bleeding in the first trimester, especially if you also have abdominal pain or cramping, can be an early sign of miscarriage. But it isn’t necessarily a sign, and actually, about half of women who miscarry don’t have any bleeding prior to diagnosis. Other signs of a possible miscarriage are discharge of liquid or tissue from your vagina, and no longer feeling any pregnancy symptoms (like morning sickness). If feeling better is your only symptom, however, try not to worry! Many pregnant women don’t experience nausea in the first trimester and have very healthy pregnancies.

Ectopic pregnancy. Early pregnancy bleeding also can warn of an ectopic pregnancy – when the embryo implants outside the uterus, usually in one of the fallopian tubes. Sometimes bleeding is the only sign, but other common symptoms include pain in the belly, pelvis, or shoulder. An ectopic pregnancy can be life-threatening, so let your doctor know right away if you have bleeding or moderate to severe pain in your first trimester.

Molar pregnancy. This rare complication happens when the placenta doesn’t develop properly, and it can’t sustain the embryo. A molar pregnancy can be serious, and it needs prompt treatment.

Infection. An infection can irritate or inflame your cervix and make it more likely to bleed, especially after you have sex. These are some of the infections that can cause bleeding:

• Chlamydia
• Gonorrhea
• Herpes
• Yeast infection
• Trichomoniasis

Because certain infections can cause pregnancy complications, your doctor might prescribe antibiotics or another treatment.

You might also notice some spotting or light bleeding after sexual intercourse or a pelvic exam. More blood flows to your cervix during pregnancy, so it’s not unusual. A cervical polyp (a noncancerous growth on the cervix) can also cause spotting or bleeding after sex or an exam.

What causes second or third trimester bleeding?

Bleeding later in pregnancy might also be nothing to worry about. Light bleeding could be a sign of harmless inflammation, a cervical polyp, or other changes in your cervix. And a few days before your delivery date, bloody discharge called “show” is a sign that your cervix is getting ready for labor.

Heavy bleeding late in your pregnancy is a more worrisome sign. It’s worth making a call to your doctor right away.

Here are some common causes of bleeding in your second and third trimesters:

Placental problems. Bleeding or spotting after the first trimester can be a sign of a problem with the placenta, such as:

• Placenta previa, when the placenta partially or fully covers the cervix; usually this is diagnosed at your mid-pregnancy ultrasound or anatomy scan. Your placental location will continue to be monitored as pregnancy progresses, and your obstetrician will recommend that you abstain from intercourse as long as the placenta is over or near the cervix.
• Placenta accreta, when the placenta becomes abnormally embedded in the uterine wall. Although this is a rare complication, the risk slowly increases with each cesarean delivery.
• Placental abruption, when the placenta entirely or partially separates from the wall of the uterus. This is more likely to occur as a result of trauma (car accident, domestic violence), uncontrolled hypertension, or labor.

Late miscarriage. Most miscarriages happen in the first trimester, but bleeding between 13 weeks and the middle of your pregnancy can be a sign of late miscarriage.

Preterm labor. Bleeding is one sign of preterm labor (labor that starts before 37 weeks). Other symptoms are:

• Abdominal pain, cramps, or contractions
• Low backache
• Changes in vaginal discharge
• Pressure in your pelvis or lower abdomen

How much bleeding during pregnancy is normal?

Some light bleeding is normal, especially early in your pregnancy when the fertilized egg implants. But really, bleeding can happen at any point in your pregnancy, and for many different reasons. And because some causes are more serious than others, it’s always a good idea to let your doctor know about it.

Heavier bleeding that soaks through a pad, or bleeding that doesn’t go away is more concerning. It could signal a serious problem with your pregnancy that needs immediate medical attention. Calling your doctor right away or going to an emergency room could help you head off a problem and protect both your health and your baby’s.

When should I call my doctor about spotting or bleeding during pregnancy?

Any type or amount of bleeding in pregnancy is worth calling your doctor about, to make sure that nothing is wrong. This is important, even if your last ultrasound showed that your baby is healthy and growing according to schedule.

Heavy or consistent bleeding is a reason to call immediately. Your doctor can check for any problems, and either reassure you that you’re ok, or treat the problem.

When you call your doctor, let them know how long you’ve been bleeding and how much you’ve bled. Also tell them about other symptoms, like cramps, that you’ve had along with the bleeding. Also, be sure to be honest with them about recent sexual activity and medical history when you call.

Lastly, whenever the bleeding occurs, if your blood type is RH-negative, your doctor will want to make sure you get a Rhogam shot to protect future pregnancies. Call your doctor if you are RH-negative and have bleeding anytime in pregnancy. If you are RH-positive, this isn’t something you have to worry about.

Learn more:

• Pregnancy symptoms you should never ignore
• Vaginal discharge during pregnancy
• Rectal bleeding during pregnancy

how to cure, causes, symptoms, prevention, doctor’s advice, consequences

Abnormalities may occur at any stage of the perinatal period, and the last trimester is no exception. It happens that blood begins to flow at the 30th week of pregnancy from the genital tract. This is a dangerous symptom indicating deviations and pathologies.

Contents of the article

Why is this happening?

At this gestational age, this manifestation is an undoubted deviation, in which it is necessary to urgently hospitalize a woman to identify and eliminate the cause.

The main causes of this phenomenon:

• In case of placental abruption abundant bleeding from the mother’s vagina begins. Even a normal placenta, for some reason, can peel off the walls of the cervix before labor begins. The reasons why this process occurs are unknown. This phenomenon is accompanied by a severe form of preeclampsia, preeclampsia. Most often, dark-colored discharge with clots, increased uterine tone and severe pain in the abdominal region are observed. Complete detachment is a very rare phenomenon, most often a small area is affected. CTG is performed in order to register uterine contractions and fetal heartbeats. In some cases, a caesarean section is indicated. But at the thirtieth week, such a procedure will lead to the death of the child.
• Placenta previa is the second most common cause of this manifestation. With changes in the mother’s body that occur in the third trimester of gestation, the load cannot be maintained and flaking begins. The following clinical picture is observed: in 70% of cases, red discharge is visible, there are no pains; 10% there are no external factors; 20% experience acute pain in the lower abdomen.
• The rarest, but also encountered factor is problems with the vessels of the fetus. Such symptoms are caused by an anguish (vessels) or detachment of the umbilical cord. The doctor immediately observes a strong heartbeat of the child, gradually decreasing. After examining the condition of the fetus, the gynecologist decides on further actions.

Factors independent of the position of the woman:

• Fissures in the genital tract, which often occurs after intercourse.
• Pathology of the vagina (polyps, erosion).
• Infectious diseases or fungus.
• Bleeding from bursting varicose vessels of the woman’s vagina.
• Heredity.

If you notice blood in the 30th week of pregnancy, your first action is to go to the hospital immediately, as this is a serious case leading to the death of the baby.

Prevention

Know how to prevent recurrence of this symptom.

Risk reduction is:

• No stressful situations, calm, good environment.
• Daily walks in the fresh air (blood is enriched with oxygen, blood circulation improves).
• Consumption of sufficient clean water.
• Absence of bad habits. Contraindicated intake of alcohol, tobacco.
• Daily gymnastics for pregnant women, which reduces the risk of preeclampsia.
• Do not use drugs without the permission of a doctor.

Take care of your health!

If you feel unwell, do not self-medicate, but seek qualified medical help from a specialist.

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Early pregnancy bleeding: causes, symptoms and treatment

This disease is treated by Gynecologist

Bleeding during pregnancy is always an alarm. It does not matter how long it occurred and how intensely. In no case should this phenomenon be left unattended. Even women who already have experience of pregnancy will not be able to determine the cause of the bleeding themselves.

Moreover: its intensity does not always indicate how serious the situation is: intense bleeding may not be dangerous, and poor discharge may be the result of an extremely difficult situation. A woman who is faced with such a problem should immediately contact a doctor and follow all his appointments, and if necessary, go to the hospital.

Symptoms depending on time and type

The appearance of bleeding in early pregnancy can be due to various reasons: from spontaneous abortion to tubal (ectopic) pregnancy. Depending on what caused it, the discharge is strong, accompanied by pain in the lower abdomen, but it can also be low-intensity, smearing.

In the later stages, the appearance of blood should always be alarming, since the situation poses a threat to both the expectant mother and the baby. The external picture and causes may be the same as in the first trimester, but doctors will have a different goal and treatment tactics. If, with bleeding during the development of pregnancy in the early stages, the task is to preserve it, then closer to childbirth, doctors decide on urgent delivery.

Causes of bleeding during early pregnancy

The most common causes of bleeding in relatively early pregnancy include the following.

Spontaneous abortion (miscarriage). In general, about 80% of all miscarriages occur at the beginning, in the first weeks after conception. Bleeding in this case is intense, accompanied by pain. If fragments of the fetal egg remain in the uterine cavity, this can lead to inflammation. Therefore, after a miscarriage, a woman must undergo an examination. In addition, the doctor will give recommendations, say whether it is possible to avoid termination of pregnancy in the future and whether it is necessary to pause before the next attempt.

Ectopic pregnancy – attachment of the embryo outside the uterine cavity, for example, in the fallopian tube. As the embryo grows, its walls stretch, and this is why the tube eventually bursts. This is accompanied by bleeding, which is usually mild and painful.

Vesical skid is a pathology in which chorionic villi (fetal part of the placenta) are reborn into fluid-containing vesicles. In this case, the discharge usually becomes dark in color, pathology leads to the death of the fetus.

Implantation , that is, the introduction of the embryo into the mucous membrane. The process may be accompanied by a small amount of blood, the woman marks her traces on the linen.

Pathologies of the cervix .

If we single out the most common cause of bleeding during early pregnancy, then this will be chorion detachment. It is caused by endocrine, immunological, genetic disorders, infections, etc.

Bleeding in the 2nd and 3rd trimesters

Most of the bleeding in late pregnancy is associated with placental abruption and its supply.

Placental abruption is a serious condition when, at a gestational age of more than 20 weeks, the placenta moves away from the uterine wall. It can be caused by trauma, chronic infections, circulatory disorders, endocrine diseases (such as diabetes), uterine tumors, and other causes. Blood discharge may be bright scarlet or dark, but is painless.

Placental abruption is dangerous for the baby, as its nutrition and oxygen supply are disrupted.

Placenta previa is an organ arrangement in which the placenta is attached to the lower segment of the uterus. As the uterus grows, the placenta quite often “pulls up”, move up. But it can remain in the lower segment and close the internal os of the uterus. In this case, the woman bleeds, the discharge has a bright scarlet color and can proceed without pain.

Disease diagnosis

Obstetrician-gynecologists who see pregnant women at the GMS Clinic use two main diagnostic methods: chair examination and ultrasound.

During a gynecological examination, the doctor assesses the condition of the cervix (if a miscarriage occurs, it opens), as well as the tone of the uterus. Ultrasound makes it possible to assess the state of the muscular layer of the uterus – the myometrium, to see the embryo, to determine what exactly caused the bleeding, and in the later stages – to observe the position of the placenta.

The advantage of observation at the GMS Clinic is that all obstetrician-gynecologists are proficient in ultrasound diagnostics and, if necessary, can do it during an appointment. A woman does not need to make an additional appointment and wait for an appointment, the doctor will do the examination in the same office. If necessary, the patient can just as quickly pass all tests, blood tests and others, and get the results.

Also, the benefits of monitoring pregnancy in GMS Clinic are:

• availability of a prenatal diagnostic room, where on the day of the examination you can get the results of expert ultrasound and biochemical genetic screening;
• the presence of its own laboratory, thanks to which a woman can do all the necessary tests in one clinic;
• the opportunity to constantly receive advice and assistance: if necessary, the expectant mother can go to a day or round-the-clock hospital, her doctor is in touch with her during the day, and at night you can contact the specialist on duty;
• observation in a single highly professional women’s center, where a woman can apply at the stage of pregnancy planning or simply undergo regular examinations.

Thanks to such an integrated approach, the expectant mother can be sure that doctors will not miss any nuances of pregnancy and provide the necessary consultations at any time.

Treatment

If the diagnosis showed that the pregnancy was not interrupted, then the doctor’s first recommendation is bed rest. At GMS Clinic, a woman who comes in with bleeding and other problems at an early stage is offered hospitalization in her own hospital. This is the preferred option for patients who have small children at home. If the home environment allows for peace, then hospitalization is not necessary.

Medical treatment is carried out in two directions:

• antispasmodic therapy – doctors prescribe drugs that relieve tension in the uterus;
• preparations of progesterone, which is called the “essential hormone of pregnancy.” It is produced by the ovaries, adrenal glands, and also the placenta. It reduces muscle tone, and its deficiency is one of the causes of bleeding and miscarriage.

The remaining possible treatment options are selected by the GMS Clinic doctor when it is determined what led to the bleeding. If it is an infection, diseases of the blood coagulation system and other pathologies, then the treatment is aimed at eliminating them.

What to do if you bleed during pregnancy

Women who observe pregnancy should consult a doctor at the first alarming symptoms of bleeding. Even if your doctor is not receiving an appointment at this moment, the clinic always has gynecologists on duty who will provide the necessary assistance around the clock. Our clinic employs leading specialists in miscarriage who diagnose and prescribe treatment even in the most difficult cases. If hospitalization is needed, then GMS Clinic has a day and night hospital, where the woman will be under constant control.

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