You should tell your doctor if you have bleeding at any point in your pregnancy—early or late. Your health and that of your baby may depend on getting prompt treatment.

Bleeding in Early Pregnancy

Many women have vaginal spotting or bleeding in the first 12 weeks of pregnancy. Bleeding of the cervix may occur during sex. An infection of the cervix can also cause bleeding.

If you are bleeding in early pregnancy, your doctor may do a pelvic exam. You will be asked how much blood you have passed and how often bleeding has occurred. Your doctor also will ask whether you have had any pain, and if so, its location and severity.

A blood test may be done to measure human chorionic gonadotropin (hCG). This substance is made by your body during pregnancy. You may have more than one test because hCG levels increase throughout pregnancy. Your blood type also will be checked to see if you need treatment for Rh sensitization. Ultrasound may be used to find the cause of the bleeding. Sometimes the cause is not found.

If you have bleeding while you are pregnant, you may need special care. You have a higher chance of going into labor too early (preterm labor), having an infant who is born too small, or having a miscarriage.

Miscarriage

Miscarriage can be caused by a problem with the pregnancy. Bleeding does not always mean that miscarriage will happen. About one half of pregnant women who bleed do not miscarry.

Miscarriage can occur any time in the first half of pregnancy. Most often it occurs in the first 13 weeks. It happens in about 15–20% of pregnancies.

The following signs and symptoms may indicate a miscarriage:

• Vaginal bleeding
• Cramping pain felt low in the abdomen (often more strong than menstrual cramps)
• Tissue passing from the vagina

If you think you have passed fetal tissue, take it to the doctor’s office. The doctor may send it to a lab to be examined.

If some tissue stays in the uterus, bleeding often continues. Your doctor may then recommend one or more treatment options. Medication may be used to help you pass the tissue. The tissue may be removed by dilation and curettage (D&C). It also may be removed by a suctioning device. This is called suction curettage. Sometimes more than one option is needed.

Most miscarriages cannot be prevented. They are often the body’s way of dealing with a pregnancy that was not normal. There is no proof that exercise or sex causes them. Also, there is no proof that stress or work causes them. Having a miscarriage does not mean you cannot have more children. It does not always mean something is wrong with your health. If you have two in a row, your doctor may suggest tests to look for a cause.

Ectopic Pregnancy

An ectopic pregnancy occurs when the fertilized egg does not implant in the uterus. Instead, it implants somewhere else, often in one of the fallopian tubes. An ectopic pregnancy causes pain and bleeding early in pregnancy.

A major risk with this type of pregnancy occurs if the fallopian tube ruptures. A rupture needs prompt treatment. There may be internal bleeding. Blood loss may cause weakness, fainting, pain, shock, or death.

Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women are at a higher risk if they have had

• an infection in the fallopian tubes (such as pelvic inflammatory disease)
• a previous ectopic pregnancy
• tubal surgery

Bleeding in Late Pregnancy

The causes of bleeding in the second half of pregnancy differ from those in the first half. Common problems that cause light bleeding include an inflamed cervix or growths on the cervix. These may be treated with medication.

Heavy bleeding usually involves a problem with the placenta. The two most common causes at this time are placental abruption and placenta previa. Preterm labor also can cause such bleeding.

Late bleeding may pose a threat to the health of the woman or the fetus. It may require treatment in a hospital or delivery.

Placental Abruption

The placenta is attached to the uterine wall. It may detach from the wall before or during labor. This may cause vaginal bleeding. It often causes pain, even if bleeding is light or not seen.

When the placenta becomes detached, the fetus may get less oxygen. This can pose a danger.

Only 1% of pregnant women have this problem. It usually occurs in the last 12 weeks before birth. Those at high risk include women who

have already had children are older than 35 years have had abruption before have sickle cell anemia

Placental abruption has been linked to

• high blood pressure
• injuries to the abdomen
• cocaine use
• smoking

Placenta Previa

When the placenta lies low in the uterus, it may cover the cervix. That means it partly or completely blocks the opening. This is called placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs without pain.

Placenta previa occurs in 1 in 200 women. It is more common in those who

• have had more than one child
• have had a cesarean birth
• have had surgery on the uterus
• are carrying twins or triplets

Like placental abruption, placenta previa is a serious condition that needs to be treated quickly.

Labor

Late in pregnancy, vaginal bleeding may be a sign of labor. A mucus plug that covers the opening of the uterus is passed just before or at the start of labor. A small amount of mucus and blood is passed from the cervix. This is called “bloody show.” It is common. It is not a problem if it happens within 3 weeks of your due date. If it happens earlier, you may be going into preterm labor. You should contact your doctor right away.

Other signs of preterm labor are

• vaginal discharge
• change in type of discharge (watery, mucus, or bloody)
• increase in amount of discharge
• pressure in the pelvis or lower abdomen
• low, dull backache
• stomach cramps, with or without diarrhea
• regular contractions or uterine tightening

Taking Action

Call your doctor immediately if you have bleeding in late pregnancy. You may need to be admitted to the hospital to find its cause. Ultrasound may be advised. You may have to stay in the hospital for a few weeks. A blood transfusion may be needed.

Conditions that cause bleeding in late pregnancy pose a risk to both mother and fetus. If the risk is serious it may require early delivery, sometimes by cesarean birth.

Finally...

For many women, bleeding while they are pregnant is a minor annoyance. It may need no treatment. For other women, bleeding can be a sign of a serious problem. You should tell your doctor right away if you have bleeding at any point—early or late. Your health and that of your baby may depend on getting prompt treatment.

Glossary

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Cesarean Birth: Delivery of a baby through an incision made in the mother’s abdomen and uterus.

Dilation and Curettage (D&C): A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in one of the fallopian tubes.

Fallopian Tubes: Tubes through which an egg travels from the ovaries to the uterus.

Human Chorionic Gonadotropin (hCG): A hormone produced during pregnancy; its detection is the basis for most pregnancy tests.

Miscarriage: Early pregnancy loss.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Rh Sensitization: A condition in which an Rh-negative mother makes antibodies that attack the Rh factor, a protein on red blood cells.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women’s health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © November 2008 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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