Bleeding During Pregnancy

Bleeding in pregnancy is common and usually indicates a minor/temporary event; however, this is not always the case, and it should be evaluated.

Early Pregnancy

Bleeding in the first trimester is very common.  Sometimes, this is from the implantation of the baby into the lining of the uterus when pregnancy begins. Bleeding can also occur after sex because of a friable cervix. Other times, it is from a hematoma (collection of blood) behind the developing placenta.  Bleeding can also be due to an early miscarriage of the pregnancy.  Calling your provider about bleeding is important, so an exam and possible ultrasound can help determine the diagnosis.   

Miscarriage:  Approximately half of women who experience bleeding during pregnancy do not have a miscarriage, but the best way to make the diagnosis is using an ultrasound and sometimes blood testing.

Signs of a miscarriage include:

• Vaginal bleeding
• Cramping pain felt low in the stomach (stronger than menstrual cramps)
• Tissue passing through the vagina

Many women have bleeding with no cramping that stops, and the pregnancy goes on. Others have bleeding and cramping that may become stronger. Then, miscarriage occurs.

If you think you have passed fetal tissue,  please notify your doctor, as bleeding can continue if some tissue remains in the uterus. If this is the case,  your doctor may need to remove the remaining tissue through a procedure called dilation and curettage (D&C).

Ectopic Pregnancy: this is a pregnancy that is located in the “wrong” place, meaning outside of the uterus-most commonly in the fallopian tube.  A patient with an ectopic pregnancy usually has pain and bleeding.  Sometimes, there is a history of an ectopic pregnancy, infection, or prior tubal surgery.  This is potentially a life-threatening situation if not addressed – prompt diagnosis and treatment with close follow-up is the standard of care.

Molar Pregnancy is a very uncommon cause of bleeding early in pregnancy. This is a growth of abnormal tissue instead of an embryo. Treatment for a molar pregnancy is with a D & C.

Late Pregnancy

Bleeding in late pregnancy can be from the cervix, labor, or a placenta problem. Evaluation is needed as this can be serious. The two most common causes of HEAVY bleeding include placental abruption and placenta previa.

Placental Abruption is where the placenta detaches from the uterus.  This compromises blood flow to the baby and can be very serious. Only one percent of women have this problem during the last 12 weeks of pregnancy.

Those at high risk are women who:

• Have already had children
• Are over 35
• Have had abruption before
• Have sickle cell anemia

Placental abruption has been linked to:

• High blood pressure
• Trauma
• Cocaine use
• Smoking

Placenta Previa is when the placenta lies low in the uterus near to or over the cervix. Placenta previa is serious and requires immediate care. The diagnosis is made by ultrasound.

Labor may cause bleeding late in pregnancy. As the cervix dilates, a small amount of blood can pass. This is common and is not an issue if it occurs at term (37 weeks or after).  If it happens earlier than 37 weeks,  it can be a sign of preterm labor.

• Other signs of preterm labor include:
• Vaginal discharges
• Pelvic or lower abdominal pressure
• Low, dull backache
• Stomach cramps with or without diarrhea
• Regular contractions or uterine tightening

Call your healthcare provider if you have bleeding late in pregnancy so that proper evaluation and treatment can be given.

Many women have bleeding during pregnancy with minor conditions that need no treatment. Other times, it can be a sign of a severe problem. Bleeding at any point during pregnancy should be discussed with your healthcare provider.