Definition

Vaginal bleeding during the first trimester of pregnancy is common. It is often nothing to worry about. Bleeding during the second or third trimester can mean there is a significant complication.

If you have vaginal bleeding at any point during pregnancy, call your doctor.

Vagina

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Causes

Vaginal bleeding in pregnancy has many causes. The effect on the pregnancy depends on which phase the bleeding occurs in. Some common causes include:

• First half of pregnancy:
  • Cervical infection
  • Ectopic pregnancy —a fertilized egg implants outside the uterus and begins to grow
  • Implantation bleeding—light spotting that occurs 6-12 days after conception (as the fertilized egg implants in the uterine wall)
  • Threatened miscarriage (threatened abortion)
  • Miscarriage
  • Molar pregnancy, also called gestational trophoblastic disease (GTD)—the growth of abnormal tissue, instead of an embryo, inside the uterus
  • Trauma from intercourse
  • Urinary tract infection
• Second half of pregnancy:
  • Growths on the cervix
  • Inflamed cervix
  • Placental abruption —premature separation of the placenta from the wall of the uterus
  • Placenta previa —the placenta partially or completely covers the opening of the uterus
  • Preterm labor—labor that begins before the 37th week of pregnancy

Risk Factors

Risk factors that increase your chance of having bleeding during pregnancy include:

• Risk factors for ectopic pregnancy:
  • Smoking
  • Endometriosis —uterine tissue growth outside the uterus
  • Pelvic inflammatory disease (including infection in the fallopian tubes)
  • Pregnancy after failed tubal sterilization
  • Previous ectopic pregnancy
  • Previous pelvic surgery
  • Scarred fallopian tubes
  • Use of fertility drugs
• Risk factors for molar pregnancy:
  • Under age 20 or over age 40
  • Previous molar pregnancy
  • Previous use of birth control pills
  • Type A or AB blood
• Risk factors for placental abruption:
  • Over age 35
  • Abnormalities of the uterus or umbilical cord
  • Smoking
  • Cocaine use
  • Early membrane rupture—water breaks before it should
  • High blood pressure
  • Multiple pregnancy —twins or higher
  • Previous childbirths
  • Previous placental abruption
  • Sickle cell anemia
  • Too little amniotic fluid
  • Trauma or injury to the stomach
• Risk factors for placenta previa:
  • Over age 35
  • Smoking
  • Multiple pregnancy—twins or higher
  • Previous childbirths
  • Previous uterine surgery (especially prior cesarean section)
• Risk factors for preterm labor:
  • Under age 17 or over age 35
  • African-American ancestry
  • Certain infections
  • Smoking
  • Little or no prenatal care
  • Multiple pregnancy—twins or higher
  • Previous preterm birth
  • Stress
  • Trauma or injury to the stomach
  • Use of drugs or alcohol
  • Uterine or cervical abnormalities
  • Working long hours with extended periods of standing

Symptoms

The amount of bleeding will be different for each cause. Wear a pad so you can tell how much you are bleeding. The blood may also appear different for different causes. Make note of how heavy the bleeding is and how the blood appears so you can tell your doctor.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A pelvic exam may also be done.

Your doctor may need to assess blood loss or determine blood type. This can be done through blood tests.

Your doctor may need pictures of your vagina and/or abdomen. This can be done with:

• Ultrasound
• Laparoscopy

Treatment

Treatment depends on the cause of the bleeding and the severity of the condition. Treatments include:

• For vaginal or cervical infections: antibiotics that will not harm the baby
• For ectopic pregnancy:
  • Medication to dissolve the pregnancy
  • Surgery to remove the abnormally placed embryo
• For molar pregnancy:
  • Surgery to remove molar tissue
  • Hysterectomy (in more serious cases)
  • Administration of methotrexate
• For placental abruption:
  • Bed rest
  • Hospitalization
  • Corticosteroids to speed the baby’s lung development and reduce the risk of certain complications of premature birth
  • Prompt delivery by cesarean section or induced labor (if abruption occurs close to the baby’s due date)
• For placenta previa:
  • Bed rest
  • Hospitalization
  • Cesarean delivery
• For preterm labor:
  • Corticosteroids to speed the baby’s lung development and reduce the risk of certain complications of premature birth
  • Tocolytics to help postpone labor
  • Antibiotics as a preventive measure if you have not been tested for GBS

Prevention

To help reduce your chance of experiencing vaginal bleeding during pregnancy, take the following steps:

• Eat a healthy diet. Your diet should be low in saturated fat and rich in whole grains, fruits, and vegetables.
• Have regular prenatal check-ups
• If you smoke, quit.
• Avoid drugs and alcohol.