Vaginal Bleeding in Pregnancy

Overview, Causes, & Risk Factors

Vaginal bleeding in pregnancy means bleeding that happens at any time during pregnancy before the delivery of the baby.

What is going on in the body?

There are many causes of vaginal bleeding in pregnancy. It occurs in as many as 20% of pregnant women during the first trimester, or first three months of pregnancy. Bleeding can also take place later in pregnancy. A healthcare provider should check into any vaginal bleeding during pregnancy. Some causes of bleeding are not of concern. However, others may be life-threatening to the mother and baby.

Bleeding may be related to conditions other than the pregnancy itself. For example, vaginal tears or certain infections may lead to vaginal bleeding.

What are the causes and risks of the condition?

Following are some causes of vaginal bleeding during pregnancy:

ectopic pregnancy, which occurs when the fertilized egg implants outside the uterus

inflammation of the cervix

injury to the cervix, which may occur after intercourse

miscarriage, or loss of the baby in the first half of pregnancy

a molar pregnancy, in which the fetal tissue becomes a tumor

normal implantation of the fertilized egg into the wall of the uterus

a tumor or cancer

Common causes of bleeding in late pregnancy are as follows:

normal labor, which may be preceded by blood and mucus from the vagina

placenta abruptio, a condition in which the placenta detaches from the wall of the uterus before or during labor

placenta previa, a condition in which the placenta is abnormally located over the cervix, blocking the birth canal

premature labor

Symptoms & Signs

What are the signs and symptoms of the condition?

Any symptoms that go along with vaginal bleeding during pregnancy should be reported to the healthcare provider. These include:

abdominal cramping or pain

abnormal vaginal discharge

dizziness, lightheadedness, or fainting

fever or chills

passage of tissue or clots from the vagina

shoulder pain

skin color that is lighter than normal

vaginal bleeding, which may range from spotting to bleeding that is heavier than a menstrual period

weakness

Diagnosis & Tests

How is the condition diagnosed?

Diagnosis of vaginal bleeding during pregnancy begins with a medical history and physical exam. The healthcare provider may perform a pelvic examination. This will determine how much bleeding there has been, whether the cervix has opened, and whether fetal tissue is present in the vagina.

The healthcare provider may order these tests:

blood tests to determine the amount of blood loss

pregnancy ultrasound

progesterone level blood test

repeated testing of beta HCG levels, or pregnancy hormone levels

Prevention & Expectations

What can be done to prevent the condition?

Early prenatal care will allow the healthcare provider to screen for pregnancy risk factors. Eating a balanced diet rich in folate may prevent miscarriages caused by genetic problems. Avoiding cigarettes, cocaine, and trauma may decrease the risk of the placenta detaching. Practicing safer sex methods can help prevent sexually transmitted diseases. These are a common cause of ectopic pregnancy.

What are the long-term effects of the condition?

The long-term effects of vaginal bleeding in pregnancy depend on the cause and severity. Potential effects are as follows:

abdominal cramping or pain

death of the mother and child

the need for blood transfusions

the need for surgery

premature delivery and the consequences of early delivery

problems related to any cancer, such as the need for chemotherapy

psychological and emotional problems related to miscarriage

Rh sensitization if RhoGAM is not given to a woman who is Rh-, which can lead to health problems for the fetus in future pregnancies

shock

What are the risks to others?

Vaginal bleeding is not contagious. It poses no risk to anyone except the mother and child.

Treatment & Monitoring

What are the treatments for the condition?

Not all vaginal bleeding in pregnancy needs treatment. If bleeding occurs but a miscarriage or early delivery does not take place, observation is all that is needed. Treatment for other causes is as follows:

blood transfusions in the event of severe blood loss

C-section delivery of the baby

D&C to remove retained tissue in the uterus after a miscarriage or molar pregnancy

medicines, such as ritodrine, to stop premature labor

methotrexate to treat very small ectopic pregnancies

surgery to remove tissue growing in abnormal locations.

What are the side effects of the treatments?

Surgery may cause bleeding, infection, and allergic reaction to anesthesia. Blood transfusions carry the risk of infection and allergic reactions. All medicines have side effects, such as allergic reactions and stomach upset.

What happens after treatment for the condition?

The aftereffects of vaginal bleeding depend on the underlying cause. Women with bleeding often have pregnancies that continue without further problems. In the event of a miscarriage, a woman may be advised by her healthcare provider to wait 3 to 4 months before attempting another pregnancy.

If premature labor is halted, medicines to relax the uterus may be needed to extend the pregnancy beyond the 36th week. If significant blood loss has occurred, iron and vitamin pills may be recommended to help regain health. Counseling or other supportive therapy might be helpful to relieve distress related to conditions such as miscarriage.

How is the condition monitored?

Monitoring depends on the cause of bleeding. In some cases, it may consist of a wait-and-see approach. Repeat pregnancy ultrasounds or blood tests may be used.

Women with molar pregnancies need careful monitoring, as molar pregnancies can recur. When a molar pregnancy comes back, small cells from the placenta can spread to other organs like cancer. Chemotherapy may be needed for a person with recurrent molar pregnancy.

Any additional episodes of vaginal bleeding should be promptly evaluated by the healthcare provider. New or worsening symptoms should be reported to the healthcare provider.