Vaginal Bleeding during Pregnancy

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KEY POINTS

• Vaginal spotting or bleeding during pregnancy may be normal or may be a sign of miscarriage.
• Always let your healthcare provider know if you have spotting or bleeding during pregnancy.
• Ask your provider what symptoms or problems you should watch for and what to do if you have them.

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What is vaginal bleeding during pregnancy?

A tiny amount of blood in your underwear or on a pad is called spotting. Bleeding is a larger amount of blood. Vaginal spotting or bleeding during early pregnancy may be normal or may be a sign of miscarriage or tubal (ectopic) pregnancy. An ectopic pregnancy happens when a baby starts growing outside the uterus. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

You can have signs of miscarriage without actually losing the baby. This is called a threatened miscarriage. If you have signs of a miscarriage, but you have not yet lost the baby, there is a chance that your pregnancy will continue normally.

If you have bleeding during the second half of pregnancy, it could be a sign of early labor or problems with the placenta. The placenta is tissue inside the uterus attached to the baby by the umbilical cord to carry oxygen and food from your blood to the baby’s blood.

What is the cause?

Some bleeding and spotting during pregnancy may be normal. Possible causes are:

• Having sex
• When the fertilized egg implants into the lining of the uterus at the start of a pregnancy
• Changes in your hormone levels
• Pelvic exam by your healthcare provider

More serious causes of bleeding are:

• Infection
• Ectopic pregnancy where the embryo attached some place outside of the uterus
• Threatened miscarriage
• Problems with the cervix
• Early labor before 37 weeks (preterm labor)
• Placenta previa, which means that the placenta grows over the opening of your cervix
• Placental abruption, which means that the placenta pulls away from the wall of your uterus too early
• A tear in your uterus

Other possible causes include infections or problems in the uterus, uncontrolled diabetes, or a problem with your hormones. A problem with the cervix sometimes causes a miscarriage. The cervix is the opening of the uterus into the birth canal. During labor the opening of the cervix gets bigger so that the baby can pass into the birth canal. If the cervix starts opening too early in the pregnancy, there is a risk of miscarriage. Often, if the problem is found early, it can be treated and the pregnancy can continue.

Miscarriage may be your body's way of ending a pregnancy that is not developing normally, especially early in the pregnancy. It may happen because there is something wrong with the baby such as a genetic problem.

What are the symptoms?

Symptoms may include:

• Spotting or bleeding from the vagina that can be a few drops of dark brown or bright red blood to a heavy flow of blood. The bleeding may start with no warning, or you may first have a brownish discharge.
• Cramps or pain in your lower belly
• Dizziness

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have tests such as:

• A pelvic exam to check your uterus, cervix, and vagina
• An ultrasound, which uses sound waves to show pictures of your uterus and organs around it. It can show if the baby is still in your uterus or if the baby started growing outside the uterus. It may show that the pregnancy never developed into a baby.
• Blood tests

How is it treated?

If you have a threatened miscarriage, your provider may suggest that you:

• Rest in bed for 1 to 2 days
• Stop exercise
• Stay off your feet as much as possible
• Not have sex until your provider says it’s safe

Depending on your blood type, your healthcare provider may want to give you a shot that protects against a problem called Rh incompatibility. This is a problem that might affect future pregnancies. It can happen if your Rh blood type is different from the blood type of the baby.

How can I take care of myself?

Always let your healthcare provider know if you have spotting or bleeding during pregnancy. Tell your healthcare provider the color, how much, and how often you are spotting or bleeding.

Follow the full course of treatment prescribed by your healthcare provider. Ask your provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.