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.


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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

Placenta Previa

Placenta Previa
© 2009 Nucleus Medical Media, Inc.

Risk Factors

These factors increase your chance of developing bleeding during pregnancy. Tell your doctor if you have any of these risk factors:

  • 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:
  • 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


Your doctor will ask about your symptoms and medical history. She will also do a physical exam. The exam may include a pelvic exam.

Tests may include the following:

  • Blood tests—to determine how much blood has been lost or to determine how well blood is able to coagulate
  • Ultrasound —a test that uses sound waves to examine the vagina and/or abdomen
  • Laparoscopy —a thin, lighted tube inserted through a small incision in the abdomen to look at the abdominal organs


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:
    • Administration of methotrexate (a drug that dissolves the pregnancy)
    • Surgery to remove the abnormally placed embryo
  • For molar pregnancy:
    • Surgery to remove molar tissue
    • Hysterectomy in more serious cases
  • For placental abruption:
    • Bed rest
    • Hospitalization
    • Administration of corticosteroids—drugs that 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:
    • Administration of corticosteroids—drugs that speed the baby’s lung development and reduce the risk of certain complications of premature birth
    • Administration of tocolytics—medications that help postpone labor


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.