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

Placenta Previa

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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:
  • 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

Diagnosis

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

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

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.