Bleeding at the end of pregnancy

Vaginal bleeding in late pregnancy: MedlinePlus Medical Encyclopedia

One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away.

You should understand the difference between spotting and bleeding:

Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.
Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus.

Mid- or late-term bleeding may also be caused by:

Having sex (most often just spotting)
An internal exam by your provider (most often just spotting)
Diseases or infections of the vagina or cervix
Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

To find the cause of your vaginal bleeding, your provider may need to know:

If you have cramping, pain, or contractions
If you have had any other bleeding during this pregnancy
When the bleeding began and whether it comes and goes or is constant
How much bleeding is present, and whether it is spotting or a heavier flow
The color of the blood (dark or bright red)
If there is an odor to the blood
If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
If you have had recent injuries or falls
When you last had sex and if you bled afterward

A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:

Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
If spotting or bleeding continues, call your provider.
If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.

For any other bleeding, call your provider right away.

You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
Your provider will also tell you whether you can drive yourself or you should call an ambulance.

Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2021. Philadelphia, PA: Elsevier 2021:1227-1229.

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 46.

Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.

Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Vaginal bleeding in late pregnancy Information | Mount Sinai

What Causes Bleeding Later in Pregnancy?

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus.

Mid- or late-term bleeding may also be caused by:

Having sex (most often just spotting)
An internal exam by your provider (most often just spotting)
Diseases or infections of the vagina or cervix
Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

What to Tell Your Health Care Provider

To find the cause of your vaginal bleeding, your provider may need to know:

If you have cramping, pain, or contractions
If you have had any other bleeding during this pregnancy
When the bleeding began and whether it comes and goes or is constant
How much bleeding is present, and whether it is spotting or a heavier flow
The color of the blood (dark or bright red)
If there is an odor to the blood
If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
If you have had recent injuries or falls
When you last had sex and if you bled afterward

What Should Happen Next?

A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:

Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
If spotting or bleeding continues, call your provider.
If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.

For any other bleeding, call your provider right away.

You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
Your provider will also tell you whether you can drive yourself or you should call an ambulance.

Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2021. Philadelphia, PA: Elsevier 2021:1227-1229.

Last reviewed on: 10/5/2020

Reviewed by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Bloody discharge during pregnancy ᐈ Blood during early pregnancy

Seeing bloody discharge, a pregnant woman is always frightened. They are considered a symptom of miscarriage and other equally serious pathologies. At the same time, in some cases, the appearance of a small amount of blood is considered the norm and does not pose a threat to the life and health of the fetus or the expectant mother.

In early pregnancy, bloody discharge occurs in 25% of women. In most cases, they are associated with the implantation of the fetal egg to the wall of the uterus. Also, scanty spotting may appear on the dates of the expected menstruation. If they end quickly, are not accompanied by pain, and the woman has not had miscarriages or pregnancy complications before, most likely she has nothing to worry about. However, it is necessary to consult an obstetrician-gynecologist and undergo an examination.

Why bloody discharge can appear and when it is dangerous, said Elena Petrovna Domnich, obstetrician-gynecologist of the highest category, gynecologist-endocrinologist, ultrasound specialist of the ADONIS medical center.

Elena Nikolaevna, tell me, can a woman have periods during pregnancy?

- Sometimes during pregnancy, a woman may experience spotting, but this should not be interpreted as menstruation. Menstruation occurs at the end of the menstrual cycle, during which the endometrium changes, first proliferative, then secretory. During the cycle, the endometrium prepares for pregnancy, and if it does not occur, then menstruation begins.

In the event of pregnancy, menstruation is not possible, although bleeding may occur at the expected time. Because of this, some women do not immediately know that they are pregnant. However, when the obstetrician-gynecologist at the reception asks them about the nature of the discharge, it always turns out that they are different from menstrual. As a rule, they are more scarce, pass faster and are not accompanied by other symptoms. Sometimes a woman says that her period was very recent, but at the time of examination and examination, we find that she is already 8 or 12 weeks pregnant.

How often does this happen? Is spotting during pregnancy an exception or a fairly common occurrence?

- Bloody discharge is not common in pregnant women, but still it cannot be said that these are exceptional cases.

Tell me, if a woman is planning to conceive a child, and during the expected period she has atypical discharge, should she take a pregnancy test?

– Yes, but it is better to visit an obstetrician-gynecologist. There are cases when a woman is pregnant, but the test strip shows a negative result. To accurately determine whether there is a pregnancy, allows a blood test for the level of hCG.

So bleeding during pregnancy is not menstruation, but bleeding? Why can it appear and why is it dangerous?

- Yes, that's right. This is bleeding, not menstruation. It can be a symptom of a miscarriage, ectopic pregnancy, or other pathology. For diagnosis, you must consult a doctor.

Tell me more, if a woman has a discharge and thinks she is menstruating, but a previous pregnancy test came back positive, could it be wrong?

- A pregnancy test is sometimes positive even if it is not. This happens if a woman has formed luteal cysts or developed a thyroid disease.

Bloody discharge during pregnancy requires contacting the antenatal clinic or the medical center where the woman was registered for pregnancy management. Sometimes they may not be dangerous, but without diagnosis, it cannot be ruled out that this is a symptom of a serious disorder.

Bleeding may occur with:

threatened miscarriage;
ectopic pregnancy;
infectious diseases of the reproductive system;
cysts;
myomas;
cervical erosion;
placental abruption;
threatened preterm birth.

You can watch the video version of Elena Petrovna Domnich's interview here. More helpful videos on our YouTube channel.

What is it? Normal and abnormal discharge during pregnancy

Today we will talk with Elena Yurievna Romanova, an obstetrician-gynecologist at the Expert Center for Pregnancy Management at the Mother and Child Clinic, about what discharges during pregnancy should be feared and what discharges from the genital tract are regarded as normal.

Increased vaginal discharge during pregnancy is natural

Normal pregnancy discharge is milky white or clear mucus without a strong odor (although the smell may change from before pregnancy), this discharge does not irritate the skin and does not cause discomfort to the pregnant woman. The discharge can have a different color - from completely colorless (most often) to whitish and yellowish. The consistency of discharge at the beginning of pregnancy resembles raw chicken yolk - they are thick, jelly-like, often released in the form of clots.

With normal discharge, it is enough to use panty liners or change underwear twice a day.

Due to the activity of progesterone in the first 12 weeks of pregnancy, the discharge will be scarce and viscous.

Due to the increase in estrogen activity from 13 weeks, the discharge becomes less viscous and more abundant.

By the end of the pregnancy, vaginal discharge becomes more and more abundant. Each time you need to evaluate the nature of the discharge, change the gasket. If the fluid continues to ooze, this may mean leakage of amniotic fluid and the need to contact an obstetrician-gynecologist in the emergency department of a hospital with a maternity ward. There are auxiliary tests, thanks to which, as well as obstetric ultrasound, leakage of water can be excluded.

Not all discharge in pregnant women is the norm.

For example, a white, thick, crumbly, odorless discharge that itchs and burns the skin and causes discomfort during intercourse is likely a sign of a yeast infection (candidiasis).

White or grayish discharge, the smell of which after sex begins to resemble the smell of fish, is the main symptom of bacterial vaginosis, vaginal dysbacteriosis.

A yellowish or greenish discharge that has a strong unpleasant odor usually occurs with nonspecific vaginitis, and a foamy discharge is a sign of trichomoniasis, a sexually transmitted disease.

In all these cases, contact your doctor immediately. It should not be treated with over-the-counter drugs and folk remedies. According to some external signs, a diagnosis cannot even be made by a doctor, in addition, infections in pregnant women should be treated especially carefully and only by a professional. After proper treatment, the discharge returns to normal. There is no need to get rid of the usual discharge for pregnant women. After childbirth, they will stop naturally, and before that they are a sign of the normal course of pregnancy.

Allocations can change their nature and amount under the influence of irritants or intolerance to a particular substance, for example, when using panty liners. Such secretions are transparent and abundant, they stop when the irritant is removed.

"Thrush" is a disease caused by fungi of the genus Candida, present in small quantities in all women. During pregnancy, immunity decreases and fungi begin to actively multiply, causing inflammation, abundant white flocculent discharge with a sour smell, burning and itching in the vulva. The disease can manifest itself throughout pregnancy.

Bloody discharge in the first half of pregnancy usually indicates a lack of the hormone progesterone, which can lead to spontaneous miscarriage. Discharge may be accompanied by pain in the lower abdomen and lower back. In the treatment of the threat of abortion, the appointment of progesterone drugs, such phenomena disappear.

If bleeding from the vagina appeared during pregnancy during the second or third trimester, then this is a sign of a formidable complication, namely, placenta previa or its premature detachment. With improper attachment of the placenta in the uterine cavity and overlapping of the placental tissue with the area of the internal pharynx, they speak of placenta previa. In this case, spotting occurs in a third of pregnant women. This most often occurs between 28 and 30 weeks, when the lower segment of the uterus is most prone to stretching and thinning. The discharge is repeated, the woman does not experience any pain, so it may be too late to see a doctor for an examination. This threatens the child with a lack of nutrients and oxygen, because it is through the placenta that the fetus is nourished. For a pregnant woman, this is fraught with acute placental abruption and severe bleeding, which is always problematic to stop, especially at home.

Bloody discharge during pregnancy should force a woman to immediately contact her obstetrician-gynecologist.

Brown discharge during pregnancy also indicates the threat of termination of pregnancy, or bleeding "erosion" (decidual polyp) of the cervix. Therefore, you should not understand these issues on your own; when brown discharge appears, it is better to consult your doctor.

Brown discharge during a delay in menstruation as a sign of an ectopic pregnancy is very dangerous. This condition requires immediate surgical care, as the growing embryo can rupture the wall of the fallopian tube at any time and cause internal bleeding. Therefore, with pain in the lower abdomen, which is accompanied by brown discharge from the genital tract and delayed menstruation, you should immediately call an ambulance.

When the vagina becomes inflamed, the mucous discharge acquires a mucopurulent character, a greenish-yellow color, an unpleasant odor, burning and itching appear in the genital area. This is how chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis manifest themselves. Is it necessary to treat the infection during pregnancy, or is it better to do it after childbirth?

All sexually transmitted infections in pregnant women require treatment, as they can pass to the fetus and cause intrauterine infection (IUI). IUI is very dangerous for a child - it leads to his death or serious illness. Infection of a child during childbirth can lead to such serious complications as pneumonia, severe damage to the brain, kidneys, liver, and blood poisoning (sepsis).

Today, obstetricians and gynecologists have learned to treat any infection in pregnant women in accordance with special guidelines for the timing of pregnancy, so that it is effective and safe for mother and fetus. It is not the treatment that should be feared, but the infection itself and its consequences.

Medicines that are used to treat pregnant women have passed the necessary clinical trials, during which it was proved that they do not have a negative effect on the pregnant woman and the fetus, including that they do not have a teratogenic effect (do not cause deformities in the fetus).

Sometimes the discharge is mucous in nature, occurs upon contact with an irritant or allergen. It can be synthetic tight underwear, allergies to fabrics, toiletries, personal care products. If irritation and allergens are not eliminated in time, then an infection that lives on the mucous membranes of the genital organs will definitely join.

Hygiene measures are mandatory for pregnant women.