Pregnant and heavy bleeding

Vaginal Bleeding and Blood Clots During Pregnancy

Written by Stephanie Watson

In this Article

• Bleeding in the First Trimester
• Bleeding in the Second and Third Trimesters
• What to Do If You Have Abnormal Bleeding During Pregnancy

Bleeding during pregnancy is common, especially during the first trimester, and usually it's no cause for alarm. But because bleeding can sometimes be a sign of something serious, it's important to know the possible causes, and get checked out by your doctor to make sure you and your baby are healthy.

Bleeding in the First Trimester

About 20% of women have some bleeding during the first 12 weeks of pregnancy. Possible causes of first trimester bleeding include:

Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you conceive as the fertilized egg implants itself in the lining of the uterus. Some women don't realize they are pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts from a few hours to a few days.

Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns with first trimester bleeding. However, first trimester bleeding does not necessarily mean that you’ve miscarried or will miscarry. In fact, if a heartbeat is seen on ultrasound, over 90% of women who experience first trimester vaginal bleeding will not miscarry.

Other symptoms of miscarriage are strong cramps in the lower abdomen and tissue passing through the vagina.

Ectopic pregnancy. In an ectopic pregnancy, the fertilized embryo implants outside of the uterus, usually in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life-threatening to the mother. Although ectopic pregnancy is potentially dangerous, it only occurs in about 2% of pregnancies.

Other symptoms of ectopic pregnancy are strong cramps or pain in the lower abdomen, and lightheadedness.

Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can spread to other parts of the body.

Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the uterus.

Additional causes of bleeding in early pregnancy include:

• Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test, which cause contact with the cervix, can trigger bleeding. This type of bleeding isn't cause for concern.
• Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Bleeding in the Second and Third Trimesters

Abnormal bleeding in late pregnancy may be more serious because it can signal a problem with the mother or baby. Call your doctor as soon as possible if you experience any bleeding in your second or third trimester.

Possible causes of bleeding in late pregnancy include:

Placenta previa. This condition occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. Placenta previa is very rare in the late third trimester, occurring in only one in 200 pregnancies. A bleeding placenta previa, which can be painless, is an emergency requiring immediate medical attention.

Placental abruption. In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labor and blood pools between the placenta and uterus. Placental abruption can be very dangerous to both the mother and baby.

Other signs and symptoms of placental abruption are abdominal pain, clots from the vagina, tender uterus, and back pain.

Uterine rupture. In rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section.

Other symptoms of uterine rupture are pain and tenderness in the abdomen.

Vasa previa. In this very rare condition, the developing baby's blood vessels in the umbilical cord or placenta cross the opening to the birth canal. Vasa previa can be very dangerous to the baby because the blood vessels can tear open, causing the baby to bleed severely and lose oxygen.

Other signs of vasa previa include abnormal fetal heart rate and excessive bleeding.

Premature labor. Vaginal bleeding late in pregnancy may just be a sign that your body is getting ready to deliver. A few days or weeks before labor begins, the mucus plug that covers the opening of the uterus will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as "bloody show"). If bleeding and symptoms of labor begin before the 37th week of pregnancy, contact your doctor right away because you might be in preterm labor.

Other symptoms of preterm labor include contractions, vaginal discharge, abdominal pressure, and ache in the lower back.

Additional causes of bleeding in late pregnancy are:

• Injury to the cervix or vagina
• Polyps
• Cancer

What to Do If You Have Abnormal Bleeding During Pregnancy

Because vaginal bleeding in any trimester can be a sign of a problem, call your doctor. Wear a pad so that you can keep track of how much you're bleeding, and record the type of blood (for example, pink, brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for testing. Don't use a tampon or have sex while you are still bleeding.

Your doctor might recommend that you rest as much as you can and avoid exercise and travel.

You should expect to receive an ultrasound to identify what the underlying cause of your bleeding may be. Vaginal and abdominal ultrasounds are often performed together as part of a full evaluation.

Go to the emergency room or call 911 right away if you have any of the following symptoms, which could be signs of a miscarriage or other serious problem:

• Severe pain or intense cramps low in the abdomen
• Severe bleeding, with or without pain
• Discharge from the vagina that contains tissue
•  Dizziness or fainting
• A fever of more than 100.4 or more degrees Fahrenheit and/or chills

Health & Pregnancy Guide

1. Getting Pregnant
2. First Trimester
3. Second Trimester
4. Third Trimester
5. Labor and Delivery
6. Pregnancy Complications
7. All Guide Topics

How Much Bleeding Is Normal In Early Pregnancy?

Light amounts of vaginal bleeding early in your pregnancy can occur. In most cases, it’s not serious. It can happen in the first 20 weeks for different reasons. It can be the result of something serious or non-serious. Continued bleeding throughout the pregnancy is not common. Call your doctor immediately if you are bleeding heavily. Go to the emergency room if you have severe pain.

Path to improved health

Vaginal bleeding can happen from conception to delivery. Spotting is a type of light bleeding. You may see just a few drops of blood in your underwear. Heavy bleeding is more noticeable. It will require a sanitary pad to protect your clothing.

Call your doctor whenever you experience bleeding of any kind. Call your doctor if you have vaginal bleeding or spotting. This is important even if an ultrasound test confirms your pregnancy is normal. An ultrasound is where a technician moves a wand around your stomach to see an image of the baby.

Non-serious reasons for bleeding early in your pregnancy can include:

• Implantation (as the egg settles into your uterus the first 6-12 days)
• Sex
• Infection
• Hormones.

More serious causes of vaginal bleeding during the early part of pregnancy can include:

• An ectopic pregnancy (a pregnancy that starts outside the uterus and will not survive but can be life threatening).
• A miscarriage (losing the baby early in a pregnancy).
• A molar pregnancy (a fertilized egg that implants in the uterus that does not live).

In later pregnancy, the following serious medical conditions can cause vaginal bleeding:

• Placental abruption (the placenta detaches from the wall of the uterus before birth).
• Placenta previa (the placenta is lying too low in the uterus and nearly covers the cervix).
• Placenta accreta (when the placenta invades the uterus and doesn’t separate from the uterine wall).
• Preterm labor (labor that starts before completing 37 of 40 weeks of pregnancy).

Bleeding may be just one sign of preterm labor. Preterm labor also can include vaginal discharge, pressure in your pelvis or abdomen (lower stomach), a dull backache, cramps, contractions, and your water breaking.

If you are bleeding early in your pregnancy, your doctor will want to know how long and how much. If you have cramps and pain early in the pregnancy, he or she will order tests. This may include an ultrasound, blood, and urine tests.

If continued bleeding is not serious, your doctor may treat it by recommending that you rest, relax, stay off your feet, and not have sex. Keep your body healthy. Take a prenatal vitamin with folic acid daily while pregnant. Take it earlier if you plan to get pregnant. Avoid smoking, drinking alcohol, and taking illegal drugs. Talk to your doctor before taking prescription medicine. When you are pregnant, you should never douche (use vaginal cleansing products) or use tampons. Serious bleeding may need to be treated with a long-term bed rest, hospitalization, or surgery.

You cannot prevent a miscarriage after it has started. The exact cause is usually unknown. It’s rarely something the mother did wrong. Most women can have healthy pregnancies in the future. If you have lost more than 3 pregnancies, talk to your doctor.

Things to consider

If you experience bleeding or spotting at any time during your pregnancy, your doctor will want to collect as much information as possible. That will include:

• How far along is your pregnancy?
• Have you had bleeding at any other time during your pregnancy?
• When did the bleeding start?
• Is the bleeding heavy or spotting?
• Does it start and stop?
• How much blood is there?
• What color is the blood (bright red or dark brown)?
• Does the blood have an odor?
• Do you have cramps or pain?
• Do you feel weak, tired, faint, or dizzy?
• Have you experienced vomiting, nausea, or diarrhea?
• Do you have a fever?
• Were you recently injured (such as a fall or car accident)?
• Have you engaged in any physical activity?
• Are you under extra stress?
• When did you last have sex? Did you bleed afterward?
• Do you have a bleeding disorder? Women with bleeding disorders are at risk of complications during and after pregnancy. This includes iron-deficiency anemia, bleeding during pregnancy, and serious bleeding after delivery (postpartum hemorrhage). Talk to your doctor before getting pregnant if you have a bleeding disorder. Also, bleeding disorders are genetic.
• What is your blood type? If your blood type is Rh negative, you will need treatment with a medicine called Rho(D) immune globulin. This prevents complications with future pregnancies.

Vaginal bleeding is usually blood without clots or tissue. If you see something other than blood, call your doctor immediately. Try to collect the discharge in a container and bring it with you when you see your doctor. It may mean you have miscarried. If that is the case, your doctor will provide additional care. If not all the tissue from the miscarriage has passed, your doctor may need to perform a procedure. This procedure is called a dilation and curettage (D and C). It involves opening (dilating) the cervix. Your doctor will gently suction out the remaining tissue from the miscarriage.

Questions to ask your doctor

• Can certain foods (such as spicy foods) cause bleeding?
• Is it best to avoid having sex throughout your entire pregnancy?
• Is spotting during later pregnancy normal?
• Is my life at risk?
• I feel sad. Is there someone I could talk to about my feelings? Is there a support group?

Resources

U.S. National Library of Medicine, Vaginal bleeding in early pregnancy

March of Dimes, Bleeding and Spotting From the Vagina During Pregnancy

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Pathological and physiological causes of bleeding during early pregnancy

The gestation period is a complex process that does not always go well. Every second woman has various complications. Most often, women go to the doctor with complaints of spotting. Why does bleeding occur during early pregnancy, how dangerous is it?

Causes of bleeding in pregnancy

Blood in the first trimester of pregnancy in the vaginal secretion is observed in 30% of expectant mothers. Bleeding can be weak, spotting, plentiful. nine0003

Most often, blood during early pregnancy is observed during implantation of the fetal egg. When the egg is attached, the vessels are often damaged, which leads to the appearance of blood secretions. They are similar to menstruation, last 1-2 days. This process is considered natural, does not indicate any pathologies.

Any bloody discharge during early pregnancy is a reason for an urgent appeal to a gynecologist. Even if there is no additional discomfort. At a remote consultation, our doctor will collect an anamnesis, draw up a clinical picture in order to identify the cause of bleeding. And he will select effective methods to eliminate the problem. nine0003

Blood during pregnancy - other common causes

In addition to the main ones, there are some other reasons why pathology can develop.

Bleeding in the first trimester can be caused by causes that appear at any gestational age. These are fibroids, polyps in the uterus and cervical canal, cardiovascular pathologies that are associated with a weakening of the endothelium. nine0003

Physiological or pathological bleeding during gestation - differences

Clinical manifestations of bleeding in pregnant women depend on the causes. Physiological discharge of blood from the genital tract in the early stages of gestation proceeds without deterioration in well-being. With bleeding caused by erosion, fibroids and polyps, there are also no additional discomfort. In this case, only a few drops of blood are released, it bleeds for a short time. nine0003

Abundant bleeding, similar to menstruation, against the background of a general satisfactory condition, occurs with a deficiency of progesterone.

Bleeding with spontaneous interruption is accompanied by constant or periodic pain in the lumbar region, abdomen. Disturbed by nausea, bouts of dizziness, slightly increased body temperature. Bleeding can be weak or intense, and clots are often observed in the discharge.

Learn more about implantation bleeding

Why does it bleed at the initial stages of gestation? Most often, the appearance of spotting during pregnancy is associated with the implantation of the embryo. They occur 6-12 days after conception and are often one of the first signs of conception.

Usually, the appearance of spotting at the beginning of pregnancy coincides with the time of the onset of menstruation, if the cycle is regular. But discharge in pregnant women is not as abundant as menstrual bleeding. Duration - from several hours to three, with the first pregnancy up to 5 days. nine0003

How does implantation bleeding manifest?

• weak, pulling pain in the lower abdomen;
• headache, dizziness;
• sudden change of mood;
• bouts of nausea;
• increased sensitivity, swelling of the mammary glands;
• fatigue, drowsiness.

Important! When the embryo is implanted, little blood is released, usually these are small spots. The discharge may be pink, brown, orange, and there should be no clots. nine0003

Possible causes of early bleeding by week

The first months of pregnancy are the most difficult and dangerous. It is in the early stages that various pathologies and complications often appear.

Why blood may appear in the early stages during pregnancy:

1. At the 4th week of pregnancy, discharge with an admixture of blood may appear - this is implantation bleeding. Heavy bleeding is a dangerous sign, most often indicates a miscarriage. Spontaneous abortion can be caused by exercise, fever, infections, drugs or alcohol. Such bleeding is profuse, painful, blood clots are present. nine0156
2. The appearance of sanious discharge at the 5th week of pregnancy may be a sign of a missed pregnancy. The reasons are overwork, Rh conflict, bad habits, bacterial and viral diseases of the reproductive system, genetic disorders in the embryo. Symptoms - causeless fever, severe pain in the lower back and lower abdomen, the disappearance of signs of toxicosis.
3. Blood in the discharge at the 6th week of pregnancy appears with an ectopic attachment of the fetal egg, fetal fading, Rhesus conflict. Discharge with blood at 6 weeks of pregnancy is a reason for an urgent visit to the gynecologist. nine0156
4. At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
5. From the 8th week of pregnancy, one of the most dangerous periods of pregnancy begins. The formation of the placenta begins, the hormonal background changes. Bloody discharge appears with the threat of miscarriage or spontaneous abortion. Pregnancy is often not saved.

Pay attention! nine0170 In the second trimester, bleeding occurs only in 5-10% of women. Most often this is due to late spontaneous abortion, isthmic-cervical insufficiency. The appearance of blood in the third trimester mainly occurs with presentation, placental abruption.