What causes bleeding when pregnancy

Vaginal bleeding - NHS

Bleeding during pregnancy is relatively common and does not always mean there's a problem – but it can be a dangerous sign.

Urgent advice: Call your midwife or GP immediately if:

• you have any bleeding from your vagina

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Causes of bleeding in early pregnancy

Implantation bleeding

In early pregnancy, you might get some harmless light bleeding, called "spotting". This is when the developing embryo plants itself in the wall of your womb. This type of bleeding often happens around the time your period would have been due.

Cervical changes

Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding – after sex, for example.

Miscarriage or ectopic pregnancy

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy.

However, if you bleed at this stage of pregnancy it's likely you will go on to have normal and successful pregnancies.

Miscarriage

If a pregnancy ends before the 24th week, it's called a miscarriage. Around 1 in 5 pregnancies ends this way.

Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can also be other causes of miscarriage, such as hormone or blood clotting problems.

Most miscarriages occur during the first 12 weeks (3 months) of pregnancy and, sadly, most cannot be prevented. Other symptoms of miscarriage include:

• cramping and pain in your lower abdomen
• a discharge or fluid from your vagina
• a discharge of tissue from your vagina
• no longer experiencing the symptoms of pregnancy, such as feeling sick

If you have bleeding or any of the symptoms above, contact your midwife or GP straightaway.

Ectopic pregnancy

An ectopic pregnancy is when a fertilised egg implants outside the womb – for example, in the fallopian tube.

It can cause bleeding and is dangerous because the fertilised egg cannot develop properly outside the womb. The egg has to be removed, which can be done through an operation or with medicines.

Symptoms of an ectopic pregnancy tend to develop in the 6th week of pregnancy but can happen later.

Other signs of ectopic pregnancy can include:

• tummy pain low down which may be on one side
• vaginal bleeding or a brown, watery discharge
• pain in the tip of your shoulder
• discomfort when peeing or pooing

Call 111 if you have symptoms of an ectopic pregnancy.

Causes of bleeding in later pregnancy

Cervical changes

These can lead to bleeding, particularly after sex.

Vaginal infections

Your midwife or doctor can discuss tests and treatment with you.

A 'show'

This is when the plug of mucus that has been in the cervix during pregnancy comes away, signalling that the cervix is getting ready for labour to start. It may happen a few days before contractions start or during labour itself.

Find out about the signs of labour and what happens in labour.

Placental abruption

This is a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.

Low-lying placenta (placenta praevia)

This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy, and put you and your baby at risk.

You may be advised to go into hospital for emergency treatment, and a caesarean section will usually be recommended.  The Royal College of Obstetricians and Gynaecologists has more information on placenta praevia.

Vasa praevia

This is a rare condition where the baby's blood vessels run through the membranes covering the cervix.

When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a life-threatening amount of blood.

Finding out the cause of bleeding in pregnancy

To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels.

Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes it might not be possible to find out what caused the bleeding.

If your symptoms are not severe and your baby is not due for a while, you'll be monitored and, in some cases, kept in hospital for observation.

How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are.

Being in hospital allows staff to keep an eye on you and your baby, so they can act quickly if there are further problems.

Find the answers to common health problems in pregnancy

Video: What should I do if I start bleeding during early pregnancy?

In this video, a midwife tells you what to do if you start to bleed during early pregnancy.

Media last reviewed: 20 March 2020
Media review due: 20 March 2023

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

Bleeding during pregnancy - causes, symptoms, diagnosis and treatment

Bleeding during pregnancy - a sign that can occur regardless of the period of embryogenesis and indicates ongoing changes in the body of a woman. It can be observed with spontaneous miscarriage, ectopic pregnancy, Rh conflict, placenta previa and other conditions. This manifestation can develop against the background of general well-being or be accompanied by painful sensations in the lower abdomen, lower back, and sacrum. Diagnosis of bleeding during pregnancy is carried out on the basis of data from a gynecological examination, an ultrasound assessment of the condition of the patient and the fetus. The treatment of this pathological symptom is determined by its cause and is prescribed exclusively by a specialist.

General information

Bleeding during pregnancy is an obstetric symptom indicating the possible development of a number of disorders, the cause of which can be both physiological changes in the woman's body after conception, and pathological conditions. Only an obstetrician-gynecologist can finally find out the etiology of such a manifestation after a complete examination. Bleeding during pregnancy occurs in about one in five patients. In 50%, they indicate pathological changes and end in spontaneous miscarriage. In half of the patients, the symptom is physiological in nature. Bleeding occurs more often in the first and third trimester of embryogenesis.

The danger of bleeding during pregnancy lies in the fact that a variety of factors can provoke them, including those that pose a threat to the mother and fetus. In some situations, there are no other pathological signs. Any bleeding during pregnancy should be a reason for immediate medical attention. Only a specialist is able to assess the danger to the health of a woman and the fetus, as well as decide on further tactics. Timely assistance provided even with an abnormal course of pregnancy allows you to continue its management and save the life of the child.

Bleeding during pregnancy

Causes of bleeding during pregnancy

Bleeding during pregnancy can occur at any stage of embryogenesis, develops both against the background of physiological changes in the body of a woman, and as a result of the formation of a certain obstetric pathology. In the early stages, half of the women have a slight separation of blood due to the implantation of the fetal egg in the uterine cavity. Such bleeding during pregnancy is often regarded by the patient as menstrual, so she does not seek medical help, which in the future may make it difficult to determine the timing of embryogenesis. A similar symptom is possible with insufficient production of progesterone in the early stages of gestation.

The most common cause of abnormal bleeding during pregnancy in the first trimester is spontaneous miscarriage. This symptom appears both with a just-started and with a complete abortion. Approximately 6 weeks after conception, the symptom occurs with an ectopic attachment of the fetal egg. Also, bleeding during pregnancy at this time may indicate an Rhesus conflict, fetal fading. Similar manifestations are characteristic of women suffering from varicose veins that feed the uterus. In this case, bleeding during pregnancy is due to increased blood supply to the tissues.

Bleeding during pregnancy in the second trimester is diagnosed much less frequently, in about 5-10% of all cases of gestation. As a rule, the symptom is caused by pathological changes and in most cases indicates spontaneous late abortion or isthmic-cervical insufficiency. Sometimes the separation of blood from the genital tract is observed during intrauterine death of the fetus. Bleeding during pregnancy in the third trimester also always speaks of the development of gestation pathology. The most common cause is placenta previa. In this case, the embryonic organ completely or partially covers the uterine os, while due to the high load on the lower segment, placental micro-ruptures occur, which causes a similar sign.

Less commonly, bleeding during pregnancy in the third trimester is due to premature detachment of a normally located placenta. In this situation, there is a high threat to the life of the fetus. The danger also lies in the fact that initially internal bleeding develops during pregnancy or the formation of a hematoma, and only then the blood flows out. The rarest, but most dangerous for the life of the mother and child, the cause of the development of this symptom is uterine rupture. Such a complication is diagnosed in the presence of a scar on the myometrium and tissue overstretching, provoked by polyhydramnios, large fetuses or multiple pregnancies. It is extremely rare that bleeding during pregnancy occurs due to a violation of the integrity of the membranes or umbilical cord vessels.

Also, bleeding during pregnancy can be triggered by causes that appear at any stage of embryogenesis. Such reasons include benign neoplasms - fibroids, polyposis growths in the cervical canal and uterine cavity. Often bleeding during pregnancy occurs in women with cervical erosion. Sometimes a sign occurs due to increased blood circulation in the pelvic organs. The risk of developing a symptom is also present with violent sexual intercourse, significant physical exertion, concomitant cardiovascular diseases associated with a weakening of the endothelium.

Classification and symptoms of bleeding during pregnancy

Depending on the origin of bleeding, two groups can be distinguished:

• Physiological bleeding during pregnancy - occurs due to the restructuring of the body, does not pose a threat to the health and life of the fetus or mother.
• Pathological bleeding during pregnancy - indicate its abnormal course, may be accompanied by a risk to the life and health of the woman and baby, require immediate medical attention.

Clinic of bleeding during pregnancy directly depends on the cause of such a symptom. Isolation of blood from the genital tract in the early stages of embryogenesis, provoked by physiological changes, proceeds against the background of general well-being. Bleeding during pregnancy, which has developed due to the presence of polyps, erosion, fibroids in most cases also does not cause disturbances in well-being. In this case, there is a slight release of biological fluid - just a few drops, the symptom is of a short-term nature. More abundant, similar to menstrual, will be bleeding during pregnancy associated with a deficiency of progesterone.

In case of bleeding during pregnancy associated with its spontaneous termination, the patient is worried about constant or cramping pain in the lumbosacral region, abdomen. Additionally, nausea, dizziness, malaise, and a slight increase in body temperature may occur. Bleeding during pregnancy in this case can be of varying intensity, often in the discharge there are pieces of tissue. With an ectopic attachment of the fetal egg, as well as with a rupture of the uterus, a serious threat to the life of a woman arises. In such a situation, internal bleeding initially develops during pregnancy, and only then do pathological discharges from the external genital tract appear. There is acute pain in the abdomen with irradiation to the anal region, the lateral parts of the body. With significant blood loss, a state of shock occurs with a threat of death.

Bleeding during late pregnancy is also not always accompanied by a detailed clinical picture. In the case of placenta previa, this is the only symptom that should cause alertness in a woman and become a reason for contacting an obstetrician-gynecologist. As for the premature detachment of a correctly attached placenta, in this case, bleeding during pregnancy develops against the background of uterine hypertonicity, there is pain in the abdomen, deterioration in general well-being. During cardiac monitoring of the fetus, there is a violation of the heart rate, motor activity.

Diagnosis and treatment of bleeding during pregnancy

A gynecological examination of the woman is performed to identify the cause of bleeding during pregnancy. With changes in physiological origin, no deviations from the norm can be detected. With pathological bleeding during pregnancy against the background of spontaneous abortion, an opening of the cervix is ​​observed. An increase in the tone of the myometrium may indicate the onset of placental abruption. Of the laboratory diagnostic methods, an analysis is used to determine the concentration of hCG (human chorionic gonadotropin). With ectopic pregnancy and bleeding, this figure will be reduced. Instrumental diagnosis of bleeding during pregnancy is to conduct an ultrasound scan. Using this method, it is possible to assess the state of the myometrium and the embryo, the level of blood flow in the vessels, the exact localization of the placenta and (possibly) its incipient detachment. Using CTG, the diagnostician can make a conclusion about the vital activity of the fetus.

Treatment of bleeding during pregnancy also depends on the cause of the symptom. If there are no pathological changes or the manifestation is provoked by damage to the polyp, medical attention is not required. In rare cases, the doctor recommends its removal. Expectant tactics are also used in case of cervical erosion. Her cauterization is carried out after childbirth. Bleeding during pregnancy against the background of the threat of miscarriage and placenta previa requires immediate hospitalization in an obstetric hospital, followed by the appointment of drug treatment. To reduce uterine tone, sedatives, tocolytics are used. Pregnancy management in this case requires careful monitoring by a specialist.

Bleeding during pregnancy due to ectopic attachment of the ovum, rupture of the scar, or completed spontaneous abortion, requires hospitalization and surgical treatment. After removal of the remnants of fetal tissues or emergency delivery, antibiotic therapy is prescribed. In this case, stopping bleeding during pregnancy is carried out in different ways, depending on its intensity, often ligation of the uterine arteries is performed. With premature detachment of the placenta, an emergency caesarean section is indicated.

Prognosis and prevention of bleeding during pregnancy

Bleeding during pregnancy is usually accompanied by a favorable prognosis. Timely medical care can save the life of the fetus and the woman. Lethal outcome is extremely rare. Prevention of bleeding during pregnancy consists in the early detection of benign neoplasms and their treatment even before conception. To prevent the development of a pathological symptom, you should register as soon as possible, take all the necessary tests, and if any violations occur, immediately seek advice from an obstetrician-gynecologist. Prevention of bleeding during pregnancy also consists in avoiding stress, physical exertion, violent sexual contacts.

Bleeding in the first half of pregnancy - Information