Understanding Bleeding in Pregnancy

Reviewed by James Brann, MD

Bleeding in Pregnancy

Several different things could cause either vaginal bleeding or spotting during a pregnancy. Some of these things are serious. Vaginal bleeding may happen in early pregnancy or late in your pregnancy.
A lot of women will have bleeding or vaginal spotting during the first 12 weeks of their pregnancy. During sex, there may be what’s called bleeding of the cervix. Bleeding may also be caused by an infection of the cervix. A small amount of bleeding can stop all on its own.

Sometimes bleeding during a pregnancy is a sign of a serious problem. It may indicate you are at increased risk of having preterm labor (having labor too early), having a miscarriage, or having a small baby.

Checking bleeding during pregnancy

If you’re bleeding in the early part of our pregnancy, your doctor may want to do a pelvic exam. Your doctor will ask how much blood you’ve passed and how often you are bleeding. They will also want to know about any pain you’re having, how severe it is, and where it’s located.

A blood test may also be performed to measure human chorionic gonadotropin, or hCG. This type of substance is made by your body during your pregnancy. You may need more than just one test, though, because hCG levels do increase during a pregnancy. Your doctor will also check your blood type to see if you need to be treated for Rh sensitization. This is when an Rh-negative mother is making antibodies that attack the Rh factor, a protein on red blood cells.
Sometimes, an ultrasound can determine what’s causing the bleeding. There are other times, though, that doctors can’t determine the cause.

Miscarriage

A miscarriage, or early pregnancy loss, may happen at any time during the first half of your pregnancy. Most commonly, though, it occurs during the first 13 weeks of pregnancy. This occurs in about 15-20% of all pregnancies.

Signs include:
  • Cramping in lower abdomen (stronger than menstrual cramps)
  • Passing tissue from vagina
  • Bleeding from vagina


For some women with vaginal bleeding, they have very little or even no cramping at all. Sometimes, too, the bleeding will stop and their pregnancy progresses normally. Other times, though, the cramping and bleeding strengthens, and a woman has a miscarriage.
After a miscarriage, if some tissue stays in your uterus, the bleeding may continue. Your doctor may recommend additional treatment. You may need medication to pass the tissue. The tissue may also be removed by what’s called dilation and curettage, or D&C. A suctioning device, or suction curettage, may also remove it. In certain situations, you may need more than one treatment.

Ectopic pregnancy

When there’s an ectopic pregnancy, the fertilized egg doesn’t implant in your uterus. It implants somewhere else instead, most commonly in the fallopian tubes. An ectopic pregnancy will cause bleeding and pain early on in a pregnancy.

One of the largest risks with ectopic pregnancy is having one of your fallopian tubes rupture. This requires immediate treatment because you may have internal bleeding. A loss of blood may also lead to shock, pain, fainting, weakness or even death.

An ectopic pregnancy is less common than a miscarriage. It happens in one out of every 60 pregnancies. Women have more of a risk if they’ve had these things:
  • Tubal surgery
  • Prior ectopic pregnancy
  • Infection in fallopian tubes (like pelvic inflammatory disease)


Bleeding in late pregnancy

Common issues leading to light bleeding may include growths on the cervix or an inflamed cervix. It’s possible to treat these with medication.

Usually when there’s heavy bleeding there’s a problem with the placenta. The most likely causes are placenta previa and placental abruption. Preterm labor may also cause heavy bleeding.

  • Placenta previa - When the placenta is lying too low in the uterus, it may end up covering the cervix. When the opening is blocked, you may also have vaginal bleeding. There usually isn’t any pain.
  • Placental abruption - This is when the placenta detaches from the uterine wall either before labor or during labor. This could lead to vaginal bleeding. There’s often pain associated with it, even if you don’t see any bleeding, or you’re only having light bleeding. When the placenta detaches, your baby may not get enough oxygen and you need immediate attention.

Bleeding and labor

If you are in late pregnancy and having vaginal bleeding, you may be in labor. Just before labor starts, or in the beginning, you’ll pass some blood and mucus from the cervix. This is often called bloody show. It’s not an issue if this happens within three weeks of your due date. If it happens any earlier, though, you may be having preterm labor. Other signs include:
  • Type of discharge changes (bloody, watery or mucus)
  • Vaginal discharge
  • Pressure in lower abdomen or pelvis
  • Discharge increases
  • Dull, low backache
  • Uterine tightening or regular contractions
  • Stomach cramping which may include diarrhea


If you’re having any of these symptoms, call your doctor immediately.


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