Vaginal Bleeding During Pregnancy
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
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
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.
RESOURCES:
The American Congress of Obstetricians and Gynecologists
http://www.acog.org/
March of Dimes
http://marchofdimes.com/
CANADIAN RESOURCES:
Ontario March of Dimes
http://www.dimes.on.ca/asp/home.asp/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp/
References:
Bleeding during pregnancy. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/bleedingduringpreg.html . Accessed August 3, 2005.
Detailed guide: gestational trophoblastic disease: what are the risk factors for gestational trophoblastic disease? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_gestational_trophoblastic_disease_49.asp?sitearea= . Accessed August 10, 2005.
Ectopic and molar pregnancy. The March of Dimes website. Available at: http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=567&page_id=5441280&query=Ectopic+and+molar+pregnancy&hiword=Ectopic+PREGNANCIES+PREGNANCYS+PREGNANT+and+molar+pregnancy+ . Accessed August 9, 2005.
Placental conditions. The March of Dimes website. Available at: http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=567&page_id=4458240&query=placental+conditions&hiword=CONDIT+CONDITION+CONDITIONAL+CONDITIONED+CONDITIONER+CONDITIONING+PLACENTA+PLACENTAS+conditions+placental+ . Accessed August 9, 2005.
Pregnancy complications: symptoms, diagnosis, and treatment. The National Women’s Health Information Center website. Available at: http://www.womenshealth.gov/pregnancy/complicationsp.cfm . Accessed August 5, 2005.
Preterm birth. The March of Dimes website. Available at: http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=567&page_id=6095104&query=preterm+birth&hiword=BIRTHED+BIRTHING+BIRTHS+birth+preterm+ . Accessed August 9, 2005.
Vaginal bleeding in pregnancy. The National Library of Medicine–National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003264.htm . Accessed August 5, 2005.
Last reviewed December 2009 by Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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