Bleeding During Pregnancy

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Medical Author:

Pamela Dyne, MD

Coauthor:

Jodi L Adams, MD

Coauthor:

Timothy J Rupp, MD, FACEP

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Bleeding During Pregnancy Overview
• Bleeding During Pregnancy Causes
• First Trimester Bleeding Causes
• Late-Pregnancy Bleeding (Second and Third Trimester) Causes
• Bleeding During Pregnancy Symptoms
• When to Seek Medical Care
• Bleeding During Pregnancy Diagnosis
• Bleeding During Pregnancy Treatment
• Bleeding During Pregnancy Self-Care at Home
• Bleeding During Pregnancy Medical Treatment
• Bleeding During Pregnancy Follow-up
• Bleeding During Pregnancy Prevention
• Bleeding During Pregnancy Prognosis
• Picture of Intrauterine Pregnancy
• Synonyms and Keywords
• Authors and Editors

Bleeding During Pregnancy Overview

Because bleeding during all phases of pregnancy may be dangerous, a woman should call her health care professional if she has any signs of vaginal bleeding during her pregnancy.

Vaginal bleeding is any blood coming from the vagina (the canal leading from the uterus to the external genitals). This usually refers to abnormal bleeding not associated with a regular menstrual period.

• First trimester bleeding is any vaginal bleeding during the first 3 months of pregnancy. Vaginal bleeding may vary from light spotting to heavy bleeding with clots. Vaginal bleeding is a common problem in early pregnancy, complicating 20%-30% of all pregnancies.
• Any vaginal bleeding during the second and third trimesters of pregnancy (the last 6 months of a 9-month pregnancy) involves concerns different from bleeding in the first 3 months of the pregnancy. Any bleeding during the second and third trimesters is abnormal.
• Bleeding from the vagina after the 28th week of pregnancy is a true emergency. The bleeding can range from very mild to extremely brisk and may or may not be accompanied by abdominal pain. Hemorrhage (another word for bleeding) is the most common cause of death of the mother in the United States. It complicates about 4% of all pregnancies.

Bleeding During Pregnancy Causes

First Trimester Bleeding Causes

Vaginal bleeding in the first trimester of pregnancy can be caused by several different factors. Bleeding affects 20%-30% of all pregnancies. Up to 50% of those who bleed may go on to have a miscarriage (lose the baby). Of even more concern, however, is that about 3% of all pregnancies are ectopic in location (the fetus is not inside the uterus), and vaginal bleeding can be a sign of an ectopic pregnancy. An ectopic pregnancy may be life threatening to the mother. All bleeding associated with early pregnancy should prompt a call to your health care provider for immediate evaluation.

• Implantation bleeding: There can be a small amount of spotting associated with the normal implantation of the embryo into the uterine wall, called implantation bleeding. This is usually very minimal, but frequently occurs on or about the same day as your period was due. This can be very confusing if you mistake it for simply a mild period and don't realize you are pregnant. This is a normal part of pregnancy and no cause for concern.
• Threatened miscarriage: You may be told you have a threatened miscarriage if you are having some bleeding or cramping. The fetus is definitely still inside the uterus (based usually on an exam using ultrasound), but the outcome of your pregnancy is still in question. This may occur if you have an infection, such as a urinary tract infection, become dehydrated, use certain drugs or medications, have been involved in physical trauma, if the developing fetus is abnormal in some way, or for no apparent reason at all. Other than these reasons, threatened miscarriages are generally not caused by things you do, such as heavy lifting or having sex, or by emotional stress.
• Completed miscarriage: You may have a completed miscarriage (also called a spontaneous abortion) if your bleeding and cramping have slowed down and the uterus appears to be empty based on ultrasound evaluation. This means you have lost the pregnancy. The causes of this are the same as those for a threatened miscarriage. This is the most common cause of first trimester bleeding.
• Incomplete miscarriage: You may have an incomplete miscarriage (or a miscarriage in progress) if the pelvic exam shows your cervix is open and you are still passing blood, clots, or tissue. The cervix should not remain open for very long. If it does, it indicates the miscarriage is not completed. This may occur if the uterus begins to clamp down before all the tissue has passed, or if there is infection.
• Blighted ovum: You may have a blighted ovum (also called embryonic failure). An ultrasound would show evidence of an intrauterine pregnancy, but the embryo has failed to develop as it should in the proper location. This may occur if the fetus were abnormal in some way and not generally due to anything you did or didn't do.
• Intrauterine fetal demise: You may have an intrauterine fetal demise (also called IUFD, missed abortion, or embryonic demise) if the developing baby dies inside the uterus. This diagnosis would be based on ultrasound results and can occur at any time during pregnancy. This may occur for any of the same reasons a threatened miscarriage occurs during the early stages of pregnancy; however it is very uncommon for this to occur during the second and third trimesters of pregnancy. If it does, the causes also include separation of the placenta from the uterine wall (called placental abruption) or because the placenta didn't receive sufficient blood flow.
• Ectopic pregnancy: You may have an ectopic pregnancy (also called tubal pregnancy). This would be based on your medical history and ultrasound, and in some cases laboratory results. Bleeding from an ectopic pregnancy is the most dangerous cause of first trimester bleeding. An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, most often in the Fallopian tube. As the fertilized egg grows, it can rupture the Fallopian tube and cause life-threatening bleeding. Symptoms are often variable and may include pain, bleeding, or lightheadedness. Most ectopic pregnancies will cause pain before the tenth week of pregnancy. The fetus is not going to develop and will die because of lack of supply of nutrients. This condition occurs in about 3% of all pregnancies.
• There are risk factors for ectopic pregnancy. These include a history of prior ectopic pregnancy, history of pelvic inflammatory disease, history of Fallopian tube surgery or ligation, history of infertility for more than 2 years, having an IUD (birth control device placed in the uterus) in place, smoking, or frequent (daily) douching. Only about 50% of women who have an ectopic pregnancy have any risk factors, however.
• Molar pregnancy: You may have a molar pregnancy (technically called gestational trophoblastic disease). Your ultrasound results may show the presence of abnormal tissue inside the uterus rather than a developing fetus. This is actually a type of tumor that occurs as a result of the hormones of pregnancy, and is usually not life-threatening to you. However, in rare cases the abnormal tissue is cancerous. If it is cancerous it can invade the uterine wall and spread throughout the body. The cause of this is generally unknown.
• Postcoital bleeding is vaginal bleeding after sexual intercourse. It may be normal during pregnancy.
• Bleeding may also be caused by reasons unrelated to pregnancy. For example, trauma or tears to the vaginal wall may bleed, and some infections may cause bleeding.