Bleeding Late In Pregnancy

There are many causes of vaginal bleeding in pregnancy. Some result in bleeding early in pregnancy, while others result in bleeding later. This handout describes the causes of bleeding and what you should do if you bleed during pregnancy.

Late Pregnancy

The causes of bleeding in the second half of pregnancy are different from those in early pregnancy. Common conditions causing minor bleeding include inflammation of, or growths on, the cervix. At times sexual intercourse may irritate the cervix and cause bleeding.

Bleeding can also be serious and pose a threat to the health of the women or the fetus. It may require treatment in a hospital. Heavy vaginal bleeding usually involves a problem with the placenta, the tissue that connects the mother and the fetus. The two most common causes are placental abruption and placenta previa. Preterm labor can also cause vaginal bleeding.

Placental Abruption

If the placenta becomes detached from the uterine wall before or during labor, vaginal bleeding may occur. Only 1% of pregnant women have this problem, which usually occurs during the last 12 weeks of pregnancy. Abdominal pain often occurs, too, whether or not there is obvious bleeding. When the placenta becomes detached, the fetus does not receive enough oxygen. This can be lead to a stillbirth. Women who have already had children, are over 35, have had an abruption before, or have sickle cell anemia are at higher risk.

Placental abruption has been linked to:

  • High blood pressure
  • Abdominal trauma (car accidents)
  • Cocaine use
  • Smoking
  • Preeclampsia

Placenta Previa

When the placenta lies low in the uterus, it can partly or completely cover the cervix. Late in pregnancy, this may be linked to vaginal bleeding. This is called placenta previa. It is serious and requires prompt care. Placenta previa occurs in only 1 in 200 women. It is more common in women who have had more than one child, who have had a cesarean birth or other surgeries on the uterus, or who are carrying twins or triplets. Bleeding is usually painless.

Labor

Late in pregnancy, vaginal bleeding may also be a sign of labor. When the plug that covers the opening of the uterus during pregnancy is passed just before or at the start of labor, a small amount of mucous and blood is passed from the cervix. This is called “bloody show” or the “mucus plug”. It is common and not a problem if it happens within a few weeks of your due date. If it happens earlier, you may be going into preterm labor and should talk to your doctor right away. Other signs of preterm labor include:

  • Vaginal discharge-change in type(watery, mucous, or bloody) or amount
  • Pelvic or lower abdominal pressure
  • Low, dull backache
  • Abdominal cramps, with or without diarrhea
  • Regular contractions or uterine tightening

Taking Action

Contact your doctor if you have bleeding in late pregnancy. You may need to be admitted to the hospital to find its cause. Ultrasound may be advised. On occasion, a woman may have to stay in the hospital for several weeks. A woman who is bleeding late in pregnancy may need a blood transfusion. Conditions causing bleeding in late pregnancy pose a risk to both mother and fetus.

They may be serious enough to require early delivery of the baby, sometimes by cesarean birth.

Finally

Many women with bleeding in pregnancy are found to have minor conditions that need no treatment. At other times, bleeding can be the first sign of serious problem. For this reason, it is very important that bleeding anytime in pregnancy–early or late–be reported to your doctor. Your health and that of your baby may depend on getting prompt treatment.

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