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Vaginal Bleeding in Pregnancy

Bleeding from the vagina at any time during pregnancy

  • Age, genetics, and lifestyle are not significant factors

If you experience vaginal bleeding in pregnancy, you should seek immediate advice from your doctor. If you develop heavy bleeding, particularly late in pregnancy, you should call an ambulance. Severe bleeding may be life-threatening for both you and your baby, so it is vital that you receive emergency care.

What are the causes?

The causes of vaginal bleeding in pregnancy vary, depending on the stage of the pregnancy.

Bleeding before 14 weeks

Bleeding in early pregnancy can be caused by a miscarriage and may be accompanied by cramping, period-like pain. Light to heavy bleeding and severe pain before about 7 weeks may be due to a pregnancy outside the uterus (see Ectopic pregnancy).

Rarely, light, painless vaginal bleeding called spotting persists during the first 14 weeks of pregnancy. In most of these cases, the pregnancy continues.

Bleeding at 14–24 weeks

After week 14 of pregnancy, bleeding may be due to a late miscarriage, the causes of which can include a weak cervix (see Cervical incompetence). Bleeding due to miscarriage at this stage may be painful.

Bleeding after 24 weeks

After the 24th week of pregnancy, painful, light to heavy vaginal bleeding is most often caused by placental abruption, in which the placenta becomes partially separated from the wall of the uterus. Painless vaginal bleeding after 24 weeks may be due to placenta praevia, in which the placenta covers some or all of the opening of the cervix.

What might be done?

A manual examination is rarely carried out, particularly if you are in late pregnancy, because the examination could damage the placenta if it is lying low in the uterus. Using a speculum to hold the vagina open, your doctor will examine your cervix to look for a local cause of the bleeding. You will also have an ultrasound scan (see Ultrasound scanning in pregnancy) and fetal heartbeat monitoring may be carried out (see Fetal monitoring).

Treatment depends on the cause and extent of the bleeding and the stage of your pregnancy. If you have light to moderate bleeding in early pregnancy, your doctor may suggest that you rest in bed. Most of these pregnancies continue normally. However, surgery may be necessary in some cases of miscarriage or if the cause of the bleeding is found to be an ectopic pregnancy. If you have heavy vaginal bleeding later in your pregnancy, your baby may have to be delivered by an emergency caesarean section. If you have lost a large amount of blood, you may need to have a blood transfusion.

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

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