Bleeding during pregnancy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 9, 2015
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Pregnancy is a rewarding process that most women enjoy. It is also a process that creates many different changes in a woman's body, which can create concerns. One of the most common issues that women experience during pregnancy is spotting or bleeding. This does not always mean there is something wrong but it does mean that a doctor should be consulted, especially if the bleeding occurs after the first trimester or if the bleeding is accompanied by other symptoms.


Definition & Facts

Bleeding during a pregnancy is common. About 20-30% of women will experience some spotting during the first trimester. Of these a large percentage will go on to have normal pregnancies without further complications. Some will experience miscarriages, unfortunately, or other issues throughout the gestation period.

It is important to keep an eye on the amount of bleeding, since copious amounts can warn of a more severe issue. If the bleeding occurs after the first trimester, then there is usually something that has gone wrong in the pregnancy. A woman who finds spotting or bleeding that late in the gestation period needs to contact a doctor.


There are a number of causes for bleeding during pregnancies. In the first trimester, the cervix experiences a large influx of blood, which makes it likely that a woman will find spotting or blood after intercourse. A Pap smear or other vaginal exams can also cause bleeding for this same reason. An infection can also inflame the vaginal walls, which can lead to soreness and bleeding.

For women who experience bleeding in their second or third trimester, the causes can be less simple. When there is lots of bleeding as well as cramping or other pain, it can mean a miscarriage is occurring. A miscarriage itself has many different causes, including health problems, maternal age, usage of drugs, smoking and drinking, and trauma. Ectopic pregnancies, when the embryo is implanted in the fellopian tubes instead of the uterus, are also a cause.

The first symptom of the rarer molar pregnancies is also spotting. In this type of pregnancy, tissue grows in the uterus wall, not an embryo. This can end up turning into cancer or create other health difficulties. Placental issues also show themselves with bleeding. Placenta abruption, when the placenta detaches from the uterine wall, or even premature labor can all cause bleeding during the late stages of pregnancy.

When to see a doctor

Any woman who experiences bleeding during a pregnancy should consult a doctor to ensure that everything is as it should be. This is especially important if it occurs in the second or third trimester, since that is when difficulties arise. If the bleeding is accompanied with pain or cramping of any sort, a doctor is necessary.

Mucus and weight loss can also be worrisome. If the bleeding is copious and does not stop, it is vital to get assistance as well as if the blood is bright red or if there is a continuous amount of it. Even if the amount of bleeding is minor, speaking with a physician is the best way to ensure that there is nothing seriously wrong with the embryo or with the woman. If contractions start, premature labor might be occurring which requires a hospitalization to treat the embryo and the mother.

Treatment & Therapy

Depending on the cause of the bleeding, there can be different treatment options. If the bleeding is caused by intercourse or by an internal exam, no treatment will be necessary. For infections, an antibiotic or other medication can stop the bleeding and cure the underlying cause without any further complications.

Unfortunately, there is little that can be done to treat a miscarriage. The doctor will do his or her best to prevent infections and hemorrhaging, which can be life-threatening. If the miscarriage occurs late in the pregnancy, a procedure to cut any remaining tissue might be necessary. If there is a lot of bleeding, a doctor might also prescribe medications to stop it. An ectopic pregnancy can resolve itself with time, but if it does not or if it is causing other issues, then a doctor might prescribe a medication like methotrexate. This medication will end the ectopic pregnancy without requiring a surgical incision.

If a surgery is necessary, then a laparoscopy is the best option, since it will leave no scarring. For most women, the ectopic pregnancy can be ended without any issues or rupturing of fallopian tubes. When it comes to a molar pregnancy, the treatment involves dilation and curettage. This means the physician will dilate the cervix and remove the tissue from the uterus using a type of medical vacuum. If the molar pregnancy is too advanced, then a hysterectomy might be recommended. This will prevent further pregnancies. Once the tissue has been removed, the doctor will monitor hCG levels to ensure that there will be no more health issues caused by the ectopic pregnancy.

Prevention & Prophylaxis

Preventing bleeding during pregnancy can be difficult to do, since it is so common and can have numerous different causes. Many women look for ways to prevent miscarriages, but the majority of these are results of chromosomal issues with the embryo and can therefore not be prevented. Any woman thinking of getting pregnant can, however, take certain steps to ensure that they have the best possible chance of conceiving and having a successful pregnancy.

This involves regular exercise, a moderate diet, keep stress as low as possible, avoid smoking, and take folic acid. Once a woman is pregnant, some effective ways to prevent issues is to not drink alcohol, not smoke, keep the abdominal area safe, consult a doctor before taking any medications, limit caffeine, and avoid overly strenuous exercise or movements.

Exercise is always healthy when done moderately and safely, though high impact sports can cause the kind of bleeding that can be worrisome. The prevention of bleeding during pregnancy is not as important as knowing what is causing it, since most instances it can be harmless and a natural process. Any woman who begins to see spotting or bleeding at any point in their pregnancy should consult a qualified physician.

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