Vaginal bleeding in late pregnancy

What Causes Bleeding Later in Pregnancy?

When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of bleeding mixed in with normal vaginal discharge, or mucus.

Mid- or late-term bleeding may also be caused by:

• Having sex (most often just spotting)
• An internal exam by your health care provider (most often just spotting)
• Diseases or infections of the vagina or cervix
• Uterine fibroids or cervical growths or polyps

More serious causes of late-term bleeding may include:

• Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.
• Placenta abruptio (abruption) occurs when the placenta separates from the inner wall of the uterus before the baby is born.

What to Tell Your Doctor?

Your doctor or midwife may need to know these things to find the cause of your vaginal bleeding:

• If you have cramping, pain, or contractions
• If you have had any other bleeding during this pregnancy
• When the bleeding began and whether it comes and goes or is constant
• How much bleeding is present, and is it spotting or a heavier flow
• The color of the blood (dark or bright red?)
• Is there an odor to the blood?
• Is there fainting, dizziness, nausea, vomiting, or diarrhea? Is there a fever?
• If you have had recent injuries or falls
• When you last had sex and if you bled afterward

What Should Happen Next?

You can watch at home a small amount of spotting without any other symptoms that occurs after having sex or an exam by your health care provider.

• Place a clean vaginal pad and recheck every 30 - 60 minutes for a while.
• If spotting or bleeding continues,call your health care provider. If the bleeding is heavy or your belly feels stiff and painful, or you are having strong and frequent contractions,you may need to call 911. 

For any other bleeding, you should call your health care provider right away.

• You'll be advised about whether you should go to the emergency room or to the labor and delivery area in your hospital.
• Your health care provider will also tell you whether you can drive yourself or should call an ambulance.

References

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 19.

Update Date: 9/18/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.