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What causes vaginal bleeding during pregnancy? How do you know if it is serious and when should you do something about it?

When you’re pregnant, even the smallest amount of vaginal bleeding can be frightening. However bleeding does not always signal trouble. In fact, many pregnant women experience light vaginal bleeding at some point during their pregnancy, especially during the first trimester. Often, such bleeding is the result of a normal event during pregnancy, such as the embryo’s implantation in the uterine lining a little over a week after conception.

Don’t panic if you experience vaginal bleeding during your pregnancy but at the same time bleeding should always be taken seriously when you are pregnant. Monitor your bleeding closely and take note of related symptoms, such as abdominal cramping. By understanding the most common causes of bleeding during pregnancy, you’ll know what to look for and when to call your healthcare provider.

Bleeding in the first trimester

Many women have spotting or bleeding in the first 12 weeks of pregnancy. In most cases, women who experience light bleeding in the first trimester go on to have normal, successful pregnancies. There is no rule about how much you are bleeding but take note anyway as you will need to tell your healthcare provider about your bleeding and any other symptoms you may be experiencing.

What causes it?
Common causes of early pregnancy bleeding include:

  • Implantation bleeding. Implantation bleeding causes spotting or bleeding 10 to 14 days after fertilization. It happens when the fertilized egg attaches to the lining of your uterus. It’s usually earlier, spottier and lighter in color than a normal menstrual period, and it doesn’t last long. Some women actually mistake this light bleeding for a period and don’t realize they’re pregnant.
  • Cervical changes. When you’re pregnant, there’s an increase in the blood supply and blood flow to your cervix. So you may experience light spotting after contact to this area, such as after sexual intercourse or a pelvic exam. This type of light bleeding in pregnancy is usually normal.
  • Miscarriage. Bleeding in the first trimester can be a sign of miscarriage. Miscarriage occurs most often in the first 12 weeks of pregnancy. 15 to 20 percent of known pregnancies end in miscarriage. However, bleeding doesn’t necessarily mean you’re having a miscarriage — at least half the women who bleed in the first trimester don’t have miscarriages.
  • Ectopic pregnancy. This condition occurs when the embryo implants in a fallopian tube or somewhere outside the uterus. It’s much less common than miscarriage. An embryo implanted outside the uterus can’t develop into a normal baby, and it can cause serious internal bleeding. Ectopic pregnancies must be removed to save the life of the mother. Other symptoms of ectopic pregnancy include abdominal pain, which is usually worse on one side, lightheadedness and an urge to have a bowel movement.
  • Molar pregnancy. In this rare condition, an abnormal mass — instead of a baby — forms inside the uterus after fertilization. Bleeding is the most common symptom of a molar pregnancy. This is an uncommon cause of bleeding in the first trimester.
  • Other reasons not related to pregnancy. Trauma or tears to the vaginal wall can also cause spotting and bleeding. Some cervical infections also may cause bleeding in early pregnancy.

When to call your health care provider and what to expect

If you have slight spotting that goes away within a day, tell your healthcare provider at your next visit. If you have any spotting or bleeding that lasts more than a day, call your healthcare provider within the next 24 hours. Contact your healthcare provider immediately if you have:

  • Moderate to heavy bleeding
  • Any amount of bleeding accompanied by pain, cramping, fever or chills
  • Passing of tissue from the vagina

Your healthcare provider will likely perform a physical exam, including a pelvic exam. Depending on the seriousness of your symptoms, your healthcare provider may order tests or an ultrasound to assess the status of your pregnancy. These tests can detect the presence of an embryo that has a heartbeat and determine if it’s growing according to schedule. Treatment for spotting or vaginal bleeding in early pregnancy depends on the cause.

Bleeding in the second or third trimester

Common conditions, such as cervical growths or inflammation, can cause minor bleeding in the second half of pregnancy. But bleeding can also pose a threat to your health or the health of your baby. The most common cause of heavy vaginal bleeding in late pregnancy is a problem with the placenta, such as placenta previa or placental abruption.

What causes it?
Bleeding in the second trimester may come from:

  • Miscarriage. Although miscarriage is less common in the second trimester than the first, a risk still exists.
  • Problems with your cervix. A cervical infection, inflamed cervix or growths on your cervix can cause vaginal bleeding in the second or third trimesters. Occasionally, light bleeding from the cervix may be a sign of cervical incompetence — a condition in which the cervix opens spontaneously, leading to preterm delivery. This condition occurs most frequently between 18 and 23 weeks of pregnancy and requires prompt medical care.
  • Placenta previa. Moderate to heavy bleeding in the late second or third trimester may indicate placenta previa — a problem in which the placenta lies too low in the uterus and partly or completely covers the opening to the birth canal. The main sign of placenta previa is painless bright red vaginal bleeding. The bleeding may stop on its own at some point, but it nearly always recurs days or weeks later. This is a serious condition that requires immediate care. It occurs in one in every 200 pregnant women, most often in the third trimester.
  • Placental abruption. In this condition — which affects only 1 percent to 2 percent of pregnant women — the placenta begins to separate from the inner wall of the uterus before birth, causing bleeding within the uterus. The bleeding from placental abruption may be scant, heavy or somewhere in between, but it’s usually accompanied by abdominal pain. This condition usually occurs in the last 12 weeks of pregnancy.
  • Uterine rupture. In women who have had a previous Caesarean birth, a disruption of the surgical scar in the uterus is a rare but dangerous cause of vaginal bleeding, intense abdominal pain and abdominal tenderness. It causes the baby to be partially or completely expelled into the abdomen.
  • Preterm labor. Light bleeding from 20 to 37 weeks may indicate preterm labor, especially when accompanied by pelvic or abdominal pressure, dull backache, abdominal cramps or uterine contractions. If you have any signs or symptoms of labor before 36 weeks, call your health care provider right away.
  • A sign of labor (bloody show). During pregnancy, a thick plug of mucus seals the opening of the cervix to prevent bacteria and other germs from entering the uterus. As your body prepares for labor, the cervix begins to thin out and relax, and the mucous plug is dislodged. When this happens, you may notice a thick or stringy discharge that may be tinged with blood. Known as the bloody show, this is a normal sign of labor that may occur up to a week or two before delivery day.

When to call your health care provider and what to expect next

See your healthcare provider if you have any spotting or bleeding in the second or third trimester. See your health care provider immediately if you have any amount of bleeding accompanied by:

  • Pain
  • Cramping
  • Fever
  • Chills
  • Contractions

Many times, there will be an explanation for the bleeding that isn’t threatening to you or your baby but it is important to find out the cause of this bleeding to make sure that you and your baby are not at risk

Your doctor will likely suggest an ultrasound to check for placenta previa. If placenta previa is ruled out, you’ll have a vaginal exam to see if your cervix is dilated. You may also be hooked up to monitors that can detect contractions and track your baby’s heart rate.

Treatment for vaginal bleeding in late pregnancy depends on the cause of the bleeding, your health and the gestational age of your baby. Treatment may include bed rest, medications or even urgent delivery of your baby.

Details are key to diagnosis

Although you may be embarrassed to talk about vaginal bleeding, your health care provider has to know all the details so that he or she can identify the cause of the bleeding and the necessary next steps. Don’t be shy about explaining your symptoms — including how much blood you passed, what it looked like, and whether it included any clots or tissue. If you use pads to soak up the blood, keep track of how many. All this information can help your health care provider decide if your spotting or bleeding is a normal part of pregnancy or something more serious. Then, the two of you can decide what to do next.

Cramping during pregnancy:

  • Implantation cramping. Some women will experience cramping upon implantation. Implantation usually occurs 8-12 days after ovulation. You should not experience implantation cramping after a positive pregnancy test, however many woman experience cramping throughout their pregnancies for other reasons.
  • Stretching of the uterus. As your body prepares for it’s new baby your uterus will stretch and expand. The ligaments that support the uterus will stretch and with this stretching may cause mild cramps. This is the most common cause of pregnancy cramps.
  • Miscarriage. Cramping during early pregnancy, especially accompanied by spotting or bleeding, is a warning sign of a possible miscarriage.
  • Ectopic pregnancy. Ectopic pregnancy is a serious condition and requires immediate medical attention. Signs of an ectopic pregnancy include cramping and abdominal pain (particularly on one side), spotting, or bleeding.
  • Other causes. Constipation or pains due to gas. This is very common in pregnant woman.

Causes of Cramping During Your Second & Third Trimester

  • Round ligament pain – The infamous round ligament pain strikes pregnant women often in their second and third trimester. As in early pregnancy the uterus continues to stretch and grow. As the uterus expands the ligaments stretch to support it. Mild cramping may occur.
  • Pre-term labor – Cramping, mild or severe, diarrhea, and back pain can all be indicators of pre-term labor.
  • Braxton Hicks contractions – In the second and third trimester pregnant women will often have Braxton Hicks contractions.. Braxton Hicks contractions are the irregular intermittent contractions that occur during pregnancy, natures way of preparing you for the real thing.
  • Labor – During early labor cramping is a common symptom.

Whenever you have any bleeding or cramps during your pregnancy you should always see your healthcare provider about it as it can lead to or be something serious.

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