Vaginal bleeding in late pregnancy
One out of 10 women will have vaginal bleeding during their 3rd trimester. At times, it may be a sign of a more serious problem. In the last few months of pregnancy, you should always report bleeding to your health care provider right away.
You should understand the difference between spotting and bleeding:
- Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.
- Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.
When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood 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 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 Health Care Provider
To find the cause of your vaginal bleeding, your provider may need to know:
- 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 whether it is spotting or a heavier flow
- The color of the blood (dark or bright red)
- If there is an odor to the blood
- If you have fainted, felt dizzy or nauseated, vomited, or had diarrhea or a fever
- If you have had recent injuries or falls
- When you last had sex and if you bled afterward
What Should Happen Next?
A small amount of spotting without any other symptoms that occurs after having sex or an exam by your provider can be watched at home. To do this:
- Put on a clean pad and recheck it every 30 to 60 minutes for a few hours.
- If spotting or bleeding continues, call your provider.
- If the bleeding is heavy, your belly feels stiff and painful, or you are having strong and frequent contractions, you may need to call 911 or your local emergency number.
For any other bleeding, call your provider right away.
- You will be told whether to go to the emergency room or to the labor and delivery area in your hospital.
- Your provider will also tell you whether you can drive yourself or you should call an ambulance.
Baeseman ZJ. Vaginal bleeding in pregnancy. In: Kellerman RD, Rakel DP, eds. Conn's Current Therapy 2021. Philadelphia, PA: Elsevier 2021:1227-1229.
Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.
Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 46.
Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.