Bleeding During Pregnancy – 7 Causes Of Vaginal Bleeding

Bleeding During Pregnancy

It can be frightening if you experience vaginal bleeding during pregnancy. According to ACOG (American College of Obstetricians and Gynecologists), around 15-25% of pregnant women experience vaginal bleeding during early pregnancy.

However, blood loss in early pregnancy doesn’t always mean you could be experiencing a miscarriage.

Vaginal bleeding during pregnancy

To help you quickly access what you need to read the most, here’s a list of what you need to know about bleeding during pregnancy.

• Does vaginal bleeding during pregnancy always mean a miscarriage?
• 7 causes of vaginal bleeding during pregnancy
• How much bleeding during pregnancy is normal?
• When should I worry about bleeding during pregnancy?
• Heavy bleeding during pregnancy
• What should I do if I’m bleeding during pregnancy?
• What if i’m experiencing a miscarriage?

Does vaginal bleeding during pregnancy always mean a miscarriage?

No, vaginal bleeding during pregnancy doesn’t automatically mean you’ll experience a miscarriage.

According to a study, around 25% of participants reported vaginal bleeding during pregnancy, and 8% of women reported heavy bleeding.

Most incidences occurred between week five of pregnancy and week eight of pregnancy.

In most cases, the blood loss lasted no more than three days.

Of the women who experienced bleeding during pregnancy, 12% had a miscarriage, compared with 13% of women who did not bleed.

While most women will have one incidence of bleeding, a small number of women will bleed throughout their pregnancy. It can take the form of spotting, streaking, or period-like blood loss, with or without clots.

7 causes of vaginal bleeding during pregnancy

Below are seven of the most common causes for vaginal bleeding during pregnancy.

As you will see, it’s not always sinister. It’s also possible to experience mild cramping or stretching sensations during a healthy pregnancy.

But no matter if it’s early pregnancy or late in pregnancy, if you’re experiencing vaginal bleeding accompanied by strong cramping, speak to your doctor or midwife as soon as possible.

#1: Implantation Bleeding or Streaking

When a fertilised egg attaches to the uterine lining, it can result in light spotting or streaking (streaks of blood). Usually it lasts only a day or two and occurs around the time of implantation or when your period would have been due. Some women mistakenly think they have simply had a light period and don’t realise they are pregnant.

Find out everything you need to know about implantation bleeding.

#2: Breakthrough Bleeding

Some women experience what is known as ‘breakthrough bleeding’, during the times when a period would have normally been due. Therefore bleeding would appear at around 4, 8 and 12 weeks of pregnancy. It’s often accompanied by the feeling you would normally associate with your period being imminent, i.e. backache, cramps, a heavy sensation in the pelvis, feeling bloated and ‘off’.

Of course, because you are actually pregnant, your period doesn’t arrive (even though you feel like it will).

During pregnancy, hormones prevent your period from occurring. Sometimes, if the hormone levels are not yet high enough to stop your period, the result is breakthrough bleeding. It can last for about three months; after this time the placenta begins to take over hormone production from the ovaries.

Some women experience breakthrough bleeding throughout the pregnancy, and under the close watch of their carer, have healthy babies.

#3: Threatened or Actual Miscarriage

Studies indicate that around one third of pregnancies end in miscarriage.

That sounds like a huge number, but don’t despair. It refers to the first 12 weeks of pregnancy, and includes very early miscarriages which occur before a woman even realises she is pregnant. A miscarriage of this kind is often a result of a damaged fetus; it means a woman’s body is rejecting a pregnancy that’s unable to survive its complications. Find out more in our article about early miscarriage signs and symptoms.

During an ultrasound, if a heartbeat is seen, you can rest assured that 90% of women at this stage will not miscarry.

Once you have reached the 14-16 week mark, you can be fairly sure your pregnancy is safe.

Common signs of miscarriage include vaginal bleeding (most common), cramping, backache and stomach pains. Women commonly say that they no longer ‘feel pregnant’ when they have miscarried and are bleeding. If you are bleeding and feel this way, then chances are you have lost the baby. If you’re bleeding but still feel pregnant, the chances are very good that the bleeding is just a scare and your baby is fine. An ultrasound will usually be reassuringly normal.

#4: Bleeding After Sex

Bleeding after sex is one of the most common causes of bleeding during pregnancy. It’s completely harmless and is caused by increased blood supply and softening of the cervix.

Although this form of bleeding is not serious, you should always report it to your carer. When you phone the maternity ward, be prepared  for the very personal question, “Have you recently had sex?”

You don’t need to stop having sex, but you might need to reassure your partner that he hasn’t hurt the baby, who is safely protected in your uterus, well above the vagina.

Find out everything you need to know about Bleeding After Sex During Pregnancy.

#5: Ectopic Pregnancy

An ectopic pregnancy occurs when your fertilised egg implants itself outside the uterus, usually in a fallopian tube. You might experience severe pain down one side of your abdomen, or generalised pain which doubles you over, and you might feel faint and nauseous. The pain can  disappear suddenly if the tube ruptures but it will return within hours or days and you will feel really unwell.

This is an emergency situation. An ectopic pregnancy can rupture the fallopian tube and cause internal bleeding, damage to the tube and maternal collapse. Your fallopian tube might have to be removed, along with the pregnancy, but it does not mean you will have trouble conceiving in future, provided your other ovary and fallopian tube are healthy.

For more information, read our article on Ectopic Pregnancy.

#6: Bleeding From The Placenta

Painless vaginal bleeding can result from an abnormally placed placenta. It’s not uncommon to have a low-lying placenta in early pregnancy. More often than not, late in the third trimester, the placenta would have moved out of the way as the uterus grew upwards. In a small amount of cases, the placenta does have some problems, often causing vaginal bleeding.

Below are three different placental issues which can result in vaginal bleeding.

Placenta previa

Placenta previa occurs in about 0.5% of pregnancies. This occurs when the placenta implants itself partially or fully over the cervix.

Placenta previa will inevitably result in vaginal bleeding at some point in your pregnancy – usually after the 20 week mark. There are differing degrees of severity, but they all require repeat ultrasounds for an accurate diagnosis. To prevent risk to your baby, the condition might require bed rest, an induction or c-section if the placenta remains over the cervix in the remaining weeks of pregnancy.

Find out more about placenta previa

Placental abruption

Another cause of vaginal bleeding later in pregnancy is placental abruption, where the placenta partially or completely separates from the wall of the uterus. It occurs in approximately 1 in 200 (0.005%) pregnancies. Symptoms include generalised severe pain and heavy bleeding. The blood might be visible or concealed in the uterus, which will be tense, tight, hard to the touch and very painful.

If you smoke, or have high blood pressure, kidney problems or pre-eclampsia, you are more at risk. The condition requires urgent admission to hospital, and depending on the severity of the bleeding, you might be prescribed bed rest, an induction or a c-section.

Placenta accreta

Especially if you’ve had a previous c-section or other procedures in your uterus, vaginal bleeding may be caused by placenta accreta. Rates of placenta accreta are on the increase, as c-section rates around the world are significantly increasing.

Find out more about placenta accreta.

#7: Uterine Fibroids

Uterine fibroids are masses of compacted muscle and fibrous tissue, which can be found inside or outside the uterine wall. They can be either problematic or unproblematic during pregnancy – it mainly depends on the location of the fibroids and if they grow or not. Experts aren’t sure why, but pregnancy hormones can cause fibroids to either shrink or grow.

Fibroids are best removed prior to a pregnancy, because worst case, they can cause ectopic pregnancy, heavy bleeding and pregnancy loss. However, many women are able to give birth without any problems too.

If you have uterine fibroids, it’s important to see a specialist to manage your individual case and suggest what to do next. Avoid cures found on the internet – you really need to see a specialist to receive a proper assessment of the situation.

Read more about fibroids during pregnancy.

How much bleeding during pregnancy is normal?

If you’re bleeding during pregnancy, you might be wondering exactly how much vaginal bleeding is normal.

Vaginal blood loss in any trimester can be a sign of problems or complications, so it’s important to report any bleeding to your healthcare provider as soon as possible.

Yes, first trimester spotting or light bleeding is common, and many women do go on to have healthy pregnancies. But common does not mean normal – you won’t know that until you see your healthcare provider.

Vaginal bleeding during pregnancy in the second and third trimesters are not normal. Any vaginal blood loss in the second and third trimesters should be treated seriously – seek medical advice immediately.

When should I worry about bleeding during pregnancy?

Firstly, all and any vaginal bleeding during pregnancy should be reported to your doctor or midwife. This not only ensures you and your baby’s health are being monitored, but it will give you peace of mind.

If you’re experiencing period-like blood loss or if you’re in the second or third trimester of pregnancy, contact your healthcare provider immediately.

You especially need to see a doctor or midwife within 72 hours of any bleeding if you have a rhesus negative blood group (e.g. O- or A-).

The reason for this is to check whether your baby’s blood may have mixed with yours. If the blood has been mixed, and your baby is rhesus positive (e.g. O+ or A+) your body will see this as foreign matter and produce antibodies. In future, these antibodies will attack a baby with positive blood, if you have any subsequent pregnancies.

Find out more in our article about rhesus negative blood groups during pregnancy for more information.

Heavy bleeding during pregnancy

If your vaginal bleeding is heavy (i.e. flowing out and you are passing clots) and if it’s accompanied by stomach cramps, backache and period-like pain, contact your hospital immediately.

Quite understandably you will be upset, but try to remain as calm as you can, and remind yourself that bleeding can occur during pregnancy.

Remember, it is your blood, not the baby’s blood you’re seeing, and it’s quite possible to continue with a healthy pregnancy.

What should I do if I’m bleeding during pregnancy?

If you’re in your second or third trimester, seek medical advice immediately.

In order to avoid any infections, do not use tampons if you experience bleeding during pregnancy; always use pads. If the bleeding is light and you have no pain, contact your midwife or obstetrician to discuss the next step.

Once you’ve been checked by a medical professional, you could seek out an experienced acupuncturist who is a specialist in fertility or pre-natal care. There are some points that can be treated to help you with vaginal bleeding. Acupuncturists work with patients who have had recurrent or threatened miscarriage so it might be worth a try. It’s a safe, natural and healthy option.

What if i’m experiencing a miscarriage?

If you’re experiencing a miscarriage, unfortunately nothing can prevent it from occurring. Although a miscarriage can be disappointing, upsetting and emotionally painful, there’s nothing you can do but take care of yourself emotionally and physically.

You are not responsible for a miscarriage happening, and you have not done anything to cause it. You cannot prevent a miscarriage from occurring, but there are things that will help you to feel more physically comfortable.

• Bedrest
• Paracetamol/Panadeine/Naprogesic (a drug designed for period pain) for the cramps
• Hot water bottle for your tummy
• Tea and support from your partner

You might pass the developing fetus and other tissue, then the bleeding will then stop. But if you continue to bleed, you will need an anaesthetic and a curette to ‘clean out’ your uterus.

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