Up to 10% of women have vaginal bleeding at some time during their pregnancy, especially in the first trimester (first 3 months). Bleeding is even more common with twins.

To help prevent a miscarriage or other problems during pregnancy, avoid smoking and the use of drugs of any kind, including alcohol. Eat a well-balanced diet, and obtain regular medical checkups.

Any vaginal bleeding at any point in pregnancy should always be reported to your doctor.

Vaginal bleeding during the first 3 months of pregnancy may be an indication of a spontaneous abortion (miscarriage). See the doctor immediately.

Vaginal bleeding during the fourth to ninth month of pregnancy may be caused by a miscarriage, but may also be an indication of abnormal location of the placenta, such as placenta previa or abruptio placentae.

An ectopic pregnancy, in which the embryo becomes implanted outside the uterus, is often accompanied by unexpected vaginal bleeding and severe abdominal pain. Ectopic pregnancy is sometimes associated with current use of an IUD.

A cervical infection can cause bleeding at any time, including during pregnancy.

Trauma to the cervix from intercourse may cause a small amount of bleeding.

Early labor is sometimes accompanied by a small amount of bleeding (bloody show).

Note: There may be other causes of vaginal bleeding in pregnancy. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on the age of the woman, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints.

Any bleeding during pregnancy should be evaluated by your health care provider. For a threatened miscarriage, follow the doctor's orders. Bed rest is often recommended to stabilize the pregnancy. Medication is usually not necessary. Don't take any medication without consulting the doctor. Avoid sexual intercourse until the outcome is known. Drink only fluids if the bleeding and cramping is severe.

If a miscarriage occurs, expect a small amount of vaginal bleeding for up to 10 days. Avoid using tampons for 2 to 4 weeks. Wait through 2 or 3 normal menstrual cycles before attempting to become pregnant again.

For vaginal bleeding caused by placenta previa, get to the hospital immediately. Bed rest in the hospital, at least until bleeding stops, is mandatory, and a cesarean section is likely if it is close to the delivery date, or if the bleeding persists.

For bleeding caused by an ectopic pregnancy, surgery or medical treatment to remove the growing embryo and control internal bleeding is likely to be needed.

Vaginal or cervical infection is treated with antibiotics that are safe for a developing fetus.

• There is any vaginal bleeding during pregnancy, or go directly to the hospital. Treat this as an emergency!

The medical history will be obtained and a physical examination performed.

Medical history questions documenting the vaginal bleeding during pregnancy in detail may include:

• Time pattern
  • Has bleeding occurred before during this pregnancy?
  • When did the bleeding begin?
  • Has it been constant since the beginning of the pregnancy?
  • How far along is the pregnancy?
• Quality
  • How much bleeding is present?
  • Is cramping present?
• Aggravating factors
  • Has there been an injury such as a fall?
  • Have there been changes in physical activity?
  • Has there been additional stress?
  • Did the bleeding occur during or after sexual intercourse?
• Relieving factors
  • Does rest reduce or stop the bleeding?
• Other
  • What other symptoms are also present?
  • Is there a fever?
  • Is there a known illness?
  • Are there cramps?
  • Is there other abdominal pain?
  • Is there weakness or increased fatigue?
  • Is there fainting or dizziness?
  • Is there nausea, vomiting, or diarrhea?
  • Are there changes in urination?
  • Are there changes in bowel movements?
• Additional important information
  • Is there an IUD in place?
  • What medications are being taken?
  • Have you had previous problems during pregnancy?
  • Has there been recent vaginal penetration during sexual activity?
  • Has there been a change or increase in physical activities?

The physical examination will probably include a pelvic examination.

Diagnostic tests that may be performed include:

• Blood tests
• Ultrasound of the abdomen or pregnancy ultrasound

Intervention:
If there is a miscarriage, antibiotics may be prescribed to fight infection, and blood transfusions may be ordered if there is severe blood loss.

After seeing your health care provider:
You may want to add a diagnosis related to vaginal bleeding in pregnancy to your personal medical record.