Vaginal bleeding in late pregnancy
There are many possible causes of bleeding during pregnancy. Bleeding should always be evaluated by a health care provider.
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 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
- If you're feeling the baby move
- If you've had other complications during the pregnancy
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, contact 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.
References
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.
Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 173.
Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic hemorrhage, and abruptio placentae. In: Lockwood CJ, Copel JA, Dugoff L, et al, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 43.
Version Info
Last reviewed on: 11/8/2024
Reviewed by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
