Vaginal bleeding in pregnancy

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Anatomy of a normal placenta	Female reproductive anatomy	Placenta previa	Ultrasound in pregnancy
Vaginal bleeding during pregnancy

Pregnancy - vaginal bleeding; Maternal blood loss

Any bleeding during pregnancy should be evaluated by your health care provider. For a threatened miscarriage, follow the doctor's orders. Medication is usually not necessary -- don't take any medication without consulting the doctor. Avoid sexual intercourse until the outcome of the bleeding 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. 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 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 present?
  • Is there a fever?
  • Is there a known illness?
  • 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 a pregnancy?
  • Has there been recent vaginal penetration during sexual activity?

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.

Review Date: 05/23/2006
Reviewed By: Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network