Bleeding in Pregnancy

Bleeding in Pregnancy 20 weeks and over

Although bleeding in pregnancy can be very frightening for women, it is fairly common. It doesn’t always mean that there is a problem.

There are many different causes of bleeding in later pregnancy and some of these need to be investigated by your maternity hospital to monitor your baby to rule out any problems.

You are at more likely to have episodes of bleeding during pregnancy if you are a smoker. There are many health benefits to stopping smoking and you can get support to quit from your midwife.

Causes of bleeding in later pregnancy

Cervical changes

Pregnancy can cause normal changes to the surface of the cervix. These can lead to bleeding or “spotting”, particularly after sex. Sex is not harmful during pregnancy, but in some instances, your doctor may advise you to avoid it. 

A "show" This is when the plug of mucous that has been in the cervix during pregnancy comes away, signalling that the cervix is getting ready for labour to start. It may happen a few days before contractions start or during labour itself.

Low-lying placenta (placenta praevia)

This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy, and can put you and your baby at risk.

You may be advised to go into hospital for emergency treatment, and a caesarean may be recommended.

Placental abruption

This is a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes constant abdominal pain, and this may occur even if there is no bleeding.

Vasa praevia

This is a rare condition where the baby's blood vessels run through the membranes covering the cervix. This is usually detected at your 20week ultrasound scan and discussed with you at the time.

When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can potentially lose a life-threatening amount of blood.

Call 999 if you have any of the following:

  • Severe abdominal pain with vaginal bleeding (fresh bleeding, rather than a blood stained mucous show)

  • Signs that you may have lost a lot blood: (rapid heart rate, quick/ shallow breathing, feeling increasingly weak and tired, cool/ clammy skin, confusion or wooziness 

Contact your maternity unit immediately if you have any of the following:

  • Fresh (bright red) vaginal bleeding

  • Abdominal pain

  • Reduced or no baby movements

  • If you have been told that your placenta is low

  • Rhesus negative blood group, or you don’t know your blood group

  • Previous preterm birth before 34 weeks

  • Baby movements that are normal for you.

  • Minimal/ slight blood loss on wiping after using the toilet

  • Pink/ brown discharge

  • Small amount of blood after sex (spotting)

  • Blood stained mucous around the time of your due date is call a “show” and is a sign your body is preparing for the birth, (although not a sign it will happen straight away).

Self care

Please keep an eye on your blood loss by wearing a maternity sanitary pad.

Contact your maternity unit if you are still worried.

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