When to call the doctor

Bleeding

Leftover period

The process of menstruation is the shedding of the uterine wall. Sometimes bleeding can occur in the first trimester from part of the lining of the uterine wall that did not shed in months past. If this occurs there will be no cramping. You should note the color, the amount and whether it is clotted blood or not, then report it to your health care provider.

Implantation

Sometimes a very slight spotting may occur when the fertilized egg attaches to the uterine wall. There will be no cramping. Again, the color and amount should be noted and reported to your health care provider.

Cervical abrasion

During pregnancy, the cervix becomes puffed up with the increased blood supply – it is more fragile and prone to bleeding. Some women may notice a small amount of bright red spotting after intercourse – this is not unusual. Intercourse may have to be toned down a little, with less passion and less penetration. For your own protection any bleeding should be reported to your health care provider.

Placental tears

In the first trimester, it is possible for a small piece of the placenta to separate from the uterine wall. This will cause some bright red bleeding. This should not be confused with the very serious placental tears that occur in the third trimester, like placenta previa, marginal previa, and placenta abruption . Just the same, report any bleeding to your health care provider.

Miscarriage

The first trimester is when most miscarriages occur. Sometimes the bleeding can be a sign of a threatened miscarriage and the pregnancy will be labeled ‘high risk.' Other times, a miscarriage is inevitable because once the bleeding begins the fetus stops growing. Your health care provider can best evaluate the cause of the bleeding.

Ectopic pregnancy

An ectopic pregnancy occurs when the fertilized egg implants and starts to grow outside the uterus. This can be a dangerous, even life-threatening, situation for the mother. The embryo must be removed. Most of these pregnancies are diagnosed before 8 weeks of pregnancy, and present with persistent belly pain and/or bleeding. Emergency treatment is always necessary.

Incompetent cervix

This usually occurs about the fourth month. The cervix dilates prematurely, the amniotic sac and the fetus drop down by the force of gravity, pulling away from the uterine wall and passing through the cervix. This results in loss of the pregnancy. Fortunately, in subsequent pregnancies, a procedure called cervical cerclage sews the cervix closed so the baby may be carried to term.

Placenta previa

Placenta previa is the most common cause of bleeding during the third trimester. The placenta normally grows high in the uterine wall, but in this condition the placenta partially or fully covers the cervix. In the third trimester, as the cervix softens and dilates, there is an increased risk of serious bleeding. Hospitalization is sometimes required to monitor the mother and baby. If there is any danger to the mother or child, or when baby reaches term, the baby will be delivered by cesarean section.

Marginal previa

Marginal previa occurs when the placenta is located near but does not cover the cervix. Bleeding occurs from the stretching of the cervix. An ultrasound is usually done to see the position of the placenta. Usually, vaginal delivery can still be done safely.

Placenta abruption

This occurs in about 1 in 150 pregnancies during the third trimester. This is a tearing away of the placenta from its attachment area on the uterine wall. Tears can be small, medium or large – and they may be accompanied by mild to heavy vaginal bleeding – but sometimes the torn placenta covers the cervix and the blood doesn’t pass through the vagina. A decrease in the quality or quantity of fetal movements may also be a sign of trouble. If the placenta tears away – the blood supply doesn’t get to the baby. It may also cause a serious hemorrhage of the mother’s blood where the separation occurs. Abruption is a medical emergency, if you experience heavy vaginal bleeding, call 911 or your local emergency medical service – do not drive yourself to the hospital.