Bloody discharge during pregnancy in the 1st, 2nd, 3rd trimesters

Women, as a rule, are anxious about their pregnancy. During this period, they should worry not only about their health, but also about the normal bearing of the fetus. Discharge at any stage of pregnancy can cause anxiety: what’s wrong?

The main causes of spotting during pregnancy can be fetal abruption, placenta previa, premature placental abruption and hemostasis disorders. 

It is definitely not worth underestimating the discharge with an admixture of blood. But there is no need to panic. In the absence of additional symptoms, you can visit the antenatal clinic on your own, with bleeding, associated pain, call an ambulance.

Causes of spotting during different periods of pregnancy

Why do spotting appear during early pregnancy

The World Health Organization (WHO) classifies any spotting that occurs before the 22nd week of gestation as bleeding. But not all of them signal something bad. 

For example, at the time of attachment of a fertilized egg to the endometrium, a small amount of blood may be released. This phenomenon is called “implantation bleeding”, it is not dangerous, on the contrary, it is considered one of the first signs of conception. 

But some pathologies can provoke a large blood loss and termination of pregnancy.

1 trimester

In addition to implantation bleeding, there are other causes of spotting during early pregnancy (2):

• ectopic pregnancy;
• spontaneous miscarriage (threatening abortion, started abortion, completed abortion);
• non-developing pregnancy;
• cystic drift;
• detachment of the fetal egg.

Depending on the nature of the pathology, the discharge can vary greatly in intensity, duration and color. In addition, each condition has other symptoms. Let’s talk about the most common causes of bleeding.

Ectopic pregnancy

In the structure of gynecological morbidity, ectopic pregnancy takes up to 10% (1). In this case, the fertilized egg does not mature in the uterus, as expected, but outside it: in the fallopian tube or in the cervix. 

An ectopic pregnancy can be suspected when a period is delayed, and bleeding (usually spotting brown discharge) is one of the symptoms of its interruption. There may be other signs: pain in the lower abdomen and a fusiform formation detected by ultrasound in the region of one of the uterine appendages. 

In this case, surgery is most often needed. But if the operation is not possible, medical treatment is used.

Detachment of chorion and ovum

In the normal course of pregnancy, a fertilized egg (fetal egg) attaches to the walls of the uterus and continues to grow and develop. Around it is placed the chorion – the precursor of the placenta. 

You need to understand that the uterus is contracting, since it is a muscular organ, but the chorion is not. And it happens that with a strong contraction (for various reasons), the chorion or the fetal egg can detach (partially or completely) from the uterine wall. In this place, a retrochorial hematoma, that is, blood clots, is formed.

Symptoms can be pulling pains in the lower abdomen, spotting. 

If a woman is provided with medical care on time, there are great chances to keep the pregnancy. 

Spontaneous abortion (miscarriage)

Such a pathology in statistics is listed in 15-20% of clinically diagnosed cases of pregnancy. The vast majority of spontaneous miscarriages occur in the first 8–10 weeks (3). 

Causes leading to spontaneous abortion can be endocrinopathy, immunological problems, infections, uterine malformations and uterine fibroids, gene or chromosomal problems. It can be provoked, for example, by excessive physical activity. 

Spontaneous abortion includes three diagnoses (in fact, stages): a threatened abortion, an abortion that has begun, a miscarriage “in progress” or a completed one. 

An incomplete abortion is also sometimes noted: when parts of the fetal egg remain in the uterus.

The following symptoms may indicate a threatened miscarriage (4):

• pulling pains in the lower abdomen and in the lower back;
• scanty spotting;
• increased uterine tone;
• fetal heart rate on ultrasound.

With this diagnosis, treatment usually includes: sexual and physical rest, antispasmodics and sedative drugs. But first of all it is necessary to stop the bleeding.

If in the early stages there was a threat of miscarriage, then special care must be maintained at a later date.

Non-developing pregnancy (antenatal fetal death)

We are talking about this pathology if the embryo or fetus dies for up to 20 weeks.

Reasons can be (5):

• fetal chromosomal abnormalities
• extragenital pathology,
• sexually transmitted infections,
• inflammatory diseases of the pelvic organs,
• anomalies in the development of the uterus.

Other risk factors: multiple abortions, miscarriages and miscarriages.

Bloody discharge during non-developing pregnancy is not abundant, accompanied by slight pain in the lower abdomen.

A frozen pregnancy differs from a spontaneous miscarriage in that the fetus remains in the uterus. Therefore, medical intervention is necessary to remove the dead fetus and prevent complications. 

Bubble drift 

Another name is trophoblastic disease. It can be confused with spontaneous abortion, however, small bubbles are noticeable in the bloody discharge – these are dilated villi of the chorion (placenta) (1). In addition, this pathology is evidenced by an excessively enlarged uterus, the absence of an embryo in the uterine cavity, and a high level of beta-hCG. 

In such a situation, emptying of the uterine cavity is required, followed by curettage of its walls.

Why do spotting occur during late pregnancy

At a later date, as at the beginning of pregnancy, a woman may find spotting. Some of them are due to natural causes and are not dangerous at all. But this does not mean that blood impurities in the secretions can be ignored. It is important to understand that many pathologies and diseases are accompanied by spotting or even heavy bleeding. Therefore, if you notice something is wrong, you should consult your doctor. 

2 trimester

Before 22 weeks of pregnancy, spotting can be due to a variety of conditions, most commonly (2):

• placental abruption (without the formation of hematomas or with the formation of a retroplacental hematoma);
• placenta previa or low attachment;
• decidual reaction of the empty uterine cavity (when there is a doubling of the uterus, with a bicornuate uterus);
• antenatal fetal death in multiple pregnancies.

But there may be discharge that is not associated with diseases. 

So, with the development of the fetus, an increasing load is experienced by the internal organs of a woman, primarily the uterus. In the second trimester, any irritating factors (examination by a gynecologist, sexual intercourse) can provoke spotting. As a rule, they are not abundant, brown in color and stop on their own within 1-2 days. 

But if the discharge does not stop, other symptoms have appeared – this is an occasion to immediately consult a doctor. 

Consider the problems that are accompanied by the appearance of spotting.

Placental abruption

Premature abruption of a normally located placenta (PONRP) is rare: 0,4-1,4% (6). Nevertheless, this is a dangerous pathology, as a result of which large bleeding, hemorrhagic shock and DIC can occur. 

PONRP may be mild, with some bleeding and slight uterine tension. In a severe form of this pathology, significant pain syndrome, uterine hypertonicity, weakness, dizziness, vomiting, rapid breathing, and a decrease in pressure (BP) can be observed. 

By the way, PONRP is not always accompanied by external secretions – in some cases, only internal bleeding is noted. 

In severe cases of progressive placental abruption, an urgent caesarean section may be prescribed. In a mild form, under favorable conditions, natural childbirth is possible.

placenta previa

This is a pathology in which the placenta is located too low – so that it actually blocks the birth canal for the fetus. The main symptom is recurrent bleeding from the vagina, which occurs in about 34% of cases (7). Bloody discharge can appear at any time during pregnancy, but more often in the second half, and in the last weeks may increase.

This is due to the fact that the placenta cannot stretch following the wall of the uterus, and any sudden movement / intervention (even coughing or defecation) can provoke bloody discharge from the genital tract.

Signs of such bleeding are: 

• bright scarlet blood;
• suddenness and lack of obvious reasons;
• absence of pain;
• repeatability. 

As a rule, patients are prescribed rest, restrictions on physical activity (and in the intimate sphere), and medications, including hemostatic ones. Such conservative methods of treatment are aimed at the main task – to save the pregnancy. But only if the satisfactory condition of the woman and the fetus allows. 

Placenta accreta and, as a result, attempts to separate it, increased bleeding, may require surgical intervention (1). 

3 trimester

About half of all bleeding events occur during the third trimester of pregnancy (8). The reasons may be the same as in the second and first trimesters. Most often it is premature detachment of a normally located placenta and placenta previa. 

In addition, spotting in the third trimester can cause other causes that are completely harmless.

Natural removal of the mucous plug

The non-dangerous causes of spotting include the discharge of the mucous plug. 

The cervical mucous plug performs a protective function: that is, together with the placenta and fetal membranes, it protects the fetus from harmful microorganisms. Shortly before childbirth, the cork usually separates on its own. In the mucus on the underwear, a pregnant woman may notice an admixture of blood. Such spotting is not dangerous, they can be regarded as a signal to “get ready”: usually after a few days, childbirth begins.

Preeclampsia

Preeclampsia is of great importance in the third trimester. This complication may occur after 20 weeks or during labor and persists for 1–2 days postpartum (9). 

Preeclampsia is characterized by a profound disruption of all metabolic processes in the body, a change in the activity of the vascular and nervous systems, a dysfunction of the placenta, as well as vital organs (liver, kidneys, etc.). Outwardly, this is manifested by edema, a persistent increase in blood pressure, and protein is found in urine tests.

At the first symptoms, you should consult a doctor. It is often possible to be treated at home, but for their own peace of mind, many pregnant women prefer to lie down in a hospital, under the supervision of doctors.

Rupture of the uterus

Also, the cause of bleeding in the 3rd trimester may be uterine rupture. These events are rare in practice, with most cases of uterine rupture occurring in the presence of a scar from previous surgery (caesarean section, tube removal, or other) (10). Doctors always take into account such moments in the anamnesis of a woman. 

Alarming symptoms: sharp cramping pains, difficulty urinating, sharp pain on palpation of the uterus, spotting, blood in the urine. 

Pathology also has several stages: a threat, a break that has begun, and a break that has taken place. Therefore, when symptoms appear, emergency help is needed.

Cervical erosion

This is not dangerous, in general, a phenomenon characterized by a change in the cellular composition of the mucous membrane of the cervical canal. Cervical erosion in pregnant women is observed in 20-40% of cases (11), it can occupy the entire surface of the cervix or part of it. Such areas differ in appearance in color and texture, and on contact they bleed easily. Therefore, a woman can observe spotting even after manipulations performed by a gynecologist or after sexual intercourse.

After pregnancy, erosion can go away on its own.

What to do with the appearance of spotting during pregnancy at home

First you need to pay attention to the nature of spotting: color, volume, intensity. If it is spotting dark color before 12 weeks of gestation, observe during the day. Then be sure to schedule a visit to the doctor and conduct an ultrasound.

If spotting occurs for more than 12 weeks, immediately consult a doctor, also conduct an ultrasound scan. If the blood is bright in color, the discharge is accompanied by pain, other symptoms, at any time it is necessary to immediately seek help.

Until the arrival of an ambulance, you need to ensure peace, no hemostatic agents can be used on their own.

Popular questions and answers

How to act with spotting, tells obstetrician-gynecologist, ultrasound specialist Ekaterina Volkova.

Sources of

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