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Bleeding between weeks 12+0 – 21+6

Some reminders about bleeding - bleeding is common in early pregnancy and does not necessarily mean there is a problem. - it is not always possible to find the cause of the bleeding. - there is nothing you can do to prevent bleeding.

Check the color!

  • fresh bleeding is light red to dark red.
  • reddish brown bleeding means that the bleeding started earlier and has ended.

Check the volume!

  • bleeding is considered heavy when you saturate a pad in one hour or if you experience clotting.
  • if you are spotting and feel well otherwise, you do not need to seek emergency medical care. However, most healthcare providers in the US recommend that you contact your prenatal clinic/maternity clinic for advice if you experience any bleeding after week 12 for further evaluation.

If you are experiencing any of the following symptoms, seek emergency care immediately: - if you are bleeding, regardless of the volume, and have severe abdominal pain, either on one side or your lower abdomen. - if you are bleeding, regardless of the volume, and feel generally unwell (you feel ill, faint, dizzy and tired) - if you are bleeding to such a degree that you soak through a pad in one hour or if you experience clotting.

Bleeding between weeks 12+0 – 21+6 can have several causes:

  • Spotting after sexual intercourse, also called post coital spotting. The cervix is more likely to bleed during pregnancy so it’s common to have spotting or blood mixed discharge after sexual intercourse (looks like a dark reddish-brown discharge the day after). There is no reason to be alarmed.

  • Hydatidiform mole, or “mole”, can cause heavy menstruation-like bleeding. This is not a pregnancy but a cluster of swollen cysts that show a positive result in a pregnancy test due to the increase in hormones. It can be seen in an ultrasound. A hydatidiform mole must be surgically removed through a minor procedure involving a scraping.

  • Infection bleedings are typically caused by a bacterial infection in the vagina or cervix, often combined with heavy and/or foul-smelling discharge and are treated with antibiotics. Always notify your midwife if you notice a change in your discharge (volume, appearance and odor smell).

  • Polyp bleedings. A cervical polyp is usually a harmless benign growth on the cervix that bleeds easily. Occasionally, these need to be removed through a simple surgical procedure.

  • Cell changes. Uncommon in pregnant women, but bleeding from the cervix may be a sign of cervical cancer. Treatment to remove the cancer is possible during pregnancy, but the treatment must be modified from case to case depending on how far along the woman is in her pregnancy.

  • Placenta previa is when the placenta is attached to the uterus down toward the cervix. The placenta can either partially or totally cover the cervix. Bleeding is a common complication of placenta previa, particularly when the baby in the uterus grows and the pressure on the placenta increases. The position of the placenta inside the uterus can be seen during a routine ultrasound examination done between weeks 18 and 20. If the placenta is far down during the first ultrasound, more ultrasounds will be performed during your pregnancy to monitor its position. Some women need to be admitted to the hospital for bleeding observations once or more frequently during pregnancy if the placenta is partially or fully covering the cervix. Medication may be necessary to help the blood coagulate faster and stop the bleeding. Normally, the placenta moves higher up in the uterus as it grows, making vaginal delivery possible. However, if the placenta is partially or fully covering the cervix toward the end of pregnancy, it will be necessary to deliver the baby with a cesarean section. Avoid sexual intercourse during the last part of your pregnancy to reduce the risk of bleeding if the placenta is fully or partially covering the cervix. Speak with your midwife if you have questions or are worried.

  • Miscarriage bleeding—a more menstruation-like bleeding could be a sign of miscarriage. It is uncommon to have a miscarriage during this phase of pregnancy and the reason is usually because the cervix has not closed as it should or an infection. Before week 22+0, contact the OB/GYN emergency services or hospital emergency department if you are bleeding. Unfortunately, it is not possible to prevent a miscarriage. Taking good care of yourself is all that you can do. Eat well, exercise, rest when you are tired and don’t smoke, drink alcohol or use drugs. Many women miscarry. For most women, a miscarriage is associated with some level of grief that needs to be processed. Your body can also grieve after a miscarriage. Read more about miscarriage under “Miscarriage”.

To determine what is causing bleeding, you will have a pelvic exam and an ultrasound, if necessary.

Source: - Lärobok för barnmorskor. Faxelid, E. Course literature 2001. - Myles Textbook for Midwives. Fraser, D. och Cooper, M. Churchill Livingstone 2003.