Merck Manual

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Some Causes and Features of Vaginal Bleeding During Late Pregnancy

Some Causes and Features of Vaginal Bleeding During Late Pregnancy


Common Features*

Diagnostic Approach†,‡

Passage of a discharge containing a small amount of blood mixed with mucus (bloody show) and no further bleeding

Contractions in the lower abdomen at regular intervals plus opening (dilation) and thinning and pulling back (effacement) of the cervix

Other typical signs of labor

A doctor's examination alone

Pain or tenderness when the uterus is touched

Passage of dark, clotted, or bright red blood but sometimes only slight bleeding

Sometimes low blood pressure in the woman, with fainting, light-headedness, or a racing heart

An abnormal heart rate in the fetus

Often ultrasonography

Complete blood cell count and blood tests to determine whether blood is clotting normally

Sometimes urine drug screen

Painless vaginal bleeding with bright red blood

Little or no tenderness when the uterus is touched

Routine ultrasonography or transvaginal ultrasonography (using an ultrasound device inserted into the vagina) by an experienced practitioner

Painless vaginal bleeding

Often signs of labor, such as contractions at regular intervals

An abnormal heart rate in the fetus

Transvaginal ultrasonography using techniques to show blood flow (color Doppler ultrasonography)

Severe abdominal pain and tenderness when the abdomen is touched

Stopping of contractions and often loss of muscle tone in the uterus

Baby moves back up into the birth canal

Slight to moderate vaginal bleeding

A slow heart rate in the fetus or no heartbeat

A rapid heart rate in the woman

An incision into the abdomen (laparotomy) to directly view the uterus

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

‡ Ultrasonography is typically done in women with bleeding late in pregnancy, and a complete blood cell count, blood type, and Rh status (positive or negative) are usually determined.