Some Causes and Features of Vaginal Bleeding During Late Pregnancy
Some Causes and Features of Vaginal Bleeding During Late Pregnancy
Cause |
Common Features* |
Diagnostic Approach†,‡ |
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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 |
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Placental abruption (premature detachment of the placenta from the uterus) |
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 |
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Placenta previa (an abnormally located placenta) |
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 |
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Vasa previa (growth of the fetus’s blood vessels across the cervix, blocking the fetus's passageway) |
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) |
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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 |
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* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. |
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† 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. |
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‡ 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. |
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