The reasons for vaginal bleeding in late pregnancy include inflammation of the cervix or problems with the placenta, such as placental abruption (where the placenta comes off the wall of the uterus before birth) or a low-lying placenta, where the placenta attaches low in the uterus or over the cervix, leading to preterm labor and vaginal bleeding. If you begin bleeding late in your pregnancy, it may require hospitalization or even delivery of your baby.
 

Low-lying placenta refers to a placenta that attaches lower in the uterus than normal, usually in the lower uterine segment. This places the placenta close to or even over the cervix, which can lead to bleeding from the vaginal. This type of bleeding is usually painless. A low-lying placenta occurs in 1 out of 200 pregnancies and is more common in women who:

• Have had children before.
• Have had Cesarean section.
• Have had uterine surgery.
• Are pregnant with multiples.

*** A low-lying placenta requires careful monitoring and management by your doctor. ***

At the end of your pregnancy, vaginal bleeding can also be a sign of labor. Your mucus plug, which seals the cervix throughout pregnancy and until you are close to giving birth, is released through the vagina. You may notice some clear mucus mixed with pink or red and this will increase as labor progresses. This is normal and can occur up to three weeks before your due date. If you lose your mucus plug before 37 weeks of pregnancy, you may be at risk for preterm labor. Please contact your doctor immediately.
Other signs of preterm labor include:

• Continuous leaking of fluid from the vagina, in small or large amounts.
• Vaginal discharge that has more mucus or that is bloody.
• Cramping in your lower abdomen, sometimes accompanied by diarrhea.
• Pressure in the pelvis or abdomen.
• Back pain.
• Diarrhea.
• Uterine contractions that don’t go away after drinking water and resting.

 
What to do if you experience vaginal bleeding?
If you are pregnant and notice bleeding from your vagina at any point in your pregnancy, please contact your doctor immediately. You may be asked to come in to the hospital and may be admitted for monitoring. Always be aware of any abrupt changes to your body during pregnancy. Immediate medical care when needed can keep you and your baby safe.
 

Placental abruption occurs when the placenta, which is located in a normal position in the uterus, begins to peel off the wall of the uterus after 20 weeks of pregnancy and before birth. The placenta may peel away partially or totally, causing vaginal bleeding. Most women will experience constant abdominal pain or cramping along with some bleeding. Some women will have no bleeding at all. The placenta is responsible for keeping the baby alive and as it comes away from the uterus, the baby’s oxygen supply will be compromised. This can lead to serious complications. Placental abruption occurs in 1% of pregnancies and usually happens in the 12 weeks before birth.

Risk factors for placental abruption include:

• Previous pregnancy and birth.
• Age over 35.
• Mutiple pregnancy.
• Previous miscarriage or termination.
• Sickle cell disease.

Placental abruption may be caused by:

• Pregnancy induced hypertension.
• Injury or impact to the abdomen.
• Short umbilical cord.
• Maternal cocaine, cigarette, or alcohol use.

 
Types of Hemorrhage (Bleeding)

1. Revealed or external hemorrhage is when there is noticeable vaginal bleeding. This is a common type of hemorrhage with a placental abruption and occurs in 65 to 80% of cases.
2. Concealed or internal hemorrhage is when bleeding is contained behind the placenta within the uterus and there is no clear vaginal bleeding. This is less common and occurs in 20 to 35% of cases. This is a much more dangerous situation for the mother and her baby.
3. Mixed or combined hemorrhage is bleeding that is first concealed and that, when it worsens, leads to obvious external bleeding from the vagina.

Placental abruption is a serious issue and is extremely dangerous for the mother and the baby. Immediate medical care is essential.