When I was five months pregnant with my second child, I woke up to warm fluid leaking beneath me in the middle of the night. Bleeding during pregnancy can be understandably scary, and I feared the worst: another miscarriage. That year, I’d already lost four pregnancies. I went to the hospital, where I was admitted overnight for observation. The nurse attached a fetal monitor to my belly, tracking my baby’s heartbeat—it was still going strong. Soon I’d learn that miscarriage isn’t the only reason you may bleed during pregnancy. But those other reasons are less commonly discussed, which leaves women (like me) fearing the worst when they see red on their underwear or bed sheets.
Vaginal bleeding during pregnancy can come from multiple places, including the uterus, placenta, or the cervix, Jacqueline Hairston, MD, assistant professor and maternal-fetal medicine physician at Northwestern University Feinberg School of Medicine, tells SELF. It’s not really possible to pinpoint the source—and ultimately, the cause and severity—on your own, which is why it’s important to call your ob-gyn or head to the hospital if it happens to you.
At the hospital, your medical team will likely do a physical exam and run other tests—like an ultrasound and perhaps bloodwork—to figure out what’s going on. When this happened to me, I was consumed with anxiety. My doctors monitored my baby’s heartbeat (which was normal) as I passed multiple blood clots. Every time I closed my eyes, I pictured myself hemorrhaging, terrified I’d lose my baby. After my maternal fetal medicine (MFM) doctor did an ultrasound, she told me the bleeding was likely a subchorionic hematoma (SCH) or a mild placental abruption. Thankfully, the fetus was unharmed.
I was lucky. My bleeding stopped and I was reassured that both the baby and I would make a full recovery—though I never got a definitive answer about the root cause. Hours later, exhausted and relieved, I went home. In hindsight, I wish I’d known the potential causes of bleeding earlier in pregnancy, if only just so that I wouldn’t have assumed the absolute worst.
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How common is bleeding during pregnancy?
According to the Cleveland Clinic, bleeding occurs in 15 to 25% of pregnancies in the first trimester, and while it’s also possible in the second half of pregnancy, it’s less common. Shannon M. Clark, MD, a double-board certified professor in ob-gyn and maternal fetal medicine at UTMB-Galveston tells SELF that only 1 to 2% of women experience bleeding in their second trimester.
In general, vaginal bleeding is one of the most common reasons pregnant people are admitted to the hospital, Mariam Naqvi, MD, a maternal fetal medicine doctor and associate professor of obstetrics and gynecology at Cedars-Sinai, tells SELF. Bleeding doesn’t always signal a serious problem, but in many cases it can—and causes can run the gamut from NBD to life-threatening depending on multiple factors. Either way, it’s crucial to be proactive and get assessed and monitored for the safety of both you and your growing fetus.
Causes of bleeding during pregnancy
In the first half of pregnancy; before 20 weeks gestation
It’s actually quite normal to experience a little bleeding in early pregnancy. Part of that is because during pregnancy, the cervix is more sensitive to activities like sex and physical exams, so it can bleed more easily. A little blood can be totally benign; other times, especially when bleeding is heavy, it can signal a situation that requires swift medical attention. Here are some of the more likely causes of bleeding before 20 weeks.
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