Pregnancy (More Than 20 Weeks) - Vaginal Bleeding

Is this your symptom?

  • Vaginal bleeding during the second half of pregnancy
  • More than 20 weeks pregnant

Causes

A small amount of spotting or blood tinged mucus can be normal during the second half of pregnancy. Here are some normal reasons this can happen:

  • Bloody show: Most women have a small amount of pinkish, brownish, or blood-tinged mucus at the end of the pregnancy. This is called the "bloody show." Why does this happen? In late pregnancy the cervix (opening to the womb) starts to thin and stretch out. This causes some of the tiny blood vessels in the cervix to bleed. What does this mean? Bloody show is a sign that a mother is getting closer to delivery time. This often happens about 2 to 3 days before going into labor. Sometimes labor can start several hours later!
  • Passage of mucous plug: Many women will pass a small glob or chunk of jelly-like mucous at the end of the pregnancy. It may look like gelatin or snot. A small amount of pinkish, brownish, or blood-tinged mucus may also be present. This is called the "mucous plug." Why does this happen? In late pregnancy the cervix (opening to the womb) starts to thin and stretch out. The mucous that seals the cervix falls out. What does this mean? It may be a sign that a mother is getting closer to her delivery time. However, often it occurs a week or two before labor.
  • Spotting after sex or a pelvic exam: The cervix (opening to the womb) in a pregnant woman has very good blood flow. It can bleed easily after sex or a pelvic exam. There may be slight spotting (a few drops of blood on the underwear). There may be a small amount of pinkish or brownish mucous discharge.

However, vaginal bleeding during the second half of pregnancy can be serious. If it is more than just spotting, a woman should call her doctor right away. Another option is to go to Labor and Delivery. Vaginal bleeding can be a sign of two serious problems:

  • Abruptio placentae
  • Placenta previa

When Should You Seek Medical Help Right Away?

Here are some signs that the vaginal bleeding might be serious. You should seek medical help or call your doctor right away if:

  • Vaginal bleeding occurs (more than spotting)
  • Spotting lasts more than 2 days
  • Pinkish, brownish, or blood-tinged mucous discharge and you are less than 37 weeks pregnant
  • Your baby is moving less

Vaginal Bleeding Severity is defined as:

  • Spotting: few drops of blood or pinkish / brownish mucous discharge
  • Mild: less than 1 pad / hour; less than a normal period
  • Moderate: 1-2 pads / hour; small blood clots (such as a pea, grape, small coin)
  • Severe: soaking 2 or more pads/hour for 2 or more hours; large blood clots (such as a golf ball, large coin); non-stop red blood from vagina

When to Call for Pregnancy (More Than 20 Weeks) - Vaginal Bleeding

Call 911 Now

  • Severe vaginal bleeding (non-stop bleeding or large blood clots)
  • Severe stomach pain
  • Passed out (fainted)
  • Very weak (can't stand)
  • You think you have a life-threatening emergency

Call Doctor Now or Go to ER

  • Stomach pain
  • Pregnant less than 37 weeks (you are preterm) and pinkish or brownish mucous discharge
  • You feel weak or very sick
  • You think you need to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Spotting lasts more than 2 days
  • You think you need to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Pregnant over 36 weeks (term) and pinkish or brownish mucous discharge
  • You have other questions or concerns

Self Care at Home

  • Slight spotting (happens only once or lasts less than 2 days)
  • Slight spotting after sex (happens only once or lasts less than 2 days)
  • Slight spotting after pelvic exam (happens only once or lasts less than 2 days)
  • Pregnant over 36 weeks (term) and passed a small glob or chunk of mucous

Care Advice

Over 36 Weeks Pregnant (Term) and Passed Mucous Plug

  1. What You Should Know:
    • Many women will pass a small glob or chunk of jelly-like mucous at the end of the pregnancy. It may look like gelatin or snot. A small amount of pinkish, brownish, or blood-tinged mucus may also be present. This is called the "mucous plug."
    • Why does this happen? In late pregnancy the cervix (opening to the womb) starts to thin and stretch out. The mucous that seals the cervix falls out.
    • What does this mean? Sometimes this happens right before labor begins. However, often it occurs a week or two before labor.
  2. Discuss Your Symptoms with the Doctor at Your Next Prenatal Visit:
    • Usually by the 36th week of pregnancy you will be seeing your doctor (or midwife) every 1 to 2 weeks.
    • Tell your doctor about your symptoms at your next visit.
  3. Treatment Until You See Your Doctor:
    • Do NOT douche.
    • Do NOT use a tampon. Use a sanitary pad instead.
    • Do NOT have sex.
    • Avoid heavy lifting or hard physical work.
  4. Call Your Doctor (or Go To Labor and Delivery) If:
    • Vaginal bleeding occurs
    • Stomach pain occurs
    • Your baby is moving less
    • Your bag of water breaks
    • You think you are in labor
    • You think you need to be seen
    • You become worse

Over 36 weeks Pregnant (Term) and Bloody Show

  1. What You Should Know:
    • Most women have a small amount of pinkish, brownish, or blood-tinged mucus at the end of the pregnancy. This is called the "bloody show."
    • Why does this happen? In late pregnancy the cervix (opening to the womb) starts to thin and stretch out. This causes some of the tiny blood vessels in the cervix to bleed.
    • What does this mean? Bloody show is a sign that a mother is getting closer to delivery time. This often happens about 2 to 3 days before going into labor. Sometimes labor can start several hours later!
  2. Discuss Your Symptoms with the Doctor at Your Next Prenatal Visit:
    • Usually by the 36th week of pregnancy you will be seeing your doctor (or midwife) every 1 to 2 weeks.
    • Tell your doctor about your symptoms at your next visit.
  3. Treatment Until You See Your Doctor:
    • Do NOT douche.
    • Do NOT use a tampon. Use a sanitary pad instead.
    • Do NOT have sex.
    • Avoid heavy lifting or hard physical work.
  4. Call Your Doctor (or Go To Labor and Delivery) If:
    • Vaginal bleeding occurs
    • Stomach pain occurs
    • Your baby is moving less
    • Your bag of water breaks
    • You think you are in labor
    • You think you need to be seen
    • You become worse

Slight Spotting after Sex or Pelvic Exam

  1. What You Should Know:
    • The cervix (opening to the womb) in a pregnant woman has very good blood flow. It can bleed easily after sex or a pelvic exam.
    • There may be slight spotting (a few drops of blood on the underwear). There may be a small amount of pinkish or brownish mucus discharge.
  2. Discuss Your Symptoms with the Doctor at Your Next Prenatal Visit:
    • Tell your doctor (or midwife) about your symptoms at your next visit.
  3. Treatment Until You Talk with Your Doctor:
    • Do NOT douche.
    • Do NOT use a tampon. Use a sanitary pad instead.
    • Do NOT have sex.
    • Avoid heavy lifting or hard physical work.
  4. What to Expect: This should go away in 1 to 2 days.
  5. Call Your Doctor (or Go To Labor and Delivery) If:
    • Vaginal bleeding occurs (more than spotting)
    • Spotting lasts more than 2 days
    • Stomach pain occurs
    • Your baby is moving less
    • Your bag of water breaks
    • You think you are in labor
    • You think you need to be seen
    • You become worse

Baby Movement and Kick Count Instructions

  1. Baby Movement and Pregnancy Dates:
    • 1-15 Weeks: Baby is too small for mother to feel the baby move.
    • 16-18 Weeks: Some women begin to feel the baby move, especially if they had a baby before.
    • 18-20 Weeks: Most women begin to feel the baby move around this time.
    • 24 Weeks: All women should feel the baby move by this time.
    • Over 28 Weeks: Some doctors advise that women check kick counts each day.
  2. How to Do a Kick Count:
    • Pick the time of the day that your baby is most active.
    • Sit back in a comfortable chair or lie down on your left side in bed.
    • Do this in a quiet room (no TV, cell phone, computer, or children).
    • Count any baby movement (kicks, rolls, flutters). Count up to 10.
    • Normal Kick Count: 5 or more in one hour, or 10 or more in 2 hours.
    • Low Kick Count: Less than 5 in one hour, or less than 10 in 2 hours.
  3. Call Your Doctor If:
    • Low kick count (less than 5 in 1 hour, or less than 10 in 2 hours)
    • Kick count is normal, but you still are worried that something is wrong
    • You have other questions
    • You think you need to be seen
    • You become worse

And remember, contact your doctor if you develop any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Last Reviewed: 8/20/2017 1:16:11 AM
Last Updated: 5/17/2017 5:42:38 PM

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