Bleeding in the late stages of pregnancy

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What causes bleeding in the late stages of pregnancy?
Bleeding is a sign that cannot be ignored. If a woman bleeds at any time during pregnancy she should tell her doctor or midwife straight away.

The bleeding can be caused by quite harmless changes in the cervix (neck of the womb) called an ectropion. This is the commonest cause of vaginal bleeding in the second half of pregnancy.

It can also be the type of bleeding that occurs immediately before labour and looks like bloody mucus (a 'show').

But bleeding in the late stages of pregnancy can also be caused by one of two potentially serious complications.

• If the placenta, which nourishes the baby, is coming away from its attachment to the inside of the wall of the womb (a condition called placental abruption), bleeding will occur . Abdominal pains and a tense, sore uterus are other symptoms of this problem.
• The bleeding may originate from a low placenta that is actually blocking the opening to the cervix (a condition known as placenta praevia).

What should a woman do if she starts bleeding in the late stages of pregnancy?
If bleeding starts suddenly, the woman should lie down and arrange to be taken to hospital immediately.

What will the doctors do?
The woman will be examined and looked after on the maternity ward. If she is close to the expected date of birth the doctors will decide whether it is best for her and the baby if the baby is delivered immediately.

If the placenta is breaking away, the doctor or midwife, will break the baby's waters and induce the labour.

If, on the other hand, the placenta is blocking the opening to the vagina, the mother will probably need delivery by Caesarean section.

If the symptoms are less severe or the expected date of birth is a long way off, doing nothing other than monitoring the mother and baby's condition may be more appropriate. This will enable the pregnancy to continue and allow the development of the baby to proceed further.

Bleeding should never be ignored. If in doubt please contact a doctor - or the maternity ward at your local hospital immediately. A woman bleeding in the late stages of pregnancy should never have a vaginal examination outside a hospital as such an examination may cause further brisk bleeding.

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