Bleeding Should Be Checked By Your Healthcare Provider.
I have experienced vaginal bleeding twice during this pregnancy, but the baby is doing fine. What could be causing this? - Michele, Texas
The expert answers
There are many possible causes of bleeding during pregnancy, including the onset of labor, miscarriage and placental abruption (abruptio placentae), the term for premature separation of the placenta from the uterine wall.
Some other sources of bleeding include, but are not limited to, the following:
Implantation bleeding occurs when a blastocyst (early embryo) attaches to the lining of the uterus (endometrium), fingers of cells called the synciotrophoblasts burrow into the wall of the uterus in order to tap into a blood supply. This can result in spotting as the placenta is formed. Implantation bleeding is also called Hartman's sign, a potentially early sign of pregnancy, but not very many women get it.
Cervical varicosities (varicose veins of the cervix) can develop and become a problem. These vessels are very delicate and even limited activity levels can result in bleeding. In some women, "pelvic rest," i.e. no intercourse, is recommended for the duration of pregnancy.
Infections or cervicitis (such as trichomonas, bacterial vaginosis, Chlamydia, gonorrhea) can cause the cervix to become very friable (soft) and bleed. Screening for infection is often necessary in women who complain of bleeding.
Trauma means that during intercourse, the cervix can become "traumatized" by the penis and cause small blood vessels on the surface of the cervix to crack open and bleed. This is usually self-limiting and very mild. Trauma might also occur after a medical exam during which the cervix is checked.
Premature dilation, when an incompetent cervix prematurely starts to dilate (usually around 20 weeks), can result in bleeding. Also, premature labor/preterm labor (PTL) can result in bleeding if the cervix dilates. Obviously, with this condition, contractions accompany the bleeding. With an incompetent cervix, only pelvic or abdominal pressure is encountered early.