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| |    Different Causes of Bleeding During Mid to Late Pregnancy by Elisa Ross, MD reviewed and revised by Marjorie Greenfield, M.D. Brisk, red bleeding may be a sign of something serious at any time during pregnancy and always warrants a call to your practitioner. Most of the time, however, the cause of the bleeding is never discovered. Usually it stops on its own and poses no real danger. Spotting, brown mucus discharge, or dark blood also should be evaluated, but the need to do so typically is not as urgent as when bright red bleeding or passing clots is involved. It's helpful to note that not all blood found on toilet paper is from the vagina. It's extremely common to experience bleeding from the rectum during pregnancy. Most of the time it comes from small tears in the rectal lining that are caused by constipation. Sometimes hemorrhoids bleed, and you may occasionally have blood in the urine because of a bladder infection. In any case, your practitioner can help you sort these factors out. Vaginal bleeding If the vagina is definitely the source of the bleeding, sometimes the situation can provide some hints to the cause. Bleeding happens, not uncommonly, after intercourse, a pelvic exam, or a Pap smear. Some lighter bleeding at the end of pregnancy, near the due date, can be normal. Pink or brown mucus discharge is sometimes called "bloody show" and can signal cervical dilation and passage of the mucous plug. Heavy bleeding Heavy or brisk, bright red bleeding that fills up a sanitary pad, or the passing of clots, needs to be reported promptly. This type of bleeding could account for two potentially serious conditions of pregnancy, called placenta previa and placental abruption. Most of the time, though, the bleeding is caused by neither. Placenta previa occurs when the placenta implants low in the uterus, covering the cervical opening. This usually can be seen by ultrasound. If the placenta is disturbed by contractions, intercourse, or pelvic examination, it can start to bleed. Keep in mind that this is the mother's blood, not the baby's. Usually the bleeding will stop on its own, but it can be quite heavy. Depending on the exact situation--the maturity of the baby and the degree of the bleeding--a decision may be made for delivery by cesarean section. If placenta previa is seen on ultrasound early in the pregnancy, it usually doesn't go on to cause bleeding, and in fact moves away by the time the baby needs to be born. In placental abruption (abruptio placentae), the placenta becomes dislodged from the wall of the uterus, allowing the mother's blood to collect behind it and eventually make its way to the vagina. This collection of blood often irritates the uterus, causing contractions. Surprisingly, the baby can remain healthy using only the part of the placenta that is still attached. If the detachment continues, certain warning signs that your doctor will screen for might call for delivery, even if it's early in the pregnancy. Bleeding in Rh negative mothers Mothers with Rh negative blood type should get a RhoGam shot whenever there is the chance that significant mixing of fetal blood into the mother's circulation has occurred. This may happen if any significant vaginal bleeding takes place in pregnancy.
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