Some Causes of Bleeding During Late Pregnancy
Cause | Suggestive Findings | Diagnostic Approach* |
|---|---|---|
Passage of blood-tinged mucus plug, not active bleeding Painful, regular uterine contractions with cervical dilation and effacement | Maternal vital signs and serial pelvic examinations Fetal heart rate monitoring | |
Dark, clotted, or bright red blood, bleeding may be profuse; in some women, slight or absent bleeding before delivery (concealed abruption) Painful, tender uterus, often tense with contractions Sometimes, maternal hypotension Signs of fetal distress (eg, bradycardia or prolonged deceleration, repetitive late decelerations, sinusoidal pattern) | Maternal vital signs and pelvic examination Fetal heart rate monitoring Complete blood count, coagulation tests Often, ultrasonography, although it is not very sensitive | |
Sudden onset of painless vaginal bleeding with bright red blood and minimal or no uterine tenderness Often, a low-lying placenta detected earlier in pregnancy on routine screening ultrasonography | NOTE: DIGITAL CERVICAL EXAMINATION SHOULD NOT BE PERFORMED. Complete blood count Ultrasonography | |
Painless vaginal bleeding with fetal instability but normal maternal signs Often, symptoms of labor Sometimes, suspected based on findings during routine screening ultrasonography | Transvaginal ultrasonography with color Doppler studies | |
Severe abdominal pain, tenderness, cessation of contractions, often loss of uterine tone Mild to moderate vaginal bleeding Fetal bradycardia or loss of heart sounds Maternal tachycardia Loss of fetal station Usually, a history of prior cesarean delivery or other uterine surgery | Clinical suspicion, based on characteristic signs and symptoms Emergency cesarean delivery | |
* Evaluation of concerning symptoms in all pregnant patients should include assessment of maternal vital signs, physical examination, and evaluation of fetal status with fetal heart rate monitoring or ultrasonography. | ||