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Unlike first trimester bleeding, which is quite common and in benign in the vast majority of cases, bleeding during the second and third trimesters always requires a close medical follow-up. Not every bleeding in the second and third trimesters of pregnancy is serious, but ignoring spotting or heavier bleeding can be dangerous for the mother and the baby. In general, slight vaginal discomfort, mild pain, or spotting can be considered as "a variation of normal". Of course, these symptoms should not be ignored, and prompt medical examination is needed.

IMPORTANT: If you pass any tissue or a clot from the vagina, save them in a plastic bag or a container and take it to your doctor immediately! If you are not able to reach your doctor right away, keep those samples in the fridge until you contact your doctor. Analysis of those samples can be of huge help in diagnosing the cause of the bleeding.

Pregnancies in women who have had previous cesarean sections need to be monitored closely. In case you already had a c-section and experience cramps and bleeding, call your doctor immediately, no matter how insignificant it may seem!

Am I Having A Miscarriage?

This is probably the most common and the most horrifying thought a pregnant woman with vaginal bleeding will have. Unfortunately, it happens. Severe vaginal bleeding, severe abdominal pain, cramps and passing tissue or clot material from the vagina may suggest a miscarriage is happening. Medical treatment may be needed (medicines combined with minor surgical intervention). Contact your doctor for further diagnostics.

Although those are the symptoms of a miscarriage, some other conditions may be the underlying cause and they are not related to a death of a fetus.

Spotting

  • Painless spotting

Painless spotting is quite often caused by minor cervical or vaginal trauma. Recent ultrasound examination, intercourse, or medical examinations (cervical and vaginal epithelium is more sensitive and vulnerable during pregnancy, because of hormonal changes) can cause the spotting. While it is a low-intensity bleeding that self-limits within a day or two, it is not a reason for concern. In those cases, bed rest is recommended. Also, avoid intercourse or placing anything in a vagina for 5-7 days, until the trauma heals.

  • Painful spotting

Spotting accompanied by cramps, pain, severe abdominal discomfort is a reason to call your OB. While this is what you may expect from labor contractions, such symptoms should not occur during the second trimester. Medical examination and monitoring of the fetus' vital signs and your uterine contractions as well as some lab testing may be needed. Often, painful spotting resolves without any consequences for the mother or fetus.

Placenta Previa

Placenta previa is a condition in which the placenta is inserted over the cervix. Usually, it is diagnosed during a routine ultrasound. Symptoms may differ (different degrees of bleeding accompanied with mild to severe pain, in some cases painless). Bed rest, avoiding heavy lifting or intense physical activity and abstaining from sex are very important!

Intense monitoring is needed until delivery. If the condition does not resolve by the time of delivery, a c-section is performed. Although a c-section is a safe procedure, like any other surgical intervention, it does not come without potential side effects. 

Placental Abruption

Placental abruption is a condition in which the placenta separates from the uterine wall prematurely. Symptoms include vaginal bleeding, cramps, and prolonged contractions. Depending on the severity of the abruption, immediate delivery may be indicated. The bigger the abruption, the bigger are the chances for immediate (and premature!) delivery.

Other Causes

Besides the vagina, bleeding can also come from the gastrointestinal or urinary tract.

Bleeding From The Urinary Tract

Kidney stones may cause bleeding (non-vaginal) accompanied with abdominal pain. Severe urinary infections are a common cause of bleeding as well.

Bleeding From The Gastrointestinal (GI) Tract

Hemorrhoids are the most common cause of GI related bleeding during pregnancy. Inflamed hemorrhoids can be accompanied by pain in the area of the anus which can sometimes radiate towards the genital area.

It is practically impossible to describe all causes of bleeding in the second trimester, but the most common ones are mentioned here. Some conditions are relatively rare even for OB specialists (for example, cervical varix). In some cases, the underlying condition that triggered bleeding remains a mystery, and bleeding resolves without consequences for the fetus and its mother.

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