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Vaginal bleeding in the last stages of pregnancy
Last reviewed: 12.07.2025
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The most common cause of concern in late pregnancy is placenta previa and abruptio placentae. These may lead to hemorrhagic shock, which requires intravenous fluid resuscitation and other measures before or at the time of diagnosis. Other obstetric causes include labor (with expulsion of the blood-mucous plug) in marginal placenta previa. Disseminated intravascular coagulation (DIC) is a rare but serious complication of placental abruption. As pelvic blood flow increases during late pregnancy, previously asymptomatic cervical and vaginal lesions (eg, polyps, ulcers) unrelated to the pregnancy begin to bleed.
[ Risk factors
Risk factors for placental abruption include previous placental abruption, maternal age over 35, multiparity, hypertension, smoking, substance abuse (especially cocaine ), abdominal trauma, maternal sickle cell disease, thrombotic disorders,vasculitis, and other vascular disorders. Risk factors for placenta previa include multiparity, multiple gestation, previous uterine surgery (especially cesarean section), and other uterine disorders that may interfere with implantation (eg, fibroids). Placenta previa is usually diagnosed prenatally by routine ultrasonography.
Dark bloody vaginal discharge with small clots and severe pain are typical of placental abruption. Bright, heavy bloody vaginal discharge with moderate or mild pain in the uterine area is typical of placenta previa.
Diagnostics vaginal bleeding in the last stages of pregnancy
A vaginal examination is not performed until placenta previa has been excluded. A vaginal examination may cause excessive bleeding in women with placenta previa. A gentle speculum examination may be performed. However, if placenta previa is present, a speculum examination rarely provides information that would change the clinical management of the patient.
Signs of hemorrhagic shock or hypovolemia are proportional to the degree of vaginal bleeding resulting from placental abruption.
In case of minor bleeding, the blood group and Rh factor are determined to determine the need for RhO(D) immunoglobulin administration. In case of significant bleeding, a general blood test is performed, prothrombin time, partial thromboplastin time, blood group and Rh factor are determined. If placental abruption is suspected, the fibrinogen level and fibrin degradation products are determined to diagnose DIC syndrome.
Pelvic ultrasonography or fetal monitoring is performed, but should not delay obstetric decisions because urgent delivery is indicated in such cases. Fetal distress proportional to vaginal bleeding suggests placental abruption.
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Treatment vaginal bleeding in the last stages of pregnancy
Treatment of hemorrhagic shock and DIC syndrome is carried out on an emergency basis. In case of hemorrhagic shock, DIC syndrome, placental abruption or placenta previa, the obstetrician determines the method and time of delivery.