Bleeding in the Second Half of Pregnancy

Significant vaginal bleeding in the second half of pregnancy is uncommon and complicates fewer than 5% of pregnancies. Small amounts of bleeding or spotting, especially if admixed with cervical mucous, may represent “bloody show” and may herald the onset of labor, either term or preterm. Vaginal spotting from a friable cervix may reflect recent intercourse or digital examination. In very unusual circumstances, a cervical polyp or cancer may present with bleeding in pregnancy. The focus of this article, however, is on four conditions, which can cause bleeding in the second half of pregnancy in which the bleeding originates from above the internal os of the cervix. These conditions are: vasa previa, placenta previa, premature separation of the normally implanted placenta, and uterine rupture.