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Overview of the etiology and evaluation of vaginal bleeding in pregnant women

Errol R Norwitz, MD, PhD, MBA
Joong Shin Park, MD, PhD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Vaginal bleeding is a common event at all stages of pregnancy. The source is virtually always maternal, rather than fetal. Bleeding may result from disruption of blood vessels in the decidua (ie, pregnancy endometrium) or from discrete cervical or vaginal lesions. The clinician typically makes a provisional clinical diagnosis based upon the patient's gestational age and the character of her bleeding (light or heavy, associated with pain or painless, intermittent or constant). Laboratory and imaging tests are then used to confirm or revise the initial diagnosis.

An overview of the etiology and evaluation of vaginal bleeding in pregnant women will be reviewed here. Specific causes of bleeding and their management are discussed in detail separately. (See individual topic reviews on each subject).


Overview — Vaginal bleeding is common in the first trimester, occurring in 20 to 40 percent of pregnant women. It may be any combination of light or heavy, intermittent or constant, painless or painful. The four major sources of nontraumatic bleeding in early pregnancy are:

Ectopic pregnancy

Miscarriage (threatened, inevitable, incomplete, complete)


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Literature review current through: Sep 2016. | This topic last updated: Jul 17, 2015.
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