Many women experience vaginal bleeding in early pregnancy

First-trimester bleeding occurs in about one in four pregnancies. It may vary from a small amount of spot­ting to heavy bleeding with clots and cramps. Occasion­ally the bleeding comes and goes, and you may think that you're still getting your periods.

Many mothers-to-be get a few days of bleeding right­ around the time that the embryo is burrowing into the wall of the uterus. On average, this occurs five days after conception and may be confused with a menstrual period, especially if you're not keeping close track of your cycles. This implantation bleeding is normal and is not a sign of any problem with the pregnancy. The biggest problem with implantation bleeding is that it can lead to a mistakenly later due date if it is counted as a menstrual period. The real last period from which the due date should be calculated would be the prior one.

Technically, any bleeding in the first half of preg­nancy is defined as a threatened miscarriage or (in medical terms) threatened abortion. But don't let these terms alarm you: more than half the women who have some bleeding in early pregnancy go on to have a healthy baby.

If you are having mild first-trimester bleeding, you should let your practitioner know, but there's no need to panic. It is more urgent to call your practitioner if you have bleeding heavier than your normal period, severe cramps, lower abdominal pain or fever. These can be signs of miscarriage or another pregnancy complication such as an ectopic pregnancy, in which the fertilized egg starts developing outside the uterus. Call your doctor night or day if these symptoms arise. They may give you a physical exam and usually will order an ultrasound or a blood test to see if the pregnancy is OK. When there is bleeding, germs can get up into the uterus more easily, so it is best to put nothing into your vagina until the bleeding has stopped; that means no douching, no tampons and no intercourse. You will be able to resume sexual relations when your bleeding has resolved. Although this surprises many women, bed rest is generally not necessary.

Bleeding is not uncommon in late pregnancy

If you find spots of blood on your underwear or toilet paper, it's sure to prove worrisome to you, but there's no need to panic: Keep in mind that, most of the time, the cause is never discovered and the bleeding usually stops on its own and poses no real danger. It's also important to note that not all blood found on toilet paper is from the vagina. It's extremely common to experience bleeding from the rectum during preg­nancy. Most of the time it comes from small tears in the rectal lining caused by constipation. Sometimes haemorrhoids bleed, and you may occasionally have blood in your urine because of a bladder infection.

If the vagina is definitely the source of the bleeding, there can be several causes, some serious, others not. Bleeding from the cervix is not uncommon after inter­course, a pelvic exam or a Pap smear. Some light bleeding at the end of pregnancy, near the due date, can be normal. Pink, -greenish or brown mucus discharge, as I've mentioned earlier, is sometimes called bloody show, and can signal cervical dilation and passage of the mucus plug.

It's important to remember that bleeding before the ninth month, or any bleeding that goes beyond just spotting, should be reported to your practitioner. Heavy or brisk bleeding of bright red blood that fills up a sani­tary pad, or the passing of clots, needs to be reported to your doctor promptly. This type of bleeding might indi­cate a potentially serious condition of pregnancy.

Placenta previa:

This problem occurs when the pla­centa is located low in the uterus, covering the internal opening of the cervix. Placenta previa usu­ally can be seen by ultrasound. If the placenta is disturbed by contractions, intercourse or pelvic examination, it can start to bleed. Keep in mind that this is the mother's blood, not the baby's. Usually the bleeding will stop on its own, but it can be quite heavy. Depending on the exact situation ­the maturity of the baby and the degree of the bleeding - a decision may be made for delivery by caesarean section. It is important to know that while placenta previa is often seen on ultrasound early in the pregnancy, it frequently moves out of the way by the third trimester and d_esn't cause any problems.

Placental abruption:

In placental abruption, the pla­centa becomes dislodged from the wall of the uterus, allowing the mother's blood to collect behind it and eventually make its way to the vagina. This collection of blood often irritates the uterus, causing contrac­tions. Surprisingly, the baby can remain healthy using only the part of the placenta that is still attached. If the detachment continues, certain warning signs that your doctor will screen for might necessitate delivery, even if the baby isn't yet full-term.