Pain, bleeding, and discharge in the second trimester

By Zawn Villines 

Reviewed by Valinda Riggins Nwadike

What is normal? | Causes | Emergency help | When to call a doctor | Takeaway

Some pain and a small amount
of spotting are normal during the second trimester. However, it is essential to
know when to see a doctor.

For many people, the second
trimester marks a moment of calm in pregnancy. The intense symptoms of the
first trimester often dissipate, and the exhaustion, muscle pain, and anxiety
about birth that are common during the third trimester may not have appeared.
Small amounts of bleeding
during the second trimester are typical and may not signal a problem, though it
is important to get checked if something feels wrong. In this article, we look
at the possible causes and when to see a doctor.

How much is normal?

Bleeding is common during the
first trimester of pregnancy, affecting 15 to 25 percent of pregnant women.
Bleeding in the second
trimester is less usual, with heavier bleeding being a more serious sign than
light bleeding. Causes can range from mild inflammation to problems with the
placenta or cervix.
Bleeding does not usually mean
a woman is going into labor or having a miscarriage.
Women who experience mild
bleeding, spotting, or unusual discharge should contact their healthcare
providers. When bleeding is heavy or painful, it is a medical emergency.

Causes of bleeding in the
second trimester

Possible causes of bleeding in
the second trimester include:

Minor cervical irritation
Light spotting does not
usually mean that there is a serious problem with the pregnancy, especially if
the spotting goes away on its own within a day or two.
During pregnancy, the blood
vessels in the cervix may become inflamed, especially when the weight of the
uterus puts pressure on them. Some women can experience light bleeding after a
pelvic exam or sex.

Cervical growths
Cervical polyps are benign, or
non-cancerous, growths on the cervix. They are common and rarely cause any
During pregnancy, cervical
polyps may swell or become irritated, causing them to bleed. A doctor can often
carry out a quick exam to identify whether a cervical growth is a reason for a
person’s bleeding

Placenta issues
The placenta is an organ that
nourishes and protects the developing baby. Problems with this organ are a
leading cause of bleeding during birth.
Anyone who suspects problems
with the placenta must seek immediate treatment, as issues with the placenta
can injure the baby and cause dangerous bleeding in the pregnant woman.
Some placenta issues that may
cause bleeding in the second trimester include:

  • Placenta previa: This is when
    the placenta is very low in the uterus. It may fully or partially cover the
    cervix, causing bleeding throughout pregnancy. In severe cases, doctors may
    recommend extra monitoring or a cesarean delivery.
  • Placenta accreta: Placenta
    accreta causes the placenta to grow much deeper into the uterus than usual. It
    is more likely to cause bleeding during the third trimester than the second,
    however. During delivery, the bleeding may become life-threatening, so
    healthcare professionals will monitor the pregnancy carefully, often in a
    setting with emergency medical care, which may be critical to the mother’s
  • Placenta abruption: Sometimes
    the placenta detaches from the uterus too early. It can cause bleeding, back
    pain, and intense stomach cramps. Early diagnosis can prevent severe
    complications to the woman and the baby.
Preterm labor
Bleeding can be an early sign
of labor. Some women may also notice an unusual discharge, called a mucous
plug. A mucous plug looks like a combination of vaginal discharge, mucous, and
When labor begins before 37
weeks, it is more likely that the baby will need to stay in the intensive care
unit and may also experience other problems. During the second trimester,
preterm labor endangers the baby’s life.
Bleeding can be a risk factor
for preterm labor. Women who have a history of bleeding during the second
trimester can talk to their doctors about whether they are at risk of preterm
labor and how best to minimize that risk.
Vasa previa
Vasa previa is a problem with
the baby’s blood vessels. It causes some of the baby’s blood vessels to run
parallel to the cervix, left unprotected by the umbilical cord or placenta.
These blood vessels may cause unusual bleeding, especially late in pregnancy or
during preterm labor.
When the membranes burst,
these vessels may also burst. Women with vasa previa usually have a cesarean
delivery. A woman with a history of preterm labor or bleeding who has
contractions or other intense pain should go to the emergency room.
Uterine rupture
Uterine rupture happens when
the uterus tears. This can endanger the mother and the baby by causing severe
bleeding and depriving the baby of oxygen. It can also trigger labor.
A woman who experiences
bleeding, pain, a fever, or who has recently suffered an injury to the stomach
or uterus may be experiencing a uterine rupture and should go to the emergency

Gestational trophoblastic
Gestational trophoblastic
disease (GTD) is a group of rare diseases that causes abnormal cells to grow in
the uterus during and after pregnancy. These cells can form tumors and masses.
Sometimes these masses turn cancerous, though most forms of GTD are benign.
Women with GTD may have
bleeding and an unusually large uterus.
Treatment depends on the type
of GTD, how large the growth is, and other factors. A surgeon may need to
remove the mass during or after pregnancy.

When to get emergency help

Not all bleeding during the
second trimester is an emergency. In many cases, the woman and the baby are
Nevertheless, it is important
to be cautious. Prompt intervention in emergencies can save the life of both
the woman and the baby. Anyone who is uncertain should go to the emergency
Some symptoms that warrant
emergency treatment include:

  • bleeding after an injury, such
    as a car accident or fall
  • sudden heavy bleeding
  • bleeding that is getting
    progressively heavier
  • bleeding that includes blood
  • bleeding along with pain or
  • dizziness or weakness along with
  • bleeding in a person with
    placenta accreta, placenta previa, or a history of preterm labor
When to call a doctor

Tell a doctor about any
bleeding episodes to ensure a prompt and accurate diagnosis. Anyone who is
uncertain about their bleeding should call right away.

Bleeding during the second
trimester can be worrying. However, even when the bleeding is due to a serious
complication, most women go on to have healthy pregnancies and babies.
Prompt medical care can
prevent complications and save lives, so always talk to a provider about any
bleeding, even if it seems minor.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.