Samhita is 20 weeks pregnant. She was working in her office when she had a feeling of wetness. On checking, she found she was bleeding. She rushed to her obstetrician to make sure that her baby was doing well.

Bleeding in the second trimester (14- 28 weeks)

Bleeding in the second trimester may be due to a growth (polyp) on the cervix. This can be diagnosed by the obstetrician when she inspects the cervix. Bleeding can also follow intercourse since the cervix is soft and congested in pregnancy.

The conditions which need to be watched out for are:

• Miscarriage: Although miscarriage is less common in the second trimester than the first, a risk still exists.

• Cervical incompetence or insufficiency: Occasionally, light bleeding from the cervix along with profuse white discharge, may be a sign of cervical incompetence, a condition in which the cervix opens painlessly, leading to preterm delivery. This condition occurs most frequently between 18 and 24 weeks of pregnancy and requires prompt medical attention.

• Preterm labour: Preterm labour can start off with vaginal bleeding and will then progress to cramping. If the obstetrician thinks that you are going into preterm labour, she will advise bed rest and may also start you on tablets or injections which will arrest labour.

Management of bleeding in the second trimester:

Bed rest:

If the bleeding is slight you may be advised bed rest at home. If the bleeding is moderate or heavy, you might be admitted to the hospital for a few days till the bleeding stops. You will be asked to gradually increase you level of activity and if there is no further bleeding for 1-2 weeks, you will be asked to resume your routine activity. It is best to avoid intercourse for 2 weeks following any vaginal bleeding.  

Cervical cerclage:

If there is evidence of cervical incompetence or insufficiency (painless dilatation of the cervix), an attempt will be made to suture the cervix shut. The suture will be left in place till term and then it will be removed to allow for labour. Sometimes the cervix may have dilated too much and the cerclage procedure may not be feasible.