Advanced Women's Care

The first trimester is defined as the 1st one third of the pregnancy, roughly the 1st 13 weeks.  Bleeding at this time can indicate a impending miscarriage or can be the result of reversible changes in the pregnancy allowing the pregnancy to continue.  Any amount of vaginal bleeding especially if accompanied by pelvic pain should be investigated to determine the cause.  Any extremely heavy bleeding or bleeding accompanied by moderate or severe pain may need to be investigated immediately.  Even light vaginal bleeding associated with significant pain needs to be evaluated immediately.  If you have these symptoms go immediately to the Emergency Room at McLeod Regional Medical Center or Carolina Hospital System for evaluation.  If  our office is open, please call since many times we can arrange an immediate appointment.  If your bleeding is light and only mild cramping or pain is present, call the office for an urgent appointment the office the next time it is open.  Usually little can be done to prevent a miscarriage.

First trimester bleeding is often caused by a small tear between the early placenta and the lining of the uterus.  If these tears are small, often the pregnancy continues and the tear heals with no adverse effects on the baby.  Miscarriages often occur because of genetic mistakes made at conception resulting in an abnormal amount of DNA or genetic material.  These problems can usually be detected by ultrasound, lab work, and physical examination.  One of our doctors or nurses will determine the appropriate testing required and will discuss the results plan of management with you.  We cannot usually determine the diagnosis or treatment plan over the phone.  If you have to be seen in the emergency room, we will usually allow the examination, lab work, and ultrasound to be performed by the emergency room doctor.  The emergency room doctor will initially evaluate you and then contact the doctor on call for our practice and appropriate diagnosis and therapy and follow-up will be determined.

  The second trimester starts at approximately 13 to 14 weeks. The third trimester starts at approximately 28 weeks.  Light vaginal bleeding is usually not anything to be concerned about unless the pregnancy has not yet been evaluated.  Still, women having vaginal bleeding in the second trimester should probably be evaluated to determine the cause of the bleeding.  If the bleeding is very heavy, please proceed to the emergency room at either McLeod Regional Medical Center or Carolinas Hospital System.  Again, the emergency room doctor will evaluate you first and then contact us with his results.  We will then make a determination as to the plan of management.  If the office is open, please call the office first before proceeding to the emergency room.

After 20 weeks, vaginal bleeding as heavy as a menstrual cycle should be evaluated on labor and delivery, especially if the bleeding is accompanied by cramping or contractions.  After 20 weeks, please do not go to the emergency room for evaluation of bleeding and or cramping.  Please go to labor delivery where you are to delivery your baby. Light vaginal spotting can wait until the next time the office is open as long as there are no other symptoms associated with the light bleeding.  Sometimes, bleeding can occur normally near term as the cervix begins to dilate or after a vaginal examination in the office.  Please call the office if you have any questions.  For after-hours emergencies, please proceed either to the emergency room or to labor and delivery for evaluation.