Bacterial Vaginosis (BV) is a frequent condition resulting from an imbalance in the natural population of bacteria within the vagina. This disturbance of the vaginal flora is a source of concern, particularly during pregnancy. Bleeding during pregnancy, even minor spotting, causes anxiety for expectant mothers. This article examines the connection between Bacterial Vaginosis and vaginal bleeding during gestation, along with the broader implications of this infection for a healthy pregnancy.
What Bacterial Vaginosis Is and Why It Matters During Pregnancy
Bacterial Vaginosis is characterized by a shift in the vaginal ecosystem. The protective, acid-producing Lactobacillus species are significantly reduced, allowing an overgrowth of other bacteria, such as Gardnerella vaginalis and various anaerobes. This change increases the vaginal pH above its normal acidic level of 4.5. Between 10% and 30% of pregnant women experience BV, though many may not have noticeable symptoms.
When symptoms appear, they commonly include a thin, gray or whitish vaginal discharge and a distinct, fish-like odor, which may become more noticeable after intercourse. BV matters during pregnancy because the vaginal and cervical areas are in direct proximity to the growing uterus. An infectious process in the lower genital tract presents a potential pathway for bacteria to ascend toward the developing fetus and the amniotic sac. Hormonal changes inherent to pregnancy may also contribute to this altered bacterial balance.
How BV Relates to Vaginal Bleeding
Bacterial Vaginosis is typically not the direct cause of heavy, acute bleeding, but it can be associated with first-trimester spotting or mild hemorrhage. The mechanism involves the inflammatory response triggered by the bacterial overgrowth. BV causes inflammation of the vaginal and cervical tissues, known as vaginitis or cervicitis.
This inflammation causes the delicate mucosal surfaces to become fragile and easily irritated. The tissues are more susceptible to minor damage, leading to spotting, especially following sexual intercourse or a routine pelvic examination. Studies have shown that first-trimester bleeding is statistically linked to the presence of BV.
The bleeding associated with BV is generally light, often appearing as a pink or brown discharge stemming from the irritated surface of the cervix or vagina. Any bleeding during pregnancy warrants immediate discussion with a healthcare provider. Differentiating between mild spotting caused by inflammation and bleeding from a serious obstetric complication requires medical evaluation.
Beyond Bleeding: Other Pregnancy Risks Associated with BV
The major concern regarding untreated Bacterial Vaginosis during pregnancy is its association with serious obstetric complications. The infection in the lower genital tract can ascend through the cervix, leading to an infection of the membranes surrounding the fetus. This ascending infection is the reason for the heightened risk of adverse pregnancy outcomes.
Untreated BV significantly increases the likelihood of preterm labor and delivery (birth before 37 weeks of gestation). Research suggests that the risk of preterm birth can be more than doubled in pregnant individuals with BV. BV is also associated with an increased risk of late miscarriage, particularly in the second trimester.
The infection raises the risk of premature rupture of membranes (PPROM). Babies born early due to these complications are also at an increased risk of low birth weight (less than 5.5 pounds at birth). BV can also lead to postpartum endometritis, an infection of the uterine lining that occurs after delivery.
Testing, Treatment, and Urgent Care for Bleeding
Diagnosing Bacterial Vaginosis during pregnancy involves a pelvic examination and testing a sample of vaginal discharge. A healthcare provider will check the vaginal pH, which is usually 4.5 or higher with BV, and look for “clue cells” on a microscopic slide (vaginal cells coated with bacteria). Once diagnosed, treatment is necessary during pregnancy to minimize the risk of complications.
The standard treatment involves prescription antibiotics. These may be administered orally (such as metronidazole or tinidazole) or as a vaginal gel or cream (such as clindamycin). Systemic (oral) antibiotic therapy is preferred for pregnant women, particularly those at high risk for preterm birth, as it reaches the upper genital tract more effectively. Patients must complete the entire course of medication, even if symptoms subside quickly.
Regardless of a BV diagnosis, any vaginal bleeding during pregnancy requires immediate medical evaluation. If the bleeding is heavy, similar to a menstrual period, or is accompanied by severe abdominal pain, back pain, or the passing of clots or tissue, urgent medical care is necessary. These symptoms indicate serious complications that require prompt intervention and should not be assumed to be minor spotting related to BV.