Bloody show

Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, and is one of the signs that labor may be imminent. The bloody show may be expelled from the vagina in pieces or altogether and often appears as a jelly-like piece of mucus stained with blood. Although the bloody show may be alarming at first, it is not a concern for patient health after 37 weeks of gestation.

Bloody show is recognized through the presence of mucus and blood that is combined and discharged from the cervix before labor occurs. Bloody show is sometimes used as an indication of active labor, and can occur as a result of the onset of labor. Bloody show can also occur with other symptoms of onset of labor, including painful contractions, degree of cervical effacement, and/or spontaneous membrane rupture. Severity of symptoms differs from person to person, and usually those symptoms are more commonly found than bloody show.

Bloody show may occur before labor, sometimes as early as three days before the actual delivery date. When a bloody show occurs, pregnant individuals are encouraged to see a midwife or doctor, as this may be an indication of active labor. Bloody show may occur gradually or all at once, however, it will indicate the pregnant person will go into labor soon.

Bloody show is the most common cause of bleeding during late pregnancy and often presents as minor bleeding mixed with mucus alongside other signs of labor initiation (contractions, cervical dilation, cervical effacement). While not considered as serious bleeding or deadly, the passage of a bloody show signals that labor is beginning or will begin soon.

The diagnostic examinations and tools used to determine the type of vaginal bleeding depend on a combination of gestation age, history of pregnancy and bleeding, past medical history, physical examination, and laboratory work.

Vaginal bleeding may occur at any point during pregnancy. During late pregnancy, bleeding may be normal but may also indicate a more serious underlying problem such as miscarriage, placenta previa, or placental abruption. Bloody show itself is an exclusionary diagnosis, that is, it rules out other causes of vaginal bleeding. Other causes of vaginal bleeding in late pregnancy include placental abruption, placenta previa, vasa previa, uterine rupture, and non-obstetric causes.

While bloody show is not considered as vaginal bleeding requiring medical intervention, other more serious types of bleeding may visibly present as minor bleeding. As such, if any of the following are observed, a more thorough examination is warranted to rule out serious causes of bleeding:

Bloody show is not considered abnormal within the context of pregnancy; therefore, no treatment is required.