Closed Cervix and Bleeding: How Is That Possible?

It’s not uncommon to hear reports from women who are newly pregnant, even before reaching 8 weeks, who have experienced some bleeding¹. Any spotting during the first weeks of pregnancy can be very concerning due to the risk of miscarriage. However, bleeding at any stage of pregnancy is not normal.

The first step in these situations is to go to the emergency room of a maternity hospital to find out what is happening. Once there, the doctor will run all the necessary tests, including a physical exam. And the diagnosis: closed cervix. But how is it possible to bleed if the cervix is closed? Why does it happen? Am I at risk of miscarriage? Is it a sign of labor in a more advanced pregnancy²?

Spotting can happen for several reasons. Usually, an external source of bleeding explains the presence of bleeding when the cervix is closed. The main reason for bleeding with a closed cervix is the rupture of some blood vessels in the cervix. This can be due to its growth.

The uterus has many vessels and blood-filled veins. It swells significantly at the start of pregnancy, and this swelling can cause small vessels to burst. This rupture causes bleeding that exits through the vagina, giving the false impression that the bleeding is coming from inside the uterus. The vagina is also an organ filled with blood vessels. When pregnancy occurs, it swells considerably, and, if one of the vessels inside the vagina ruptures, bleeding can also happen.

Another reason for bleeding even with the cervix closed is implantation³. Implantation bleeding can occur for several reasons and, when it’s heavy as it leaves the vagina, it can alarm the pregnant woman. Usually, this type of bleeding happens no later than 6 weeks of pregnancy and is perfectly normal, but it’s always good to keep an eye on it.

Besides implantation, another reason for bleeding even with a closed cervix is the attachment of the placenta. This is different from implantation. If bleeding occurs at a later stage, around 10 weeks, it might be because the placenta is attaching to one of the walls of the uterus.

This pregnancy bleeding can occur around 10 weeks, as the baby still has the support of the yolk sac. After the definitive placenta attaches, the yolk sac shrinks until it disappears. When the placenta fully takes over the nutrition of the fetus, it is already completely implanted. In this case, the woman may experience slight bleeding even though her cervix is closed. The types of bleeding mentioned above do not pose a risk of miscarriage.

Even with a closed cervix, which types of bleeding are concerning?

The most worrying kind of bleeding is heavy bleeding with a bright red appearance. If there are clots present, it should be assessed by a doctor as soon as possible. Usually, an ultrasound can detect the cause of this bleeding. However, clots are a sign that the endometrium, which is essential for pregnancy, is being expelled in large quantities.

In this situation, the doctor may consider prescribing medication and putting the pregnant woman on strict bed rest, including abstaining from sex. Even with a closed cervix, heavy bleeding accompanied by severe cramps can be a sign that the pregnancy may not progress due to risk of miscarriage. Therefore, talk to your doctor and ask for their honest opinion regarding your condition.

Brownish, stretchy, coffee-ground-like bleeding is also common. These types of bleeding can be caused by low progesterone levels (a hormone secreted by the corpus luteum that is responsible for the integrity of the endometrium). If this is suspected, the doctor will supplement the necessary amount of progesterone with appropriate medication, to keep the cervix closed and the endometrium intact.

In both early and more advanced pregnancies, bleeding after sexual intercourse can also happen. This bleeding may occur from rupture of the blood vessels in the vagina or cervix. This is not a concerning situation. It can also occur if the woman has placenta previa. In this case, you may notice frequent bleeding, but without significant risks to the pregnancy.

It is recommended to see your doctor or go to the emergency room if you have any sign of bleeding. It might be nothing serious, but it’s always best to know what’s going on.

Important Tip: Women in early pregnancy should take appropriate vitamins containing methylfolate, the active form of folic acid. FamiGesta is the recommended vitamin and one of the first to be developed with methylfolate. Learn more about FamiGesta here.

See also: Does Ectopic Pregnancy Exist?