This chapter addresses the issue of what advice to give pregnant women who are at risk of bleeding or who have experienced vaginal bleeding (antepartum hemorrhage) during pregnancy. Topics covered include local causes of bleeding (e.g cervix), abruption, and placenta previa. We review the published evidence, which is very limited, for the basis of any recommendations regarding sex and bleeding in pregnancy. The recommendations provided in the chapter regarding sexual activity are tailored to the various clinical presentations of antepartum hemorrhage. This includes advice for patients who are at risk of bleeding as well as those who have already experienced an episode of antepartum hemorrhage. In a unique approach using the classification of placenta previa by transvaginal ultrasound, recommendations for sexual activity are related to the risks of hemorrhage based on distance of the placental edge from the internal cervical os.

There is a paucity of data on sex with bleeding in the first trimester of pregnancy. The sexuality of couples is highly diverse, and sexual intercourse frequently declines from the start of pregnancy. An increased risk of miscarriage in the first trimester has been reported when intercourse is associated with bleeding. However, it is impossible to assign a deleterious role for sex in this statistically significant association between bleeding and first-trimester miscarriage. Overall, there seems to be no danger associated with sexual activity of whatever type during pregnancy.