Lost Mucus Plug at 28 weeks: Cause for Concern?

My daughter, now 28 weeks pregnant, began leaking amniotic fluid at 22 weeks. After two weeks of hospitalization, she stopped leaking and was released on strict bedrest. Recently, she's had heavy mucous mixed with red blood. Her regular doctor saw no concern. Should she return to her specialist for a second opinion? We live in northern Canada, and a team would have to fly in to care for a premature infant.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

Your daughter has been expelling the mucus plug. This generally happens a day to a week before labor begins. It is released in response to the cervical changes (effacement and loosening or early dilatation of the cervical os) that accompany very early labor or preparation for labor.

If this happens in a woman near term, we reassure the mother that this is perfectly normal and it really has no bearing on when labor will begin, but in a woman already at great risk for preterm labor, I would say this is a red flag.

There is no harm in losing the mucus plug. Unlike rupture of membranes, it does not put her or the baby at greater risk of infection. But it does herald cervical readiness for labor.

Cervical exams -- like nipple stimulation, orgasm, intercourse or perineal massage -- may stimulate prostaglandin release and initiate labor. That is why it is difficult for me to recommend that she get another opinion. The last thing she needs right now is for someone to do an examination of her cervix.

She needs to be very aware of any contractions, back ache, even pains in the upper thigh that come and go, can mean labor. If she suddenly feels like the baby has engaged, she should try to get to a medical center that handles high-risk pregnancies. They may be able to stop labor before it becomes too advanced.

I am assuming that she is not "bleeding" and that the blood is only in the mucus itself. If she continues to lose any blood, she should have an ultrasound to check the position and integrity of the placenta.

I know that I've not been very reassuring, but she is indeed at high risk for preterm labor. Of course, this also might mean nothing at all. If she had a recent exam, sometimes this can dislodge the mucus plug.

I hope all ends well. Please keep in touch.

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