1. What is a mucus plug?
At the very beginning of pregnancy some mucus is accumulated in the uterine cervix generated by the uterus during ovulation. As the mucus thickens, it seals the cervix tightly, blocking the way for any infection from the vagina to the cervix and thereby protecting the fetus.
Human mucus plug is formed from the cervical glands secretion. It is a thick, gelatinous mass that fills the entire cervical canal. It’s formed at the end of the first month of pregnancy, when the ovum is implanted in the uterine cavity: at this time the cervix softens, swells and gets filled with the cervical mucus produced by the cells of the cervix. With each ovulation it thickens to form rather dense clot blocking the entrance to the uterus.
Secretion of cervical glands is constantly supported by a high level of estrogen and progestin which are the hormones responsible for the fetal development. Thus, the plug isn’t formed from the thick liquid, which was generated from the beginning of pregnancy. The secretion of the cervical cells takes place on a continuous basis and the cervix mucus plug always remains “fresh”. It completely fills the uterine cervix leaving no gaps between the uterine walls. The mucus contains antibodies which help the immune system to counteract pathogens like bacteria, fungus, etc.
2. Images of mucus plug: what does it look like?
The mucus plug looks like a piece of mucus or jelly and to some women it can even resemble a jellyfish. Basically, the size of mucus plug is rather small, 4-5 cm long (when in the uterine cervix) or about two tablespoons (when it comes out). In fact, the discharge can be even smaller in size since it can come out in parts.
Usually, the color of mucus plug is white-yellowish, sometimes with blood admixture or streaks of pink or pure white. There can be some variants including beige, taupe or even brown mucus plug. All these colors are considered as variants of the norm.
The blood streaks in the plug can be observed rather often since the uterine cervix expands before labor and that can lead to bursting of capillaries. Still, there shouldn’t be any bleeding. If passing the plug is accompanied by rather heavy blood-tinged discharge of scarlet color, then you should contact your doctor immediately.
3. When does the plug come out?
Before labor starts, the balance of female hormones changes. The number of estrogens significantly increases compared with the quantity of gestogen. That is, the process of fetal development is considered to be completed and so it’s canceled. Under the influence of estrogen the plug gets thin and then passes.
Thus, passing of the plug indicates that labor is getting on regardless of the gestational age. Premature labor starts the same way as physiological or postmature delivery. So, the mucus plug discharge during early pregnancy indicates that something has gone wrong in the body of the pregnant woman and she needs to see a doctor since in this case passing the plug can be a sign of early labor.
4. How does a woman lose the mucus plug?
Losing the mucus plug is somewhat different for nonparous and multiparous women. The fact is that the cervix of nonparous pregnant women has a smaller diameter compared to those women who experienced the process of childbirth. The uterine cervix walls are thick enough to keep the mucus so firmly that the plug passes with blood (from ruptured blood vessels) or by parts. At the same time some prenatal structural changes of the cervical canal take place accompanied by separation of epithelial cells. This can come with slight bleeding. Therefore nulliparous pregnant women can observe streaks of blood in the thick secretions.
In parous women the inner surface of the cervical canal is rather elastic. The surface epithelium is loosened and the intercellular space is able to stretch. Therefore, the plug in parous women often passes in one piece and without bloodshed.
Women with lesion of the cervical canal can be an exception to the general statistical cases. Scars are formed on the inside of the cervix as a result of forced expansion during abortion or as a result of inflammatory lesions of the cervical cells by Trichomonas or other infection. Sometimes bleeding during passing mucus plug in parous women is associated with cervical erosion.
In spite of the general statistics, it’s impossible to predict the way the cervical mucus plug will pass in every woman. It passes in different ways and at different times. Some women may not even notice passing the mucus plug. After all, this can happen when a woman relieves herself (in this case you may just feel as if something is dropped during urination). Often the plug passes while a woman takes shower and in this case she can feel or see nothing. Only if it passes at night or during a day when the woman wears panties, pieces of mucus can be seen on them.
5. What should you do after the plug has come out?
If you’re sure that the plug has passed, do not panic, since the time left before labor can vary from several hours to several weeks. So if you know that the time for delivery hasn’t come yet and there are no signs of abnormality in the discharge (it has normal white or yellowish color with or without blood streaks), you don’t observe bursting of waters and don’t feel contractions, then don’t worry and just relax. However, later it’s better to see a doctor and find out if everything is fine and how soon you can expect labor. Depending on the overall condition, the doctor will give specific recommendations or will send you to the hospital.
Anyway, don’t forget that discharge of the mucous plug is an early sign of labour. So, it’s better to stay close to the hospital and your home where you can use your time profitably reviewing the things prepared for the hospital and making sure everything is ready at home.
However, you should pay attention to mild “pushes”, some tension and drawing pain in the abdomen or other feelings which can be similar to those that usually accompany menstruation. This aching pain may slip into contractions meaning the beginning of delivery and labour. Even in this case there is no need to rush to the hospital. Make sure in the intensity and frequency of the contractions. When the interval between them shortens to 10 minutes, then it’s really time to go. And as long as the intervals between contractions are longer and the contractions aren’t intense as well as they don’t cause much discomfort, it’s better to use time for getting prepared. For example, you can check all the necessary documents or take a warm shower.
But if after the mucus plug discharge the waters breaks, you have to go to the hospital immediately. In case of bleeding along with the discharge, also don’t hesitate and call the ambulance.
6. Is there any risk associated with losing a mucus plug?Losing your mucus plug during pregnancy doesn’t mean that the protection of the fetus from vaginal infection is broken. There is the second and more important protective barrier which is a thick bag of waters. Therefore, in case you have lost the plug and the labor hasn’t started yet, you shouldn’t worry but you should take some precautions. Avoid swimming in the bath, pool or sea and pay more attention to the personal hygiene (take shower and change underwear and bed linen more frequently). As for your intimate life, after losing the plug you have to abandon it since infection can get from the vagina into the uterus.
Note that rupture of the membrane (which also can come painlessly) bears great risk of infection for the fetus and the risk increases as time passes. In this case every minute counts, so if you’re not able to determine the type of vaginal discharge (whether this is the plug or the membrane), pinpoint the time of the discharge and call the ambulance immediately. At the hospital doctors would specify whether it was the plug or amniotic fluid.
7. Does loss of mucus plug in pregnancy mean going into labor immediately?
Doctors believe that the plug should come out not earlier than 2 weeks before the due date of delivery. Most often the discharge takes place 3-5 days before labor. But in fact, nobody can tell you when you lose the plug – just before labor, along with the amniotic fluid or hours, days and even weeks earlier.
So, although the discharge of the plug is one of the three early signs that labour is approaching (along with contractions and rupture of membranes), it doesn’t mean you’re going to deliver immediately. If there are no other signs of labor, you shouldn’t hurry to the hospital. But in any case, you should inform your doctor about it and then have medical examination.
8. Does the plug always pass before labor?
No, sometimes it doesn’t come out before labor. But anyway it will pass with bursting of waters or the doctor will remove it during the process of delivery. Besides, some women think that they haven’t lost the plug when they really have! You can simply miss the moment or take the discharge of the plug for other mucoid discharge.
9. Can mucus plugs in pregnancy indicate any pathology?
Some women take bursting of waters for losing the plug. Normally amniotic fluid is absolutely transparent, colorless and much thinner than the plug. Rupture of membranes is much more dangerous for the fetus because of the threat of infection. To avoid possible complications during the pregnancy, you should inform the doctor about your condition.
If you lose the plug earlier than 2 weeks before the due date determined by a physician during ultrasound examination (for example, when losing your mucus plug at 33 week), it’s also the issue for concern. This can mean premature delivery or placental abruption so in any case you should go to the hospital.
Another reason to visit your doctor is the discharge accompanied by bleeding. If you see a large quantity of bright blood in the discharge, there is a risk for the health of the unborn baby and the future mother because of damage of the placenta.
It is worth paying attention to the fact that the plug shouldn’t have foul odor. Offensive odor is usually characteristic of infection. Also make notice of the discharge color. Greenish mucus plug may indicate fetal hypoxia, so you need to inform your doctor about the suspicious discharge as quickly as possible.
By the way, during the pregnancy you should tell your doctor about all vaginal discharges. This helps to monitor the progress of the pregnancy as well as to clarify the expected date of delivery.
10. Is losing mucus plug in pregnancy painful?
Sometimes women experience aching, nagging pain in the lower abdomen that resembles the pain during menstruation. However, this is not a general rule and losing mucus plug may be really painless and even imperceptible for a pregnant woman.