Whether you’re early on in your pregnancy or about to pop, vaginal bleeding of any kind can be very scary and worrisome. Is this normal spotting or should you be concerned about your unborn baby?
In many cases, bleeding during pregnancy is normal. Where you are in your pregnancy and the severity of bleeding – whether light spotting or heavy bleeding – provide clues as to whether what you’re experiencing is normal or cause for concern.
Is there a difference between spotting and bleeding?
Spotting is light bleeding—the type of bleeding that wouldn’t cover a panty liner. Whereas bleeding is a flow of blood that’s greater than a drop here and there. It’s heavier in nature and would require a liner or pad to keep the blood from soaking through your underwear.
You should always let your provider know if you’re experiencing any type of spotting or bleeding, but the timing of when to seek help is key.
When should I seek help for vaginal bleeding during pregnancy?
If you notice pink, red or dark brown ‘spots’ smaller than a dime on undergarments or when you wipe, you can generally wait until your health care provider’s office opens to call and schedule an appointment.
“However, bleeding that soaks through a pad within an hour, and continues, requires urgent evaluation in the emergency room during the first trimester and early second trimester. Patients in mid-second trimester and beyond should go directly to the triage room in labor and delivery,” said Celia Valenzuela, MD, an OBGYN at Banner Health in Tucson, AZ. “Bleeding that is similar to your period in the third or mid to late second trimester always warrants evaluation.”
It’s important to know your blood type as some blood types may require special medication. If your blood is Rh negative, you’ll likely need medicine called Rh immunoglobulin or RhoGAM. Your provider can guide you through the timing of this. Learn more about Rh factor.
[Call 911 if you’re also experiencing intense cramping, a fever of 100.4 or higher, dizziness or thick vaginal discharge along with heavy bleeding.]
While it’s natural to go to worst case scenario at the sight of blood, read on to learn the potential causes for bleeding during the first trimester, second trimester and third trimester.
What are the most common causes of bleeding in the first trimester?
While seeing blood in your underwear can be unnerving, it’s not uncommon during the first trimester. While estimates can vary, about 1 in 4 pregnant people experience bleeding during the first trimester.
One of the most common causes of bleeding in early pregnancy occurs in the first few weeks during implantation, when the fertilized egg implants on the uterine wall.
“During pregnancy, pregnancy hormones can alter a person’s cervix, making it more sensitive and more susceptible to bleeding when touched,” Dr. Valenzuela said. “It’s not uncommon then to notice spotting or light bleeding after sex, insertion of a speculum, collection of a cervical specimen for pap test or culture and cervical examination for dilation.”
Problems that can cause bleeding in early pregnancy can include:
- Pregnancy loss or miscarriage: Roughly half of people who experience spotting in early pregnancy do miscarry, however this means half of women who spot, do not.
- Ectopic pregnancy: Usually, an ectopic pregnancy happens when a fertilized egg implants outside of the uterus. Symptoms of an ectopic pregnancy may include spotting or light bleeding and pelvic or belly pain. This is rare in pregnancies but is considered a medical emergency. “The amount of bleeding that you may experience can vary, though generally it is light prior to diagnosis,” Dr. Valenzuela said. “After an ectopic pregnancy is treated, you may have heavier bleeding as hormone levels decrease.”
- Molar pregnancy: A molar pregnancy is rare but occurs when abnormal tissue grows inside the uterus, instead of an embryo. You may think you’re pregnant, but an ultrasound shows no fetal heart rate. “Frequently, molar pregnancies are discovered during an ultrasound during the first trimester before bleeding has started,” Dr. Valenzuela said.
- Cervical or vaginal infections: Any infection of the cervix, vagina or a sexually transmitted infection like chlamydia, gonorrhea or herpes can cause bleeding.
- Cervical polyps: A harmless growth on the cervix that can result in bleeding during pregnancy.
“Many people frequently worry about miscarriage when they experience bleeding in the first trimester, and as a provider, we worry about this as well,” Dr. Valenzuela said. “Call your health care provider, so they can do the appropriate blood or ultrasound tests to identify the cause.”
What are the causes for vaginal bleeding later in pregnancy?
Like the first trimester, light bleeding or spotting during your second or third trimester may occur after sex or a cervical exam. It can also be due to a “bloody show,” a sign that labor is starting.
Problems that can occur later in pregnancy can be caused by placental abnormalities, such as placental abruptions or placenta previa.
“Placenta abruptions occur when the placenta separates partially from the uterine wall often resulting in very heavy bleeding,” Dr. Valenzuela said. “Placental previas occur when the placenta is placed over the opening of the cervix. Both require timely medical care.”
Bottom line
Not all spotting and bleeding are a cause for concern during pregnancy, but it’s best to get evaluated by your health care provider.
If you’re experiencing abdominal pain, cramping, unusual vaginal discharge, contractions, fever or soreness in the uterus, seek emergency care. These symptoms could be a sign of a serious problem or may even signal preterm labor.
