Bleeding or Spotting During Pregnancy: What’s Normal and What Isn’t?

Spotting or bleeding during pregnancy can send waves of panic and worry, but it doesn’t always mean something serious. Spotting in pregnancy is actually common and there’s usually nothing to worry about. In fact, the American Congress of Obstetricians and Gynecologists (ACOG) report that bleeding in the first trimester occurs in about 15-25% of pregnant women. However, some bleeding could indicate a more serious condition.

Early Spotting

If you’re noticing occasional drops of blood on your underwear or when you wipe with toilet paper, you are spotting. Some of the first spotting you may notice is at one to two weeks after fertilization, when the fertilized egg implants in the uterus. The cervix may cause light spotting during pregnancy because more blood vessels are developing inside it, or it may be from a harmless cervical polyp that forms because of the increase in estrogen levels during pregnancy. In addition, you may notice spotting after a routine gynecological exam or after sex. Spotting is especially common in the first trimester.

Flow Chart

Spotting is kind of a vague term. How much blood is lost? Usually, light spotting is seen when you wipe after peeing. Sometimes, it may be necessary to wear a light pad for coverage. A cause for concern is when the bleeding is heavier – if you have to change your tampon or a pad more than once in three hours, you should call the doctor. In addition, if significant pain and cramping accompanies the spotting, call your OB or midwife immediately to rule out anything serious.

Miscarriage

Bleeding and cramping can be a sign of a miscarriage. A miscarriage is defined as pregnancy loss within the first 20 weeks of gestation, often occurring within the first 13 weeks. However, not all women will experience bleeding before a miscarriage. If you have severe back pain, white-pink mucus, weight loss, painful contractions every 5-20 minutes, or severe pain in the back or abdomen that feels more severe than menstrual cramps, call your OB or midwife immediately.

Ectopic Pregnancy

Bleeding can also occur during an ectopic pregnancy. This happens when the fertilized egg doesn’t implant in the uterus and instead implants itself in one of the fallopian tubes. If the fallopian tube ruptures, it causes internal bleeding and other symptoms such as abdominal, pelvic, and even shoulder pain. Sadly, the pregnancy will be lost and immediate medical help is necessary.

Bleeding Later in Pregnancy

Spotting later in pregnancy could be the result of inflammation or a growth on the cervix. However, heavier bleeding is more serious. It can be a signal for preterm labor or a problem with the placenta such as:

Placenta previa is a condition where the placenta lies low in the uterus, and it may cover a portion of or the entire cervix. Bleeding is not usually accompanied by pain, and the condition can resolve itself by the 35th week of pregnancy when the lower part of the uterus stretches and thins out. Normal delivery is expected unless the placenta previa does not resolve. If that is the case, a cesarean delivery will be set up before the due date.

Placenta abruption materializes when the placenta detaches from the wall of the uterus before or during birth. In addition to bleeding, you can expect back and abdominal pain. It’s crucial to discover this condition early on as the baby may not get enough oxygen or mom-to-be could lose a significant amount of blood.

Placenta accrete transpires when the placenta or a portion of it invades the uterine wall and attaches itself deeply inside the uterine wall. This commonly occurs during the third trimester. A routine ultrasound will generally detect it. In rare cases, it can go undetected until after the baby is born. Since this condition can cause severe blood loss during delivery, special considerations need to be taken to ensure all resources are available. Unfortunately, a placenta accrete is often severe and a hysterectomy is required.

As always, you should never hesitate to call your OB or midwife – whether you’re experiencing spotting or heavier bleeding.

How Will I Know?

When you see the doctor, they will run tests that may include using a Doppler ultrasound or a traditional abdominal or vaginal ultrasound to detect fetal heartbeat and to view the placenta. A pelvic exam may be done to inspect the cervix and to check for dilation. Blood work may also be ordered to test the hCG hormone levels to rule out or confirm a miscarriage.

Do you have experience with bleeding/spotting during pregnancy? Was it a cause for concern? Share your stories with us.