A break from monthly bleeding is a tiny perk of pregnancy, so it’s definitely unsettling if you spy blood once you’ve conceived. But bleeding isn't always a sign of something wrong. In fact, up to 25 percent of women experience it in the first trimester and more than half go on to have healthy pregnancies and babies.
So if you're noticing light spotting, you can take a deep breath and read on for a probable (and probably reassuring) explanation. Here’s more about the difference between spotting and bleeding, what causes it during pregnancy and how bleeding is treated when you’re expecting.
How can you tell the difference between spotting and bleeding?
The difference between spotting and bleeding while pregnant usually comes down to the shade of the blood and the amount. In terms of color, spotting is often brownish or pink, similar to what you’d expect at the end of your period. And as for amount, you’re probably spotting if the blood is so light that you reach for a panty liner rather than a maxi pad.
On the other hand, bright red blood is considered bleeding, especially if it’s flowing and heavy. If you’re experiencing bleeding during pregnancy, you’ll skip over that box of liners in favor of a sanitary pad to protect your clothes.
What causes spotting during pregnancy?
Light spotting is common and usually benign, and can begin around weeks 3 or 4 of pregnancy. But spotting can happen anytime during these nine months, from the early days of fertilization up to your due date. Here are some of the common causes of spotting during pregnancy:
- Implantation bleeding. The implantation of the embryo into your uterine wall usually occurs before or around the time you expected your period, or about six to 12 days after conception. Implantation bleeding is lighter than a period, lasts from a few hours to a few days, looks pinkish or brownish and isn’t a sign of something wrong.
- Sex. Your cervix becomes tender and engorged with blood vessels, so any kind of minor bumping like getting busy between the sheets may irritate it and cause light bleeding. This spotting is pretty common, but do tell your practitioner if you’d like extra reassurance.
- Internal pelvic exam or Pap smear. The same type of spotting you might see after sex is also possible when your doctor performs an internal exam or Pap smear.
- Infection of the vagina or cervix. An infection can irritate or inflame the cervix, causing it to bleed a little (though the spotting should disappear once you're treated).
- Lost mucus plug. This barrier seals your cervix, but later in pregnancy it falls out, indicating the start of labor. It’s usually clear and sticky, but it may also be brown or yellow.
- Subchorionic bleed. Blood accumulates within the folds of the chorion (the outer fetal membrane, next to the placenta) or between the uterus and the placenta itself, causing light to heavy spotting. In most cases, it resolves on its own and isn’t a problem in pregnancy.
What causes bleeding during pregnancy?
Period-like bleeding early in pregnancy, or at almost any time, can signal that something is up. Because heavier bleeding may go hand in hand with any number of pregnancy complications, pinpointing the exact reason is best left to your practitioner. Here are a few possible causes:
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- Ectopic pregnancy. This nonviable pregnancy occurs when a fertilized egg implants outside of the uterus, and it requires immediate medical attention. You'll notice heavier vaginal bleeding and severe sharp abdominal pain, sometimes accompanied by rectal pressure, shoulder pain, lightheadedness, fainting or shock.
- Molar pregnancy. Typically discovered within weeks of conception, a molar pregnancy is when a placenta becomes a mass of cysts accompanied by a malformed or nonexistent embryo. Signs of this rare condition include dark brown to bright red vaginal bleeding with severe nausea, vomiting and cramping.
- Miscarriage. This early loss happens in about 10 percent of pregnancies and is most often related to a chromosomal or other genetic defect of the embryo, though it may also be due to hormonal or other factors. Heavy vaginal bleeding (possibly with clots and/or tissue) may occur with severe cramping, lower belly or back pain and a sudden, pronounced decrease in early pregnancy symptoms (like breast tenderness and morning sickness) that's different from the gradual diminishing as the first trimester ends.
- Placenta previa. While usually discovered on a second trimester ultrasound or possibly in the third, this relatively rare complication happens when the placenta implants on the lower part of the uterus and covers part or all of the cervix. (In most women, the placenta moves up and away before birth.) When placenta previa is accompanied by bright red bleeding, your practitioner will likely put you on pelvic rest (meaning no sex) and advise you to relax and avoid strenuous activity or exercise.
- Placenta accreta. If placenta previa is suspected or diagnosed, you may also be monitored for placenta accreta, which occurs when the placenta attaches too deeply in the uterine wall.
- Placental abruption. This condition, which almost always occurs in the second half of pregnancy and usually in the third trimester, is the early separation of the placenta from the uterine wall. In addition to light to heavy bleeding with or without clots, you may also notice abdominal aching or cramping, uterine tenderness and pain in the back or abdomen. If the separation is slight, there's usually little danger to you or your baby and you'll probably be monitored closely and told to take it easy. But if it's more severe, you may need to be hospitalized — which is why it's so important to see your doctor regularly.
- Preterm labor. If you go into labor after week 20 and before week 37 of pregnancy, it’s considered preterm. Along with bleeding, it can be accompanied by other labor signs including back pressure, unusual pelvic pressure and regular contractions that intensify and become more frequent even when you change positions. If you suspect labor is starting early, contact your practitioner immediately.
- Uterine rupture. A tear in your uterus during labor is very rare and may occur if you’ve had a prior cesarean birth or other uterine surgery that’s left a scar.
When should you worry about spotting or bleeding during pregnancy?
Concern about bleeding during pregnancy is completely normal, but remember that light spotting is as variable as it is common and is usually nothing to worry about. Some women spot on and off for their entire pregnancies, while others spot for just a day or two or a few weeks. Happily, women continue to have healthy pregnancies and healthy babies in most cases.
Still, heavy bleeding that soaks through a pad always warrants a call to your practitioner, especially if it's accompanied by cramps or pain in your lower abdomen. But it's not inevitably a sign that you're miscarrying. Some women bleed, even heavily, for unknown reasons and still deliver healthy babies.
When should I go to the doctor for spotting or bleeding during pregnancy?
If you’re at all concerned, don't hesitate to talk to your physician. Heavy bleeding at any point in pregnancy should be reported to the doctor immediately, but spotting or light vaginal bleeding during the first trimester that goes away in a day or so can be brought up at your next prenatal checkup.
At this appointment, your doctor may order a blood test to check hCG levels or perform an ultrasound to check and see that your pregnancy is progressing.
But bleeding during the second trimester, even if it’s not much to see, should be discussed with your health care provider the day it happens. And if you spy blood during the third trimester, get in touch with your doctor right away.
What is the treatment for spotting and bleeding during pregnancy?
In addition to an exam and various tests at the doctor’s office, rest and relaxation are often the best treatments for a case of spotting or bleeding during pregnancy. That might include some time away from work, getting help with little ones and chores at home, and skipping sex for a while.
More serious cases of bleeding during pregnancy may require a hospital visit or surgery, depending on the diagnosis. If your blood type is Rh negative, you’ll get an injection of RhoGAM if Rh incompatibility is diagnosed during your pregnancy.No pregnant woman wants to see vaginal blood of any amount or shade when she’s expecting, but much of the time spotting or light bleeding isn’t a serious problem. Keep track of your symptoms and speak with your doctor at any point for reassurance and guidance.