Spotting during pregnancy

Is it normal to have spotting during pregnancy?

A little light bleeding or spotting during pregnancy is common, especially in early pregnancy. Up to one in four pregnant women have some light bleeding in their first trimester. But even if the bleeding seems to have stopped, call your doctor, just to make sure everything is okay.

Spotting or light bleeding in pregnancy is probably from something minor. But it could also be a sign of a serious problem, such as an ectopic pregnancy, a miscarriage, or an infection.

Your doctor may want to do some tests, which can include a physical exam, an ultrasound, and blood tests, to check how well you and your baby are doing and to rule out any complications.

If you're actively bleeding or you have severe pain and can't reach your doctor, head to the emergency room right away.

What's the difference between spotting and bleeding during pregnancy?

Spotting is very light bleeding, similar to what you may have at the very beginning or end of your period. It will look like small drops of blood on your underwear, varying in color from pink to red to brown (the color of dried blood). Pregnancy spotting is common, especially during the first three months.

Bleeding means that you need to wear a panty liner or pad to avoid soaking your underwear. And heavy bleeding will soak through one or more pads. Continued or heavy bleeding could signal a problem with your pregnancy, which is why it's important to share with your doctor right away.

Early pregnancy bleeding: What causes it?

The most common causes of light spotting or bleeding during early pregnancy include:

Implantation. Some women have spotting even before they know they're pregnant, about a week or so after they ovulate. It's called "implantation bleeding" because it happens when the fertilized egg burrows (or implants) into the blood-rich lining of the uterus, a process that starts just six days after fertilization.

If you have a day or two of spotting in the week before your period is due, take a home pregnancy test. If the result is negative, wait a few days or a week. If your period doesn't start when you expect it, try testing again.

Subchorionic hematoma. Also called a subchorionic hemorrhage, this kind of bleeding can happen when the outer layer of the amniotic sac (chorion) separates from the wall of the uterus. It’s usually harmless and stops on its own. Small collections of blood like this early on are typically harmless. But if the collection of blood is larger, it will take longer to reabsorb, or go away. This can raise the risk of miscarriage or preterm labor, so your doctor may want to check on it regularly with ultrasound.

Miscarriage. Spotting or bleeding in the first trimester, especially if you also have abdominal pain or cramping, can be an early sign of miscarriage. But it isn't necessarily a sign, and actually, about half of women who miscarry don't have any bleeding prior to diagnosis. Other signs of a possible miscarriage are discharge of liquid or tissue from your vagina, and no longer feeling any pregnancy symptoms (like morning sickness). If feeling better is your only symptom, however, try not to worry! Many pregnant women don't experience nausea in the first trimester and have very healthy pregnancies.

Ectopic pregnancy. Early pregnancy bleeding also can warn of an ectopic pregnancy – when the embryo implants outside the uterus, usually in one of the fallopian tubes. Sometimes bleeding is the only sign, but other common symptoms include pain in the belly, pelvis, or shoulder. An ectopic pregnancy can be life-threatening, so let your doctor know right away if you have bleeding or moderate to severe pain in your first trimester.

Molar pregnancy. This rare complication happens when the placenta doesn't develop properly, and it can't sustain the embryo. A molar pregnancy can be serious, and it needs prompt treatment.

Infection. An infection can irritate or inflame your cervix and make it more likely to bleed, especially after you have sex. These are some of the infections that can cause bleeding:

• Chlamydia
• Gonorrhea
• Herpes
• Yeast infection
• Trichomoniasis

Because certain infections can cause pregnancy complications, your doctor might prescribe antibiotics or another treatment.

You might also notice some spotting or light bleeding after sexual intercourse or a pelvic exam. More blood flows to your cervix during pregnancy, so it's not unusual. A cervical polyp (a noncancerous growth on the cervix) can also cause spotting or bleeding after sex or an exam.

What causes second or third trimester bleeding?

Bleeding later in pregnancy might also be nothing to worry about. Light bleeding could be a sign of harmless inflammation, a cervical polyp, or other changes in your cervix. And a few days before your delivery date, bloody discharge called "show" is a sign that your cervix is getting ready for labor.

Heavy bleeding late in your pregnancy is a more worrisome sign. It's worth making a call to your doctor right away.

Here are some common causes of bleeding in your second and third trimesters:

Placental problems. Bleeding or spotting after the first trimester can be a sign of a problem with the placenta, such as:

• Placenta previa, when the placenta partially or fully covers the cervix; usually this is diagnosed at your mid-pregnancy ultrasound or anatomy scan. Your placental location will continue to be monitored as pregnancy progresses, and your obstetrician will recommend that you abstain from intercourse as long as the placenta is over or near the cervix.
• Placenta accreta, when the placenta becomes abnormally embedded in the uterine wall. Although this is a rare complication, the risk slowly increases with each cesarean delivery.
• Placental abruption, when the placenta entirely or partially separates from the wall of the uterus. This is more likely to occur as a result of trauma (car accident, domestic violence), uncontrolled hypertension, or labor.

Late miscarriage. Most miscarriages happen in the first trimester, but bleeding between 13 weeks and the middle of your pregnancy can be a sign of late miscarriage.

Preterm labor. Bleeding is one sign of preterm labor (labor that starts before 37 weeks). Other symptoms are:

• Abdominal pain, cramps, or contractions
• Low backache
• Changes in vaginal discharge
• Pressure in your pelvis or lower abdomen

How much bleeding during pregnancy is normal?

Some light bleeding is normal, especially early in your pregnancy when the fertilized egg implants. But really, bleeding can happen at any point in your pregnancy, and for many different reasons. And because some causes are more serious than others, it's always a good idea to let your provider know about it.

Heavier bleeding that soaks through a pad, or bleeding that doesn't go away is more concerning. It could signal a serious problem with your pregnancy that needs immediate medical attention. Calling your doctor right away or going to an emergency room could help you head off a problem and protect both your health and your baby's.

When should I call my doctor about spotting or bleeding during pregnancy?

Any type or amount of bleeding in pregnancy is worth calling your doctor about, to make sure that nothing is wrong. This is important, even if your last ultrasound showed that your baby is healthy and growing according to schedule.

Heavy or consistent bleeding is a reason to call immediately. Your doctor can check for any problems, and either reassure you that you're ok, or treat the problem.

When you call your doctor, let them know how long you've been bleeding and how much you've bled. Also tell them about other symptoms, like cramps, that you've had along with the bleeding. Also, be sure to be honest with them about recent sexual activity and medical history when you call.

Lastly, whenever the bleeding occurs, if your blood type is RH-negative, your doctor will want to make sure you get a Rhogam shot to protect future pregnancies. Call your doctor if you are RH-negative and have bleeding anytime in pregnancy. If you are RH-positive, this isn't something you have to worry about.

Learn more:

• Pregnancy symptoms you should never ignore
• Vaginal discharge during pregnancy
• Rectal bleeding during pregnancy