Spotting or Bleeding During Pregnancy

Spotting vs bleeding

• Spotting is a few drops of pink, red or brown blood, not enough to fill a panty liner.
• Bleeding is heavier flow that needs a pad.

Brown spotting is old blood and is less concerning than bright red bleeding. Do not use tampons during pregnancy, so the amount of blood can be seen and measured.

Bleeding in the first trimester (weeks 1 to 12)

Harmless or less serious causes

• Implantation bleeding: light spotting around 10 to 14 days after conception, when the embryo attaches to the womb lining, often around when a period is due
• Cervical changes: pregnancy hormones increase blood flow to the cervix, so it bleeds easily after sex or a pelvic exam
• Cervical polyps and infections such as yeast, bacterial vaginosis, chlamydia or gonorrhea
• Subchorionic hematoma: a collection of blood between the placenta and the womb wall. Many resolve on their own

Miscarriage

Miscarriage is the loss of a pregnancy before 20 weeks. It happens in about 10 to 20 percent of known pregnancies, most often in the first 12 weeks and usually because of chromosome problems in the embryo, not because of anything the mother did.

• Threatened miscarriage: bleeding with a closed cervix and a viable pregnancy on ultrasound. Most continue normally
• Inevitable or incomplete miscarriage: heavier bleeding with cramps and passing tissue
• Missed miscarriage: the pregnancy has stopped developing, sometimes with only brown spotting

Ectopic pregnancy

An ectopic pregnancy grows outside the womb, most often in a fallopian tube. It affects about 1 to 2 in 100 pregnancies and can rupture and cause life-threatening internal bleeding. Warning signs, usually between 5 and 10 weeks:

• one-sided lower belly or pelvic pain
• vaginal bleeding or brown discharge
• shoulder-tip pain, pain on passing stool, dizziness or fainting

Risk factors include previous ectopic pregnancy, tubal surgery, pelvic infection, smoking, IVF and becoming pregnant with an IUD in place.

Molar pregnancy

A rare condition where abnormal tissue grows instead of a normal pregnancy, causing bleeding, severe nausea and a womb larger than expected. See hydatidiform mole.

Bleeding in the second and third trimesters

Bleeding after about 20 weeks is always assessed promptly.

In the last weeks of pregnancy, a small amount of blood-streaked mucus (the "bloody show") is normal and means the cervix is starting to soften before labor.

What to do if you are bleeding

1. Note when it started, how heavy it is (pads used per hour), its color, and whether you have pain, clots or passed tissue.
2. Call your doctor, midwife or early pregnancy unit. Go to the ER or call 911 for heavy bleeding, severe pain or feeling faint.
3. Wear a pad, not a tampon, and avoid sex until you have been assessed.
4. If you pass tissue, your doctor may ask you to bring it in a clean container.

How bleeding is assessed

Your doctor or midwife will ask about the bleeding and pain, check your pulse, blood pressure and temperature, and examine your belly. Tests depend on how far along you are:

• Ultrasound: often transvaginal in early pregnancy, to confirm where the pregnancy is, whether there is a heartbeat, and to look at the placenta later
• hCG blood tests, sometimes repeated 48 hours apart, in early pregnancy
• Blood group and Rh factor, and a blood count
• Speculum exam to look at the cervix. After 20 weeks, a finger exam of the cervix is avoided until placenta previa has been ruled out
• Fetal heart rate monitoring later in pregnancy

Treatment

Treatment depends on the cause:

• Implantation and cervical spotting: no treatment, just reassurance
• Infections: antibiotics or antifungals safe for pregnancy
• Threatened miscarriage: no bed rest is needed. Progesterone may be offered to some women with bleeding who have had a previous miscarriage
• Miscarriage: waiting for natural passing, medicines, or a minor procedure, depending on your preference and health
• Ectopic pregnancy: methotrexate medicine for some early cases, or surgery
• Placenta previa: avoiding sex and heavy exertion, hospital care for bleeding, and a planned cesarean birth
• Placental abruption, vasa previa and heavy bleeding: hospital monitoring and often urgent delivery, depending on the baby's maturity and the severity
• Preterm labor: steroids to mature the baby's lungs, and other treatments to delay birth when appropriate

Frequently asked questions

Is spotting normal in early pregnancy?

Light spotting is common in early pregnancy and often has a harmless cause such as implantation or a sensitive cervix. Many women who spot have healthy pregnancies. Because bleeding can also signal miscarriage or ectopic pregnancy, always tell your doctor or midwife.

What does brown spotting in pregnancy mean?

Brown spotting is old blood that has taken time to leave the body. It is usually less concerning than bright red bleeding and is common after sex or an internal exam. Report it, especially if it continues, increases, or comes with cramps or pain.

Can you bleed and still be pregnant?

Yes. Many women bleed during pregnancy and go on to deliver healthy babies, especially when bleeding is light and an ultrasound shows a normally developing pregnancy with a heartbeat. Some bleeding, however, signals pregnancy loss or ectopic pregnancy.

Is bleeding in the third trimester dangerous?

It can be. Bleeding late in pregnancy may come from placenta previa, placental abruption, vasa previa or preterm labor, all of which need prompt hospital assessment. A small amount of blood-streaked mucus near your due date is often the normal "show" before labor.

Should I go to the ER for bleeding during pregnancy?

Go to the ER or call 911 for heavy bleeding, large clots, severe or one-sided pain, shoulder-tip pain, dizziness or fainting, or any bleeding after an injury. For light spotting without pain, call your doctor or midwife the same day.