Is it normal to have bleeding or spotting during pregnancy?
A little spotting or light bleeding during pregnancy is common, especially in early pregnancy. Around 1 in 4 pregnant women have some light bleeding very early in the first trimester. But even if the bleeding seems to have stopped, call your healthcare provider right away, just to make sure everything is okay.
Spotting or light bleeding is probably from something minor, but it could also be a sign of a serious problem, such as an ectopic pregnancy, a miscarriage, or problems with the placenta.
Your provider may want to do a thorough evaluation, which may 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 have severe pain and can't reach your provider immediately, head to the emergency room right away.
How is spotting different from bleeding?
Spotting is very light bleeding, similar to what you may have at the very beginning or end of your period. It can vary in color from pink to red to brown (the color of dried blood) and is usually just a few spots. Bleeding is heavy enough that you need to wear a panty liner or pad.
What causes spotting or bleeding in early pregnancy?
The most common causes of light spotting or bleeding during early pregnancy include:
- Subchorionic hematoma. Also called a subchorionic hemorrhage. This kind of bleeding can happen when the outer membrane of the amniotic sac (chorion) separates from the wall of the uterus. It’s usually harmless and stops on its own. But larger bleeds that show up later in pregnancy can raise the risk of miscarriage or preterm labor. So your caregiver will want to check on it regularly by ultrasound.
- Implantation bleeding. 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.
- Miscarriage. Spotting or bleeding in the first trimester, especially if accompanied by abdominal pain or cramping, can be an early sign of miscarriage. (About half of women who have bleeding early in their pregnancy miscarry.) But if you have an ultrasound that shows a normal heartbeat between 7 and 11 weeks, your chances of continuing the pregnancy are greater than 90 percent.
- Ectopic pregnancy. Bleeding also can be a sign 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 abdominal, pelvic, or shoulder pain. An ectopic pregnancy can be life-threatening, so let your provider know immediately if you have bleeding or pain in your first trimester.
- Infection. Spotting can also be caused by conditions unrelated to pregnancy. A vaginal infection (such as a yeast infection or bacterial vaginosis) or a sexually transmitted infection (such as trichomoniasis, gonorrhea, chlamydia, or herpes) can cause your cervix to become irritated or inflamed and vulnerable to bleeding.
What causes bleeding in the second or third trimester?
As your pregnancy progresses, bleeding is more likely to be a worrisome sign. Call your provider immediately if you have any bleeding in the second or third trimester. Here are some common causes of bleeding during that time:
- Placental problems. Bleeding or spotting after the first trimester can be a sign of a serious condition such as placenta previa (when the placenta partially or fully covers the cervix), placenta accreta, or placental abruption (in which the placenta separates from the uterus).
- Late miscarriage. Most miscarriages occur in the first trimester, but bleeding can be a sign of late miscarriage (between 13 weeks and midpregnancy).
- Premature labor. Bleeding is one sign of premature labor (labor that starts before 37 weeks). Other signs of premature labor include changes in vaginal discharge, pressure in your pelvis or lower abdomen, low backache, and abdominal pain, cramps, or contractions.
Can having sex or a pelvic exam cause spotting or bleeding during pregnancy?
Yes, you might 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 to notice spotting after intercourse, a Pap smear, or an internal exam. A cervical polyp (a benign growth on the cervix) can also cause spotting or bleeding after sex or an exam.
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