Bleeding During Pregnancy: What’s Normal and What’s Not

Most expectant moms would agree that not having to deal with a regular menstrual cycle is one of the best fringe benefits of pregnancy. For nine whole months, there are no abdominal cramps, no major mood swings, no unpredicted early starts, no uncomfortably heavy flow, and no overpriced feminine hygiene products; in short, it’s a delightful respite from the norm. 

But even though you don’t have to bother with your period for the better part of a year, you still may experience light vaginal bleeding, or spotting, from time to time. Light bleeding during pregnancy is actually fairly common, particularly early on in the first trimester — up to 30% of moms-to-be experience some amount of light bleeding within their first 12 weeks of pregnancy. 

While any type of vaginal bleeding when you’re expecting can trigger alarm bells, it isn’t always an indication that something’s wrong. Here’s what you should know about bleeding during pregnancy — what’s normal, what’s not, and why you should always give us a call anytime it happens. The team here at Rosh Maternal & Fetal Medicine is here to help.

Is it spotting or bleeding? 

Light bleeding, or spotting, is very different from moderate or heavy vaginal bleeding. Before we dive into the possible causes of bleeding during pregnancy, it can be helpful to know the difference between the two. 

As the name implies, spotting usually appears as a few small spots of blood. While its color may vary from light pink to bright red or even dark brown, spotting is light enough and brief enough that it doesn’t require you to wear a pad or liner. To put it another way, it’s similar to the kind of bleeding you may experience as your period begins or ends. 

Moderate to heavy bleeding causes a much heavier flow that’s similar to what you normally experience in the middle of your period, when your flow is at its peak; it’s the kind of bleeding that does require you to a liner or pad. 

If you start bleeding anytime during your pregnancy, it’s helpful to wear a sanitary napkin so you can keep track of the amount and type of bleeding you’re experiencing. Until you’ve been given the all-clear, it’s a good idea to avoid having sex or inserting anything into your vagina, including tampons.

Bleeding during early pregnancy

A day or two of light bleeding is common within two weeks of conception, before most women even know they’re pregnant. That’s when the fertilized egg burrows, or implants itself, into the lining of your uterus, causing perfectly normal light spotting known as implantation bleeding. 

As the first trimester continues, changing hormone levels prompt the development of new blood vessels and an increased blood flow to your uterus, cervix, and vagina, all of which can lead to normal spotting or light bleeding following sexual intercourse, intense exercise, or a routine pelvic exam. 

Some of the most common reasons for abnormal and potentially problematic vaginal bleeding during early pregnancy include:

Ectopic pregnancy

Early first trimester bleeding is sometimes evidence of an ectopic pregnancy, which happens when an embryo implants itself somewhere other than the uterus (usually in a fallopian tube). Although this kind of bleeding can occur without other symptoms, it’s often accompanied by abdominal, pelvic, or even shoulder pain. 

Because an ectopic pregnancy can be life-threatening, you should call your obstetrician anytime you experience bleeding or pain in your first trimester.

Miscarriage 

Bleeding during the first trimester — particularly when it’s accompanied by abdominal pain or cramping — can also be the first sign of a miscarriage, or early pregnancy loss. Approximately 10% of known pregnancies end in miscarriage, and about half of all women who experience unusual bleeding in early pregnancy eventually miscarry. 

It’s important to keep in mind that most miscarriages can’t be prevented; they typically occur when an unhealthy pregnancy isn’t developing as it should.   

Bleeding during late pregnancy

While it’s possible to experience harmless spotting during your second and third trimesters — especially following intercourse or a routine pelvic exam — late pregnancy bleeding of any kind is always cause for concern that warrants an immediate call to your obstetrician. 

Heavy bleeding, in particular, can indicate a serious complication in late pregnancy, such as:  

Placental problems

Worrisome late-pregnancy bleeding can be a sign that something’s wrong with the placenta or the vascular tissue that nourishes and maintains your baby while in utero. 

Placental abruption, which occurs when the placenta detaches from the uterus, often causes heavy bleeding accompanied by cramping or back pain. Placenta previa, which occurs when the placenta partly or totally covers your cervix, typically causes bleeding without pain. 

Preterm labor

Spotting or bleeding that occurs anytime in your second or third trimester — but before you reach your 37th week of pregnancy — can also be a sign of preterm, or premature, labor. 

Other signs of preterm labor include vaginal discharge changes, increased pelvic pressure, abdominal cramping, lower back pain, and contractions.

Complete-access obstetric care

Here at Rosh Maternal & Fetal Medicine, we’re committed to making sure all our expectant moms can reach us any time of day and any day of the week to report potential problems, discuss pressing concerns, or ask a simple question. 

As such, you can always get in touch with one of our experienced obstetricians for prompt advice if you happen to experience spotting or bleeding during any trimester. 

To learn more, call our Manhattan, New York City office today, or use the easy online tool to schedule a visit with one of our board-certified obstetricians. 

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