Are you pregnant? Have you experienced some spotting or bleeding and are wondering what it means?
While it can be alarming and distressing to notice blood in the bathroom when you least expect it, there are some rational explanations — and not all of them are as dire as you may be thinking. In fact, while not experienced by every mom, some level of bloody discharge during pregnancy is actually pretty common.
Read on to learn about what bleeding or spotting during pregnancy can mean, what other symptoms to watch for, and when to worry.
The Differences Between Bleeding and Spotting
Any bleeding that occurs outside your normal menstrual period is commonly referred to as breakthrough bleeding (1).
However, there are different levels of breakthrough bleeding, often differentiated by the terms’ bleeding and spotting.
- Is blood that is visible on your underwear or the toilet paper when you wipe after urinating.
- Appears as light brown or pink spots — as you see at the very beginning or end of your menstrual period.
- Does not require a pad or panty liner.
- Is bright red.
- Is heavier than spotting, more similar to a menstrual period.
- Requires a sanitary pad to manage.
What Does Bleeding During Pregnancy Mean?
When you experience any amount of vaginal bleeding during pregnancy, your mind always jumps to the worst. We get it.
It’s alarming, it’s unexpected, and it’s scary — especially when you feel so helpless and want to know what’s going on inside your body.
Try to Relax
So before you freak out, remember that a lot of changes are going on in your body. Hormones are shifting, tissues are stretching, and blood flow to your uterus is increasing.
So bleeding during pregnancy can also simply be due to a physiological process.
How Common is Bleeding During Pregnancy?
Bleeding is relatively common during pregnancy. How often it occurs and the reasons behind it differ throughout the trimesters. Up to 30% of women experience bleeding during their first trimester (2) and as many as 20 percent of women — that’s one in five — have bleeding at some point throughout the entire course of their pregnancy (3).
You’re most likely to experience bleeding at certain points along your pregnancy — like toward the beginning to middle of the first trimester, or toward the end of the third. Report to your doctor any bleeding you might notice at any point during pregnancy.
9 Causes Of Bleeding or Spotting During Pregnancy
There are many reasons you may experience bleeding or spotting during pregnancy. Some of these are:
1. Implantation Bleeding
When fertilization occurs, it happens in the fallopian tubes — well before the egg reaches the uterus. Meanwhile, the uterine walls have become thick-lined with blood and tissue, preparing for a potential pregnancy should it happen.
If pregnancy does not occur, this uterine lining is shed and is what comprises the menstrual period. If a pregnancy does occur, the fertilized egg needs to burrow its way into the lining, which can cause light bleeding. This is known as implantation bleeding.
About one-third of women experience implantation bleeding. While the timing for women varies based upon their fertility cycles, it typically occurs about 3 to 7 days before an expected period.
For this reason, it can often be mistaken as the start of a woman’s period, although it is usually of a much shorter duration, differs in color and amount.
How Long It Lasts
The bleeding is not heavy and resembles spotting. It is usually pink or dark brown and does not include clots like menstrual blood.
When you notice bleeding or spotting during pregnancy, miscarriage is typically the first thing your mind thinks of — after all, it’s a much-feared worst-case scenario. And while it is a very real possibility, try to remember it’s really not the only possible explanation.
A miscarriage is the loss of a pregnancy within the first 20 weeks of gestation. However, most miscarriages occur within the first three months (4).
As many as one out of five pregnancies end in miscarriage, primarily due to genetic abnormalities. Other miscarriages occur for no known reason.
If you do experience a miscarriage, bleeding is one of the primary symptoms. The blood may appear brown or bright red and may be accompanied by clots or tissue (5). There may also be a gush of clear or pink fluid or discharge, which is actually amniotic fluid.
If you suspect you are experiencing a miscarriage, your doctor will likely order an ultrasound and a blood test.
The ultrasound will examine the inside of your uterus to try to determine whether there is a fetus and detectable heartbeat. A blood test can measure hCG levels, also known as the “pregnancy hormone”.
The levels of hCG in your bloodstream rise rapidly during early pregnancy, and if a downward trend is detected in your blood, it could indicate a miscarriage. Remember though, hCG levels alone are not an indicator that everything is 100% OK, as they can rise and double as expected even in some cases of ectopic pregnancy. That’s why your doctor will always do an ultrasound too.
It usually takes two hCG levels to diagnose a problem with the pregnancy (6). While the absolute value varies greatly from one woman to the next, two tests 48-72 hours apart should show a doubling of the hCG level in the early first trimester.
Sometimes women experience a miscarriage and following the initial symptoms of pain and bleeding and after they notice tissue passing they can start feeling their symptoms disappear and might not want to see their doctor. This can potentially be very dangerous for the woman since there are different types of miscarriages and they can happen due to an ectopic pregnancy, so if this happens you should always see your doctor.
Editor's Note:Dr. Irena Ilic, MD
3. Placenta Previa
The placenta is the major organ that delivers blood, oxygen, and nutrients to your baby, and it grows throughout your pregnancy. It is typically attached high in your uterine wall, where it gets the best blood flow and will stay well out of the baby’s way when it comes time to deliver.
Sometimes, the placenta develops close to or directly over the cervix. This is called placenta previa (7). There are different types, depending on its position, including partial, low-lying, marginal and major or complete placenta previa.
This is typically detected in an ultrasound during the second trimester and is closely monitored for the duration of pregnancy.
Placenta previa can cause a good amount of vaginal bleeding and must be monitored, but with lifestyle modifications and modern medical procedures, you will more than likely deliver a healthy baby. Also, not all cases of placenta previa will be accompanied by heavy bleeding; it can be minimal to none. As the uterus continues to grow, it’s common for the placenta to shift out of the way of the cervix, leading to a normal delivery.
What Placenta Previa Means For Your Pregnancy
Placenta previa is relatively common, occurring in 1 of 200 pregnancies. Most of these, up to 90%, resolve by the time of delivery. It’s more likely to occur if this is not your first pregnancy, if you’re pregnant with multiples if you had any previous procedures on your uterus.
4. Placental Abruption
Placental abruption occurs when the placenta separates from your uterine wall before your baby is born (8). It is a serious condition as it affects your baby’s oxygen and blood supply, and there is no medical treatment to reattach the placenta. It usually happens in the third trimester.
Placental abruption usually develops suddenly and is accompanied by abdominal and back pain, along with heavy bleeding. However, occasionally it occurs slowly over time which can result in a light, occasional bleeding. This can be the case with chronic placental abruption, and in these cases, the baby’s growth progress might be slowed down.
If you have occasional bleeding, your doctor will also monitor your amniotic fluid levels and your baby’s rate of growth to determine how the condition is affecting your pregnancy.
It’s important to note the severity of your bleeding does not always directly correlate with the severity of your placental abruption. This means that even if sometimes there is little blood seen on the outside, there could be more blood trapped inside the uterus. Your doctor will examine your uterus and order an ultrasound to diagnose your placental abruption and its severity.
If you have a placental abruption, you may have to deliver your baby immediately if you are near the end of your pregnancy. If you are earlier in your pregnancy and your bleeding stops, you will be closely monitored for the duration of your pregnancy as there is a risk of premature labor.
Between your placenta and the uterine wall is a membrane called the chorion. Sometimes, blood collects in the folds of the chorion and results in a condition called subchorionic bleeding, or subchorionic hematoma (9). They can be of different sizes, with larger causing heavier bleeding, but with smaller being the most common.
If you experience bleeding during pregnancy, your doctor will likely order an ultrasound to screen for the presence of a hematoma. However, some hematomas are accidentally detected through routine ultrasounds with no accompanying bleeding.
There is no specific treatment for subchorionic hematoma except possible pelvic rest depending on the severity of your condition, and the good news is that it frequently resolves on its own. Your doctor might also start you on medication to prevent miscarriage.
However, in more severe cases if it does not resolve, it may result in a placental abruption, which can be a serious threat to your pregnancy.
If you are diagnosed with a subchorionic hematoma, you will likely be monitored more closely by your doctor, and have more frequent ultrasounds. You should avoid standing for long periods of time, having sex and doing exercise, and make sure to follow your bed rest instructions.
The Bottom Line
6. Vaginal Infection
The cervix is considered a blood-rich organ, which means it can easily bleed if inflamed or irritated. An infection, such as a yeast infection or bacterial vaginosis, can cause cervical irritation and bleeding.
These conditions are completely unrelated to pregnancy, but with the increased blood flow to your reproductive organs and cervix during this time, bleeding may be a symptom you don’t experience as frequently when you’re not pregnant.
Your vaginal bleeding may be due to an infection if it’s accompanied by foul-smelling or abnormal discharge, if you have redness, itching or irritation of the vaginal walls, or if you are experiencing a burning sensation when you pee (11).
What To Look For
Vaginal infections are easily treated with antibiotics, and your doctor will prescribe those safe to use in pregnancy.
Sex is safe during pregnancy, so unless you’ve been given explicit instructions from your doctor to avoid it, enjoy getting your groove on while you’re expecting.
However, the act of sex has the potential to irritate the cervix — especially if the penis bumps up against it. This can cause you to notice some very light bleeding the next day, most likely so light that you’ll only notice it on toilet paper after going to the bathroom.
This does not indicate there is a problem and is completely normal.
Don’t be shy about discussing sex during pregnancy with your partner and with your healthcare provider. There are some cases when your doctor might suggest you should avoid sex, such as having an incompetent cervix, placenta previa, unexplained bleeding. Even then, 9 months will pass soon and in the meantime, there are other ways for maintaining intimacy with your partner so don’t feel discouraged.
Editor's Note:Dr. Irena Ilic, MD
8. Losing Your Mucus Plug
During pregnancy, your body develops a mucus plug at the opening of your cervix. Sounds lovely, I know, but it has a very important purpose. It helps protect your baby and uterus from bacteria (12).
Toward the end of your pregnancy, as your cervix begins to open, this mucus plug will release, and you may experience spotting in your underwear. It looks different from typical spotting, however, in that it’s mixed with stringy or thick mucus.
Some women experience the loss of their mucus plug throughout several days and may notice it as pink-tinged bloody spots or streaks on the toilet paper when they wipe after going to the bathroom. Other women experience the loss of their mucus plug all at once. In this case, the volume of blood will be greater and the loss of the mucus plug will be more noticeable. It can also happen without you noticing it. But, if you see discharge which might or might not be your mucus plug, and it is bright red in color and not just a few drops you should contact your doctor right away, especially if you are feeling any pain.
The loss of the mucus plug usually signals that labor is imminent, though it can be up to two weeks before labor begins. Some women don’t lose their mucus plug until they’re actually in active labor. It is also known as bloody show.
If you are near the end of your pregnancy and start seeing blood in your underwear or on toilet paper, don’t panic — especially if it is mixed with discharge. It is a normal part of your body preparing for labor.
On the other hand, if you’re not nearing your due date and notice some blood-tinged mucus, contact your doctor. They will check your cervix to see if it is opening too early. If it is, you may be going into premature labor or have an incompetent cervix (13).
If either of these are diagnosed, they can be treated with labor-stopping medications or a cerclage.
9. Unknown Reasons
On rare occasions, some women will experience heavy breakthrough bleeding — almost like a regular period — intermittently throughout the entire course of their pregnancy with no known medical cause.
While this is not considered normal, if you are experiencing regular, heavy bleeding your doctor will work with you to rule out all severe causes that may threaten the life of your baby and the viability of your pregnancy.
If this happens to you regularly, track the occurrences of breakthrough bleeding to see if you can notice a pattern and help your doctor identify the cause.
Cover Your Bases
When Should I Seek Medical Help?
You should always mention any type of bleeding or spotting to your doctor at your next pregnancy appointment. If you want to get their opinion as to whether or not they’d like to see you sooner you can call them between appointments.
If you experience any of the following symptoms along with your bleeding or spotting, either ask your doctor for an immediate appointment or head to the local emergency room if they can’t fit you in:
- Severe, painful cramping.
- Bright red, heavy bleeding that soaks a pad.
- A rush of fluid in addition to blood.
- Severe nausea, vomiting, and dizziness.
- Chills and high fever (100.4 degrees Fahrenheit or higher).
If you are experiencing heavy bleeding, use a sanitary pad to manage it until you can be seen by the doctor. If you do not have a pad on hand, you can stuff a baby diaper in your underwear or a washcloth. Never use a tampon while pregnant.
The Bottom Line
While experiencing bleeding during pregnancy is alarming, rest assured that most often it occurs due to a condition that is treatable, and that most women can go on to deliver healthy babies.
However, because it may also signal a more severe condition, it’s always important to mention any level of vaginal bleeding or spotting to your doctor so they can evaluate you.