Bleeding During Pregnancy: The Good, the Bad, and the Ugly

Are you pregnant? Have you experienced some spotting or bleeding and are wondering what it means?

While it can be alarming 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 (source).

However, there are different levels of breakthrough bleeding, often differentiated by the terms bleeding and spotting.

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.

Bleeding:

  • 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 to know what’s going on inside your body.

Try to Relax

And while, yes, bleeding or spotting could indeed signal there is a problem with your pregnancy, rest assured it’s not the only explanation.

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 mean that things are going as expected.

How Common is Bleeding During Pregnancy?

Bleeding is not considered normal, but it is considered common. As many as 20 percent of women — that’s one in five — have bleeding at some point throughout their pregnancy (source).

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. Bleeding during the second trimester is least common and could be an indication something is wrong.

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

To learn what implantation bleeding is, let’s go back to Health Class 101.

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 (source). 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 a much shorter duration.

Take Note

Implantation bleeding can be a one-time occurrence or last for up to three days.

The bleeding is not heavy and resembles spotting. It is usually pink or light brown and does not include clots like menstrual blood.

2. Miscarriage

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 not the only 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 (source).

Why They Happen

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 (source). There may also be a gush of 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” (source).

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.

It usually takes two hCG levels to diagnose a problem with the pregnancy. 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.
Headshot of Christine Traxler, Medical Doctor

Editor's Note:

Christine Traxler, MD, BS

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 (source).

This is typically detected in a 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. 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.

Take Note

Women with placenta previa may have to go on pelvic rest during the rest of their pregnancy, which means they can’t have sex, vaginal exams, and may have to avoid vigorous exercise. If it doesn’t resolve by the end of your pregnancy, you will have to deliver your baby by C-section since the placenta is blocking your baby’s exit from the womb.

Placenta previa is relatively common, occurring in 1 of 200 pregnancies. Most of these, however, resolve by the time of delivery.

4. Placental Abruption

Placental abruption occurs when the placenta separates from your uterine wall before your baby is born (source). 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.

A 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 light, occasional bleeding.

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.

You Need to Know

It’s important to note the severity of your bleeding does not always directly correlate to the severity of your placental abruption. Your doctor will likely 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.

5. Hematoma

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 (source).

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 solely 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.

However, in more severe cases if it does not resolve, it may result in a placental abruption, which can be a serious threat to pregnancy.

If you are diagnosed with a subchorionic hematoma, you will likely be monitored more closely by your doctor, and be recommended for more frequent ultrasounds.

Take Note

Subchorionic hematoma occurs in about one percent of all pregnancies, and the vast majority of women go on to have healthy pregnancies and normal deliveries.

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 (source).

What To Look For

The bleeding you experience as a result of infection is most similar to spotting and will not likely be bright red or heavy.

Vaginal infections are easily treated with antibiotics, which will be prescribed by your doctor.

7. Sex

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.

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 (source).

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.

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 (source).

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 — 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

Ask your doctor if you should take an additional iron to compensate for the regular loss of blood, but don’t up your iron intake without your doctor’s guidance.

When Should I Seek Medical Help?

You should always mention any type of bleeding or spotting to your doctor at your next pregnancy appointment. However, you can call them between appointments if you want to get their opinion as to whether or not they’d like to see you sooner.

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.

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.

Remember


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.

The most common causes of bleeding or spotting during pregnancy are:

  • Implantation of the egg.
  • Miscarriage.
  • Placenta previa.
  • Placental abruption.
  • Subchorionic Hematoma.
  • Vaginal infection.
  • Irritation of the cervix due to sex or other activities.
  • Loss of your mucus plug.
  • Undiagnosed mystery causes.

While it can be scary to think about, the truth is that knowledge is power. Share this with an expectant mother in your life to help her understand what’s going on with her body and to make sure she’s prepared in case she experiences a potentially scary moment in the bathroom.

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