Vaginal bleeding can occur at any time during pregnancy. It is less likely to be a sign of a problem if it occurs during the first trimester than if it occurs in the second or third trimester of pregnancy. Although bleeding at any time while pregnant can be alarming it is not always an indication that something is wrong. In fact one in 5 women experiences some bleeding in pregnancy and the vast majority go on to have a healthy full-term baby. This is particularly true if bleeding appears as light spotting, similar to that which you might have at the beginning of a menstrual period.
When Not To Worry
A small amount of light spotting called implantation bleeding occurs in about 20 to 30 percent of pregnancies. Usually very minimal it occurs between 5 to 10 days after conception, usually around the day your next period was due. This can be confusing and many women mistake it for a period, not realizing it is one of the early signs of pregnancy and that they are in fact pregnant. Typically implantation bleeding is light to medium pink or light brown in color. See also, what causes brown spotting?
Bleeding After Sexual Intercourse
Some women experience light bleeding during or after sexual intercourse while pregnant. This is quite common and can occur in any of the trimesters. It is caused by irritation to the cervix which becomes engorged with blood vessels during pregnancy. It is usually nothing to worry about but do mention it to your ob/gyn for reassurance on your next prenatal visit.
Also known as subchorionic hematoma, this is where blood accumulates between the uterine lining and the placenta. Sometimes, but not always, it causes noticeable spotting. In fact 20 percent of first trimester bleedings are due to subchorionic bleeding. In the vast majority of cases it causes no problems, it heals itself and does not affect the baby. If there are no symptoms it may be discovered during a routine ultrasound scan. If you do experience some bleeding, never use a tampon while pregnant. A panty liner is better because it is easier to monitor how much you are bleeding.
An inflamed or irritated vagina caused by infections, such as vaginitis infections or urinary tract infections may cause some spotting. This usually disappears when the infection is treated. You should always avoid douching while pregnant.
Many women continue to experience light spotting throughout their pregnancy, or some have it just for a few weeks. Some report it as light pink or brown mucous in appearance, while others report it as bright red. Fortunately the vast majority go on to experience normal pregnancies. If you are worried, call one of your pregnancy healthcare team for some reassurance. They may order an ultrasound which if nothing else means if you have passed week 6, you will have the opportunity to see your baby's heartbeat!
When To Call The Doctor
Call a physician immediately if you experience any of the following problems:
Heaving Bleeding and Cramping
If spotting turns into heavier bleeding similar to a period, this is more cause for concern, particularly if it is accompanied by abdominal pregnancy cramping. This is a typical sign of miscarriage (also known as spontaneous abortion) and is confirmed by an ultrasound scan. Yet it is worth mentioning, many women can bleed, even quite heavily, while pregnant and still go on to deliver healthy babies at full-term.
If you experience severe abdominal pain on either both sides or in the center, call your doctor immediately.
If you are bleeding and have a fever over 100.5°F (38.6°F). Or if you have painful urination with chills. Or if there is blood in your urine, this should be checked.
Serious Causes Of Bleeding In The First Trimester
This is a spontaneous loss of pregnancy which occurs in the first 20 weeks of pregnancy. About 20 percent of recognized pregnancies (those where the woman knows she is expecting) end up in miscarriage. The main symptom is bleeding which is sometimes preceded by a brown discharge. A woman about to experience a miscarriage may feel mild cramping which can continue for several days before the actual bleeding occurs.
See: What Are The Signs Of A Miscarriage?
It is important to note that bleeding and spotting in early pregnancy can also be a sign of an ectopic pregnancy. This is a serious and sometimes life-threatening condition. It occurs when the embryo implants outside of the womb, most commonly in the fallopian tube. A common sign is brown spotting or light bleeding followed by sharp cramping pain in the lower abdomen. Women with a history of endometriosis and pelvic inflammatory disease as well as infertility of over 2 years are more prone to this complication. It needs to be treated immediately.
Also known as an embryonic pregnancy, it occurs when a fertilized egg attaches to the wall of the womb but it does not form an embryo. Although the woman will test positive in a pregnancy test, there will be no visible embryo in an ultrasound. This usually occurs in the first trimester of pregnancy, sometimes before the woman even knows she's pregnant. It normally results in light spotting and/or menstrual cramps as the body flushes the uterine lining causing a natural miscarriage.
This is where the placenta does not grow properly and instead becomes a mass of cysts, but there is no fetus. It is actually a type of cancer but is not usually harmful to the mother. All instances result in miscarriage in the first trimester. It may also be accompanied by high blood pressure and severe nausea. Molar pregnancies are quite rare occurring in about 1 in every 1,000 pregnancies. Women under 15 and over 45 are at slightly increased risk.
Serious Causes Of Bleeding In The Third Trimester
Bleeding At Week 28
Any bleeding with or without abdominal pain after week 28 is considered a true emergency. Hemorrhage complications occur in about 4 percent of all pregnancies.
Placenta previa is where the placenta partially or totally covers the opening of the womb, triggering bright red bleeding in the third trimester or during childbirth. It occurs in about 1 in every 200 pregnancies and accounts for about 20 percent of all third trimesters bleeds.
Placental abruption is where the placenta separates from the wall of the uterus (womb) prematurely rather than after childbirth as it should. If it completely detaches this puts the fetus in considerable danger because the womb is the baby's lifeline to food and oxygen. Signs include bleeding which can range from light to heavy with or without clots; abdominal pains, womb tenderness and back pain while pregnant. It occurs in about 1 in every 200 pregnancies.
Typically occurs during childbirth but can develop in the final weeks of the third trimester. A dangerous problem, uterine rupture can result in the baby being partially or totally expelled into the abdomen. Fortunately it is very rare. Signs include abdominal pain where the woman feels something ‘ripped’; chest pain and falling blood pressure caused by hemorrhage.
Vaginal bleeding a few weeks before delivery and childbirth could be an indication of early signs of labor. This can occur if the mucus plug passes and appears as a blood, watery or mucus discharge. Other signs that labor is occurring include contractions, lower backache and pelvic/abdominal pressure (also, see other causes of pelvic pain during pregnancy). Call your doctor immediately if this occurs.
Rare Causes Of Late-Pregnancy Bleeding
Fetal blood vessels connect to the mother outside of the umbilical cord.
Extremely rare form of cancer which occurs in any placenta tissue left behind after a miscarriage, abortion, ectopic or molar pregnancy.
Diagnosis, Tests And Examinations
Your doctor will perform a full physical examination, and depending on how serious the symptoms are, other tests such as pregnancy ultrasound scans and blood tests may be performed. The doctor's main goal when checking bleeding in early pregnancy is to check for miscarriage and ectopic pregnancies. For bleeding later in the second or third trimester the priority will be to stabilize the mother's condition before checking for problems such as placenta previa.
The best way to prevent complications is to start your prenatal care early by preparing for pregnancy before conception. If you do have pre-existing conditions such as diabetes or hypertension, work with your physician to ensure they are under control before conceiving. Visit your dentist because pregnancy hormones can aggravate gum and teeth problems, bleeding gums for example can be a common minor problem for pregnant women (as well as hemorrhoids in pregnancy). Maintain good relations with your ob/gyn, particularly if you have had complications in a previous pregnancy. See also Prenatal Care Guide.
Other Pregnancy Complications
• HELLP Syndrome
• Intrauterine Growth Restriction