We frequently receive questions from pregnant women who are concerned about blood spotting. It turns out that spotting is quite common during the early stages of pregnancy (about 20% of women report experiencing it in the first trimester). Sometimes, women can’t tell whether the blood they saw is spotting or bleeding. And identifying it correctly is important. Therefore, let’s review the differences between one and the other and what steps you should take if you experience either of them. But, first, DO NOT PANIC! Most women who had spotting or bleeding during pregnancy had perfectly normal pregnancies and healthy babies.
Spotting versus bleeding
If you have any discharge of blood from the vagina, it is either spotting or bleeding. Both can happen at any time in the pregnancy.
Spotting is defined as light bleeding, a few drops of blood occasionally in your underwear. Spotting is common in the first trimester and, in most cases, there is no cause for alarm.
Bleeding is a heavier flow of blood, to the extent that you will probably need a liner or pad to keep the blood from soaking your clothes.
Causes of spotting during pregnancy
The most common cause of spotting is “implantation bleeding.” This happens when the fertilized egg attaches to the uterine lining very early in pregnancy. At this stage, you may not even know you are pregnant and may wonder whether you are beginning to have your period. Implantation bleeding happens to about 20 to 30 percent of pregnant women.
Rupture of a cervical polyp during sex or pelvic exam/pap smear is a less frequent causes of spotting but it is not uncommon. This happens because, during pregnancy, your cervix becomes tender and engorged with blood vessels, and any kind of minor bumping (like intercourse or an internal exam) can sometimes irritate the cervix, causing some bleeding.
Late in pregnancy, spotting can happen when you lose your mucous plug. Heavy bleeding may be serious because it can signal a complication with you or your baby.
Causes of bleeding during pregnancy
In your first trimester, vaginal bleeding may be caused by an ectopic pregnancy, where the fertilized egg implants outside of the uterus. This requires immediate medical attention. You may also experience sharp, cramping pain in your lower abdomen, nausea, vomiting, dizziness or weakness.
Another less common cause of vaginal bleeding is molar pregnancy. In this situation, there is a placenta but without an embryo. You may also experience severe nausea, vomiting and cramping.
Late in the second trimester, or in the third, vaginal bleeding may be due to placenta previa, which is considered the most common cause of bleeding in the latter part of pregnancy. In this situation, the placenta covers part of the cervix before birth.
Another complication is placental abruption, which is the early separation of the placenta from the uterine wall. This condition, which happens in about 1% of pregnancies, may be serious and usually includes abdominal aching or cramps, uterine tenderness and pain in the back or abdomen.
When to go to the emergency room or call 911?
Go to the emergency room or call 911 immediately if you are experiencing any of the following symptoms, which could be signs of a miscarriage or other serious problem:
- Severe pain or intense cramps low in the abdomen
- Severe bleeding, whether or not there is pain
- Discharge from the vagina that contains tissue
- Dizziness or fainting
- A fever of more than 100.4 or more degrees Fahrenheit and/or chills