Overview
Bleeding or spotting during pregnancy is a very common and problematic issue affecting 1 in 4 women in their first trimester and 6% later in their pregnancy. It has a wide range of etiologies, including several medically concerning ones. However, in many instances, it will not signal a major problem, and ladies who experience it will go on to deliver healthy babies. When this happens, don’t panic and consult your healthcare provider.
What does spotting during pregnancy look like?
Spotting during pregnancy varies from patient to patient. Some patients will have it bright red, while others will report brownish or pinkish vaginal discharge only. The bleeding may be profuse, or it just spots the pantyliners. Similarly, the duration of bleeding differs, with many experiencing it once while others have continuous or recurrent bleeding episodes for longer durations.
What causes spotting during pregnancy?
Common causes of spotting during early pregnancy
When it happens in early pregnancy, it could point to one of the following causes.
Implantation bleeding
This is the mild spotting experienced by some women when the embryo implants in the wall of the womb. The bleeding is harmless and usually occurs at a time when your period would have been due.
Miscarriage
This is the loss of pregnancy before the fetus has reached the period of viability. Miscarriage is a common cause of bleeding in early pregnancy, usually due to a genetically malformed fetus. The blood loss can be heavy with accompanying abdominal cramps. The products of conception might get completely expelled on their own, or you may need evacuation of some retained products surgically.
Ectopic pregnancy
This is the implantation of the fertilized egg outside the womb, most commonly in the fallopian tubes. It can cause vaginal spotting and is dangerous as the developing fetus would rupture the tube leading to bleeding inside your abdomen. The ectopic pregnancy needs to be terminated either with medicines or surgery.
Subchorionic hematoma
It is the bleeding under the chorion, one of the membranes surrounding the fetus. The hematoma thus formed may spontaneously resolve or may lead to miscarriage if larger in size.
Molar pregnancy
Molar pregnancy occurs when there is a problem with the fertilization. The incorrect joining of sperm and egg leads to tumor growth, and the baby and placenta do not develop as they should. It is a relatively rare cause of bleeding during early pregnancy.
Common causes of spotting or bleeding in later half of pregnancy
In the later half of pregnancy, bleeding can point to serious underlying conditions needing prompt medical consultation.
Bloody show
The show is the mucus plug present in the cervical canal. When the cervix begins to dilate during labour it comes off with a mild amount of blood and is called bloody show. Uterine contractions usually accompany the show. It indicates preterm labour when your pregnancy has not crossed the 37 weeks mark.
Placental abruption
It is a serious complication in which the placenta separates from its bed. This is potentially life-threatening for the mother and the baby and needs prompt medical intervention. The bleeding can be profuse with passage of clots and accompanying abdominal pain.
Placenta previa
This is a condition when the placenta partly or completely covers the cervix. Recurrent episodes of painless vaginal bleeding differentiate it from placental abruption. The placenta often shifts upwards as the gestation advances. When present until term, the baby is best delivered by a scheduled C-section.
Vasa previa
This is bleeding from umbilical vessels running through the amniotic membrane covering the cervix. The vessels can be torn when the water breaks and the resulting bleeding can be life-threatening for the baby.
Causes not related to pregnancy
Infections
Vaginal infections, including sexually transmitted ones, can cause bleeding in pregnancy. The bleeding in such cases may be accompanied by vaginal discharge, soreness and itching and needs to be treated by a doctor.
Pelvic examination
Mild degree of spotting may also be noticed after a pelvic exam or when a transvaginal probe is used for sonography. This is due to the cervix being sensitive to the altering hormonal levels.
Sex
Some women experience post coital bleeding during pregnancy. Usually, the cause is the cervix being extra tender. Your doctor may also want to know about your pap smear history. For some women, altering hormones can lead to loss of libido and vaginal dryness, which can cause spotting with sex. Problematic vaginal dryness outside pregnancy can be effectively treated with innovative vaginoplasty techniques. However, vaginal lubricants should be used during pregnancy.
What are the associated signs that should prompt a doctor’s consultation?
Consult your doctor right away if any of the following accompanies your bleeding:
- Cramping in abdomen
- Contractions
- Fainting episodes
- Heavy bleeding with passage of blood clots
- Fever
- Breaking of your water
- Feeling of being unwell
How is bleeding in pregnancy treated?
At hospital
The management is cause-dependent and considers many factors, including the amount of bleeding, accompanying symptoms, how far along you are in pregnancy and any medical or obstetrical risk factors in your history.
Your doctor might examine you and advise blood tests and sonography to assess your and the baby’s well-being. If your bleeding is not severe and your baby is not due to be born soon, you will be monitored for some time.
In some cases, you may be admitted to the hospital for observation. The length of time you need to stay in the hospital depends on the cause of bleeding and your clinical condition. Being in the hospital allows healthcare staff to closely monitor you and your baby so they can quickly respond if any problem occurs.
Home care
Many patients are sent home after the initial assessment and inpatient observation. In discharge, your doctor will give you advice on a follow-up plan. Keep your body well nourished with foods that give blood during pregnancy to replace the ongoing loss. The usual recommendations for home care include:
- Staying off your feet
- Not lifting heavy objects
- Refraining from rigorous activities
- Avoiding travel
- Abstaining from sex
Final note
Bleeding in pregnancy is terrifying for many women. Its incidence is quite high in early pregnancy. The cause needs to be identified, as the severity of the condition depends on the underlying cause.
Bleeding in the later half of pregnancy has some serious etiologies, necessitating inpatient care at the hospital. It is essential to keep calm and realise that many women will deliver healthy babies despite experiencing troublesome vaginal bleeding.
About the Author
Dr. Jehan Ara is a highly qualified consultant obstetrician and gynaecologist with a passion for writing and health education. She has more than 10 years of practical patient care experience. She is currently working as an Assistant Professor of Obstetrics and Gynaecology in a medical school and a clinical supervisor for post graduate residents of obstetrics and gynaecology in the affiliated teaching hospital. In addition to her clinical work, Dr. Jehan is also a passionate writer and educator. She regularly writes articles and blog posts on women’s health. She is committed to helping women understand their bodies and make informed decisions about their health.