Bleeding During Pregnancy

Why am I bleeding during pregnancy?

Bleeding during pregnancy happens for many reasons. It’s common to have bleeding at some point in pregnancy, especially in the first trimester. However, vaginal bleeding at any time in pregnancy could indicate a complication or an underlying condition. It’s always a good idea to share your symptoms with your healthcare provider so they can determine if the bleeding is caused by something serious. Try not to panic and know that many people who experience bleeding during pregnancy have healthy babies.

Am I bleeding or just spotting?

There's a difference between bleeding and spotting (light bleeding) during pregnancy. Spotting is when you notice a few drops of blood in your underwear. If you put a panty liner on, the blood won't fill it. Spotting during pregnancy, especially in the first trimester, is usually not concerning. Bleeding describes a flow of blood that's greater than a drop here and there. If you need a pad to keep it from ruining your underwear, it’s usually considered bleeding. Call your healthcare provider if you experience spotting or bleeding. They may want to examine you or perform an ultrasound to determine the cause. It’s better to be overly cautious to ensure you and the fetus are healthy.

What are the most common causes of bleeding in the first trimester?

Bleeding or spotting in the first trimester can be common and doesn’t always mean there is something wrong. Try not to worry. Take notes of the type of bleeding you see and call your healthcare provider to let them know your symptoms.

Some causes of bleeding in the first part of pregnancy are:

• Implantation bleeding: This is when the fertilized egg implants in the wall of your uterus and causes light bleeding. It’s considered a normal part of early pregnancy.
• Molar pregnancy: A rare condition when a fertilized egg implants in your uterus, but a tumor forms instead of a fetus.
• Ectopic pregnancy: When a pregnancy forms outside of your uterus (like in your fallopian tubes). It can be life-threatening.
• Subchorionic hematoma: Bleeding from one of the membranes that surround the embryo inside your uterus. Subchorionic hematomas usually resolve on their own.
• Cervical polyps: A noncancerous growth on your cervix that bleeds in pregnancy due to increased estrogen levels.
• Miscarriage: The loss of the pregnancy before 20 weeks. It usually starts as light bleeding and gets heavier. It can be accompanied by severe cramping.

What are the most common causes of bleeding in the second or third trimester?

Bleeding in the second half of pregnancy is often associated with more serious conditions, so contact your healthcare provider immediately so they're aware of your symptoms.

Some conditions that can cause bleeding in the second and third trimesters are:

• Placenta previa: When the placenta covers all or part of your cervix. It’s rare after 20 weeks of pregnancy.
• Placental abruption: A rare condition where the placenta detaches from the wall of your uterus. This can be dangerous for both you and your fetus.
• Preterm labor: Going into labor earlier than 37 weeks of pregnancy. Other symptoms of preterm labor are contractions, cramping or your membranes rupturing.
• Incompetent cervix: When the cervix opens (dilates) too early and causes premature labor.
• Bloody show: Light bleeding mixed with mucus that occurs toward the end of your pregnancy. It can be a sign that your body is preparing for labor.
• Miscarriage: A loss of the pregnancy after the 20th week. This is also called a stillbirth.

What are other causes of bleeding during pregnancy?

Sometimes bleeding isn't caused by any medical conditions and your healthcare provider won't be concerned. However, it’s always better to discuss any spotting or bleeding with them to make sure.

Other reasons you may bleed during pregnancy are:

• Sex: Some women experience light bleeding after sex. This is due to your cervix being extra tender during pregnancy.
• Pelvic exam or ultrasound: Your cervix can bleed after a pelvic exam or transvaginal ultrasound because it’s highly sensitive (due to increased hormones).

• Infection: Chlamydia, gonorrhea and other sexually transmitted infections (STIs), or urinary tract infections (UTIs) can cause light bleeding. These infections will need to be treated by your healthcare provider.

How much bleeding is normal in pregnancy?

Spotting in early pregnancy (the first trimester) is usually normal and not a sign of a serious issue. However, you should still let your healthcare provider know, especially if you're unsure if it’s spotting or bleeding. There are several causes of first-trimester spotting that are not worrisome, but some are.

Is period-like bleeding during pregnancy normal?

Bleeding that resembles menstruation is not usually a symptom of pregnancy. Menstrual bleeding is a steady flow of blood lasting several days. If you experience anything more than light bleeding (spotting) or your bleeding lasts longer than 24 hours, you should contact your healthcare provider right away. Bleeding is not always a sign that something is wrong, but heavy bleeding or bleeding that's accompanied by pain might indicate a complication.

What does vaginal bleeding during pregnancy look like?

Bleeding during pregnancy can look different for everyone. Your healthcare provider will want to know what your blood looks like so they can evaluate your symptoms. Some details you will want to track include:

• The color of your blood: Your blood might be brown, pink or bright red.
• The consistency of your blood: Is it smooth, thick or watery? Does it contain clots?
• How much blood there is: Did you see a few drops? Or are you filling a pad?

All of these details can help your healthcare provider determine the level of care you need and how urgent your symptoms are. Because bleeding at any time in pregnancy could indicate a problem, it’s always recommended to call your provider.

How is bleeding during pregnancy treated?

Your healthcare provider will want to perform an ultrasound and physical evaluation to determine the cause of your bleeding. They may order blood or urine tests and perform additional imaging tests like MRI (magnetic resonance imaging).

Some treatments for vaginal bleeding during pregnancy can include:

• Relaxing and staying off your feet.
• Avoiding sex.
• Avoiding travel.
• Bedrest.
• Hospitalization or surgery if the bleeding is severe.

What can I do at home to stop my bleeding during pregnancy?

It’s always best to follow the recommendations of your healthcare provider after you're examined. In most cases, they'll recommend more rest. Avoiding things like rigorous exercise or lifting heavy objects can also help. You can also use a panty liner to contain your bleeding.

When should bleeding during pregnancy be treated by a doctor?

Your healthcare provider should know of any bleeding or spotting during pregnancy. Even if it’s not serious at that moment in your pregnancy, they'll want to make notes of your symptoms.

Call your healthcare provider right away if you experience any of the following symptoms. Heavy bleeding.

• Cramping or contractions.
• Pelvic pain or pain in your abdomen.
• Dizziness or fainting.
• Fever or chills.
• Other signs of preterm labor like your water breaking.

If your provider’s office is closed, you should go to the nearest emergency room (ER).

What questions should I ask my doctor about bleeding during pregnancy?

Bleeding during pregnancy can be scary. It’s natural to have questions for your healthcare provider. Some questions to ask your provider are:

• Is spotting later in pregnancy normal?
• When should I be concerned about bleeding?
• How do I know if I am bleeding too much?
• Is the fetus OK? Am I OK?
• Should I avoid having sex if I am bleeding?
• Do I need to reduce my activity if I'm bleeding?
• When should I go to the ER?

What questions will my doctor ask me about bleeding during pregnancy?

Your healthcare provider may ask you several questions to find the cause of your vaginal bleeding and understand your symptoms. Some questions you may be asked are:

• Have you had vaginal bleeding in prior pregnancies?
• Have you had prior surgeries on your uterus or cervix?
• How heavy is your bleeding?
• Does the blood fill a panty liner?
• What color is the blood?
• Does the blood contain clots or tissue?
• Do you have any pain or cramping?
• Have you been exercising or standing more?
• Have you fallen lately?
• When did you last have sex? Did you bleed afterward?

A note from Cleveland Clinic

Bleeding at any point in pregnancy can be scary. Sometimes bleeding during pregnancy is serious, but other times it isn’t. It’s important to contact your healthcare provider to discuss any vaginal bleeding you experience while pregnant. They'll want to rule out any complications, find the cause of your bleeding and make sure you and your fetus are healthy.