Spotting when pregnant or vaginal bleeding during pregnancy is common, especially during the first and late third trimesters (1). This event could occur due to different factors and usually does not imply a serious issue, especially in the first trimester. However, bleeding later in pregnancy may have a more severe underlying cause (2). This post discusses the difference between vaginal bleeding and spotting, the various causes of vaginal bleeding during different trimesters, and how it can be diagnosed and treated in pregnant women.
What Is The Difference Between Vaginal Bleeding And Spotting During Pregnancy?
During the early stages of pregnancy, you may experience some light bleeding, known as spotting, where a few drops of blood may appear on your underwear occasionally. It is not enough to cover a panty liner. Bleeding is a heavier flow of blood, necessitating the use of a sanitary pad or pantyliner to prevent your clothes from becoming soaked in blood (1) (3). Moreover, heavy bleeding episodes (as heavy as or heavier than normal period flow) are more likely to cause pain, be of a longer duration, have bright red blood, and occur multiple times. Meanwhile, spotting episodes are more likely to occur in isolation, be of shorter duration, and be painless (4).
What Are The Causes For Bleeding In Pregnancy?
The underlying cause of vaginal bleeding during pregnancy may or may not be serious and can differ in various trimesters.
Bleeding in the first trimester
During early pregnancy or the first trimester, bleeding or spotting is common with an incidence rate of one in four pregnant women (up to 25%) and may occur due to the following factors (1) (2) (3) (5).
Implantation (when the fetus plants itself in the uterine wall) Sexual intercourse Pregnancy-related hormonal fluctuations Normal changes in the cervix Pap test Pelvic exam by your obstetrician Genetic testing procedures, such as amniocentesis or chorionic villus sampling (CVS) Smoking
However, bleeding and spotting during early pregnancy may also be a sign of the following serious conditions (1) (3) (4) (6).
Pelvic cavity or urinary tract infections
Ectopic pregnancy (pregnancy outside the uterus) can be fatal if left untreated
Threatened miscarriage or miscarriage (pregnancy loss) Molar pregnancy (where tissue grows inside the womb instead of a fetus) Subchorionic hemorrhage or hematoma (bleeding between the uterus wall and placental membrane)
Bleeding in the later stages of pregnancy
In the later stages of pregnancy, you may experience light bleeding because of the following reasons (1).
Sexual intercourse Labor (in the third trimester)
An internal examination by your obstetrician Growths on the cervix or cervical infections or inflammation
However, heavy bleeding in the later stages of pregnancy may be due to serious conditions, including (1) (2) (5):
Preterm labor (labor starts before 37 weeks of pregnancy) Placenta previa (the placenta lies too low in the uterus and covers the cervix) Placenta accreta (the placenta grows too deeply into the uterus wall and does not detach) Placental abruption (the placenta detaches from the uterus wall before/during birth) Uterine rupture during labor Vasa Previa (the umbilical cord blood vessels pass through the cervical membranes)
When To Call A Doctor?
If you experience bleeding or spotting while pregnant, it is recommended to visit your doctor. However, contact your doctor soon if you experience (1) (6):
Heavy bleeding Bleeding with cramps or pain Bleeding and dizziness (lightheadedness) Abdominal pain or pelvic pain with bleeding Bleeding in the second or third trimester of pregnancy
How Are The Causes Of Vaginal Bleeding Diagnosed?
Even if your vaginal bleeding has stopped, contact your healthcare provider for a diagnosis. Your doctor may inquire about any other symptoms you may be experiencing with bleeding. Additionally, they may suggest the following tests (5).
Vaginal or pelvic examinations Ultrasonography Human chorionic gonadotropin (hCG) blood testing to measure the hormonal level
How Is Vaginal Bleeding During Pregnancy Treated?
Vaginal bleeding is treated depending on its underlying cause and severity. If your symptoms and bleeding are not severe, or your due date is far, you may be asked to closely monitor yourself at home. In severe circumstances, your doctor may suggest hospitalized observation. You may be required to stay overnight or until your baby is born so that you both can receive immediate medical attention (5). Usually, adequate rest is sufficient to treat the condition. Other treatment options may include (1) (7):
Taking some time off from work
Staying off your feet for a little while Avoiding sex Not douching (using vaginal cleansing products) or using tampons Taking a folic acid-fortified prenatal vitamin Abstaining from smoking, consuming alcohol, and using illegal drugs Surgery, in case of heavy bleeding due to serious complications
