Bleeding During Pregnancy — Is It Ever Normal?

Suppose you experience vaginal spotting or bleeding during pregnancy. In that case, our Capital Women’s Care obstetrics team wants you to know that it’s a common first-trimester experience — and a less common occurrence in the second and third trimesters. 

We also want you to know that you shouldn’t panic: Most women who spot or bleed while pregnant go on to deliver healthy babies. However, you should always give us a call if you notice blood in your underwear or after going to the bathroom. Here’s why. 

Light spotting vs. bleeding — what’s the difference?

Spotting or bleeding during pregnancy is common, especially in the first trimester: During the first 12 weeks of gestation, up to one in four pregnant women (25%) experience some vaginal bleeding or spotting. It’s less likely to happen as a pregnancy progresses. 

Light spotting

Spotting is when you see a few drops or splotches of light pink, bright red, or dark brown blood in your underwear or on toilet paper after you wipe. If you put a liner on to protect your clothes, you may catch a few more drops — or nothing further at all.   

Vaginal bleeding 

Bleeding means a blood flow that requires you to wear a pad to avoid staining your clothes. Significantly more than a few drops, it’s similar to normal menstrual period flow when it occurs — whether it lasts for an hour, a day, or sporadically over a few days.

Pregnancy spotting or bleeding warrants a phone call

Spotting in the first trimester isn’t usually cause for concern; it’s often a sign of embryo implantation or hormonal and cervical changes. This type of early spotting is more likely to happen after exercise or sexual intercourse.  

And while bleeding during early pregnancy certainly feels more concerning, it’s often harmless, too. However, spotting or bleeding in the second or third trimesters may indicate a more serious problem. 

In every case, you should err on the side of caution and contact your prenatal care provider. We want to hear from you if you experience:

• Any spotting after week 12
• Bleeding during any trimester

While spotting is often normal, and even bleeding can be harmless, in some cases, it means something is wrong. Letting your doctor know ASAP can provide peace of mind and help you avoid more serious complications.  

Pregnancy problems that can cause spotting or bleeding 

Many problems, some of which require medical treatment — and some of which require emergency care — can lead to spotting or bleeding during pregnancy. Let’s take a closer look at typical reasons for spotting or bleeding in early and later pregnancy:  

In early pregnancy

During the first trimester (week one through week 12), problematic reasons for spotting or bleeding include:

• Sexual infections: STDs can irritate the cervix and trigger spotting
• Other infections, like a yeast infection and bacterial vaginosis  
• A non-viable ectopic pregnancy, where the embryo is outside the womb 
• A miscarriage, also known as unexpected early pregnancy loss 

About 10-20% of known pregnancies end in miscarriage, and half of women who experience heavy bleeding in early pregnancy go on to miscarry. However, it’s important to remember that your chances of continuing a healthy pregnancy are good if a fetal ultrasound shows a normal heartbeat. 

In later pregnancy 

It’s possible to experience harmless intervals of spotting in the second and third trimesters, but late pregnancy bleeding is far more worrisome. Give us a call in the event of either.

 Serious problems that can trigger heavy bleeding in the second and third trimesters (weeks 13-27 and weeks 28-40, respectively) include: 

• Placental abruption, or a placenta that pulls away from the uterus
• Placenta previa, or a placenta that slips down and covers the cervix
• Placenta accreta, or a placenta that invades the wall of the uterus 
• Preterm labor, or going into early labor before reaching 37 weeks 
• Miscarriage (up to week 20) or stillbirth (late-stage pregnancy loss)

Many placental issues are discovered during a routine ultrasound, sometimes before bleeding occurs. But if they go undetected and untreated, they can lead to serious complications — including fetal distress and severe blood loss during delivery.  

What to do next if you experience spotting or bleeding

If you begin spotting or bleeding while pregnant, wear a panty liner or pad so you can better track the amount of blood loss you’re experiencing. Don’t insert tampons or anything else in your vagina, and avoid sexual intercourse until you’ve been checked and/or cleared. 

Then, give us a call right away. Depending on where you’re at in your pregnancy, what kind of bleeding you’re experiencing, and other symptoms you might be having, we may simply assess the situation over the phone or have you come in for an evaluation. 

Are you worried about pregnancy spotting or bleeding? We’re here to help. Visit your nearest Capital Women’s Care office in Frederick or Mount Airy, Maryland, today.