Vaginal spotting or bleeding

Approved by the BabyCenter Philippines Medical Advisory Board Last reviewed: June 2011 [Show references] [Hide references]

What is spotting and is it normal? What's the most likely cause of bleeding? What else can cause bleeding? What should I do if I notice bleeding? Will my baby be safe?

What is spotting and is it normal?

Spotting is light bleeding from your vagina. It is similar to, but lighter than, a period. The blood varies in color from red to brown. It's only natural to be concerned if you notice a little spotting or bleeding. However, rest assured that in the early weeks of pregnancy it's common. A quarter of moms-to-be have some sort of bleeding in the first trimester (Weiss et al 2004, NGC 2005, Poulouse et al 2006). You're a little more likely to have spotting if you've had IVF, or similar treatment, to help you conceive. This may be because of the way your babies were conceived. Two embryos may be put into your uterus (womb) and may implant, but then one may not go on to develop. This is called a vanishing twin (De Sutter 2006), and it can trigger some bleeding. In many pregnancies spotting turns out to be "just one of those things". However, it can be a sign of something more serious, including miscarriage. This is why it's always best to take any bleeding seriously and get it checked out.

What's the most likely cause of bleeding?

In early pregnancy, spotting and bleeding is usually harmless and caused by:

Hormones that control your menstrual cycle triggering bleeding when your period would have been due. This is called breakthrough bleeding. You may have this more than once, around the times you would have had a period if you weren't pregnant.

The fertilized egg embedding into your uterus lining, causing bleeding. This is called implantation bleeding. This type of light bleeding usually lasts a day or two.

What else can cause bleeding?

There may be other things going on inside your body that are causing some bleeding:

The opening to your uterus (your cervix) may be irritated. Pregnancy hormones can change the surface of the cervix, making it more likely to bleed. You may notice a bit of blood after sex, for instance (Symonds 2009:323).

You may have fibroids. These are growths in the lining of your uterus. Don't worry, they're not cancerous. Sometimes, the placenta embeds where there is a fibroid (Ouyang et al 2006).

You may have a small growth on your cervix. This is called a cervical polyp and is harmless (Symonds 2009:323).

You may have a cervical or vaginal infection (Gracia et al 2005).

You may have an inherited disorder, such as Von Willebrand Disease, which makes it more difficult for your blood to clot (James 2006).

Unfortunately, there are other causes of bleeding in early pregnancy that have an unhappier outcome. These are miscarriage and ectopic pregnancy. Tummy pain and cramps tend to go with both these types of bleeding. Early miscarriage usually happens when a baby is not developing properly. Bleeding from a miscarriage becomes steadily heavier. Early miscarriage is a heartbreaking event, but sadly, it's fairly common. Some women even have a miscarriage before they realise they're pregnant, and assume they're having a period. An ectopic pregnancy happens when the fertilized egg implants outside of your uterus. If you have an ectopic pregnancy, the bleeding may keep going and be dark and watery, a bit like prune juice. An ectopic pregnancy can make you seriously ill, so it has to be removed quickly (RCOG 2004a). A much rarer cause of bleeding is a molar pregnancy (RCOG 2004b). It's very unlikely that your

bleeding is caused by this. It affects only about one in 1,000 pregnancies (Cancer Research 2009). A molar pregnancy happens when the embryo doesn't develop properly, but some of the cells that form the placenta continue to grow and multiply. To protect your health, a molar pregnancy has to be removed as soon as possible. All these causes of bleeding are to do with what's going on inside your body. But it is possible for a blow to the outside of your tummy to trigger bleeding. It can be set off by a fall, a car accident, or as the result of a blow to your belly (Tillett and Hanson 1999). (Find out more about the issues around domestic violence.)

What should I do if I notice bleeding?

Call your doctor, midwife or hospital for advice, even if the bleeding eventually stops. You may need to go to hospital to see a doctor to find out more about why you've had some bleeding. Your doctor may gently examine inside your vagina to see that all is well or advise you to have an ultrasound scan. A scan can check that your baby's safely tucked up inside your uterus and rule out an ectopic pregnancy. A vaginal examination and scan are quite safe for you to have. You don't need to worry about them affecting your pregnancy. Your doctor may want to do a few routine tests. Your blood or urine may be tested to see what your pregnancy hormone levels are like (RCOG 2006: 5). A test to check your blood group and rhesus status may also be done. Most people have blood that is rhesus-positive. If turns out that you are rhesus-negative, you'll be offered an injection of anti-D immunoglobin. This will stop your body reacting if your baby is rhesus-positive and your bloods mingle at any stage.

Will my baby be safe?

Your baby is likely to be fine, because spotting or light bleeding is generally harmless. It's only natural for you to worry about it, but rest assured that many pregnancies carry on despite early bleeding problems. Although bleeding can sometimes be an early sign of miscarriage, you'd develop tummy cramps as well, and the bleeding would get heavier. Spotting or light bleeding often stops on its own. It's thought that about half of moms-to-be who ask for medical help because of early bleeding go on to have their baby without any problems (NGC 2005; Everett 1997). If you have spotting or bleeding in pregnancy, always talk to your doctor or midwife, even if it stops. Try to keep positive. Spotting or bleeding often turns out to be nothing more than a harmless mystery.