Updated: June 21, 2024
With your body going through so many changes during pregnancy, it’s no surprise that most women are constantly reaching for the phone to give their doctor a call. It can be difficult to know what’s serious and what’s just another symptom, so keep reading for everything you need to do about vaginal bleeding while pregnant.
Vaginal Bleeding in the First Trimester
During the first trimester, vaginal bleeding is actually pretty common—in fact, it occurs in about 20% of pregnancies, and most of those women go on to have perfectly healthy pregnancies. The most important thing to know is the difference between light and heavy bleeding and when to call your doctor.
Understanding Normal vs. Abnormal Bleeding During Pregnancy
For starters, there’s a big difference between spotting and bleeding. The term “spotting” refers to a few drops of blood—not enough to cover a pad or panty liner. You may already be familiar with spotting from your period days! Bleeding, on the other hand, means a blood flow that’s heavy enough to require wearing a pad.
If actual bleeding occurs during your first trimester, wear a panty liner or pad so you can get a clear idea of exactly how much you’re bleeding so you can tell your doctor. Remember that you shouldn’t use a tampon or douche while you’re pregnant.
Causes of Vaginal Bleeding in the First Trimester
Implantation bleeding occurs when the fertilized egg implants in the lining of the uterus. This typically happens around the time of your expected period, so sometimes you don’t even know you’re pregnant yet.
Hormone production during pregnancy can change and soften your cervix, making it more likely to bleed during pregnancy. You could also have a cervical polyp or benign overgrowth of tissue that can bleed easily. You could experience some spotting or light bleeding after sexual intercourse or after a pelvic examination. A vaginal infection could cause some vaginal bleeding as well and is usually accompanied by an abnormal vaginal discharge.
Vaginal bleeding could also be a sign that you have an ectopic pregnancy, which occurs when the fertilized egg implants outside of the uterus, usually within one of the fallopian tubes, where the blood supply isn’t enough to sustain a normal pregnancy. About one in every 60 pregnancies is ectopic. The most common signs are increasing abdominal pain, the absence of menstrual periods, and spotting. About half of women with an ectopic pregnancy won’t have all three signs, so if you notice any of them, it’s a good idea to talk to your doctor.
If you’re experiencing heavy vaginal bleeding during your first trimester, it could be something serious. Bleeding, abdominal pain, and back pain are all common signs of a miscarriage, which occurs in 15-20% of all pregnancies, usually during the first 12 weeks of gestation. A threatened miscarriage could also cause vaginal bleeding and mild cramping—the difference is that in a threatened miscarriage, the cervix remains closed, and the fetus is still viable. In many women, the bleeding stops, and they go on to have healthy pregnancies. Unfortunately for some, the bleeding doesn’t stop, and a miscarriage occurs.
A molar pregnancy, or gestational trophoblastic disease, is an abnormality of fertilization that results in the growth of abnormal tissue in the uterus. This tissue mimics the typical symptoms of early pregnancy, even though there’s no fetus. In a “partial mole,” the abnormal tissue is growing alongside the fetus, which results in severe birth defects. A molar pregnancy cannot result in a normal pregnancy or a normal delivery. A sonogram or ultrasound is needed to diagnose a molar pregnancy.
When blood collects between the gestational sac and the wall of the uterus, a subchorionic hemorrhage occurs. Your body frequently reabsorbs clots like these, but sometimes you may experience a passage of old, dark blood or even small clots from your vagina. While the causes of bleeding are varied in their severity, if your vaginal bleeding is heavy, you should call 911 and go to the emergency room.
Second and Third Trimester Vaginal Bleeding
While light vaginal bleeding is fairly common during your first trimester, it’s more serious in your second and third trimesters. Like the first trimester, however, sometimes having sex or a pelvic examination can cause light bleeding. Problems with your cervix, like cervix insufficiency or infection, can also lead to bleeding.
Placenta previa is a serious complication involving the placenta, an organ in the uterus that nourishes a developing baby. Proper positioning is, therefore, critical to ensure ample blood flow and proper cushioning of this life-giving organ. In a healthy pregnancy, the placenta is positioned at the top of the rounded section of the womb. However, in the case of placenta previa, the organ implants in the lower part of the uterus, partially or fully covering the cervix. Various complications may result from placenta previa, with the most notable being painless bleeding in the second or third trimester.
The bleeding could result from placental abruption, where the placenta completely detaches from the uterine wall. Another factor is cervical irritation from the stretching and thinning of the uterus. You might also bleed during intercourse, labor, and vaginal exams.
If you experience painless vaginal bleeding, consult your doctor for a thorough physical exam or ultrasound to diagnose the issue. Your doctor may recommend pelvic rest, frequent monitoring, and hospitalization depending on the severity of the placenta previa.
Preterm or premature labor is characterized by cervical effacement or dilation that begins before 37 weeks of pregnancy. Early preterm is when the baby is born before 33 weeks. On the other hand, early preterm occurs anywhere between 34-36 weeks.
Bleeding is one of the most notable signs of premature labor. This is typically a result of contractions that cause placental abruption or cervical irritation. Other signs of preterm labor include uterine cramps, vaginal discharge, and severe pain in the lower abdomen. You may also notice a watery discharge, which is leaking amniotic fluid, and a sudden lull in your baby’s movements.
If you experience any of the signs, seek immediate medical attention to prevent a premature birth. The doctor may also hospitalize you for close monitoring and use tocolytic drugs to stop the labor from progressing.
During childbirth or pregnancy, the uterine muscles may tear or rupture. This is a serious medical emergency requiring urgent intervention to lower maternal and fetal risk. Early pregnancy bleeding is one of the first signs. Others are severe and sudden abdominal pain, abnormal fetal heart rate, change in contraction patterns, and signs of shock in the mother, such as pale skin, low blood pressure, and rapid heart rate. The baby’s head may also recede if it is already in the birth canal. In most cases, a cesarean delivery will be the first course of action.
Sometimes, the placenta detaches from the uterus lining, creating a life-threatening situation for both the mom and baby. The placenta delivers oxygen and nutrients to the developing baby, and an abruption will disrupt this supply.
Besides bleeding, pay attention to irregular uterine contractions, abdominal pain, and changes in baby movements. If you suspect placental abruption, seek immediate medical assistance. Research shows that it’s the leading cause of perinatal mortality and maternal morbidity.
What to Do If You Experience Bleeding
In the best-case scenario, you should be able to carry the pregnancy to full term without complications. However, as many would attest, that’s not always the case.
Any time you notice bleeding at any stage of pregnancy, it’s reasonable to call your doctor—even if it’s just a few drops, it could be a sign of some serious problems to come. If you’re experiencing heavy bleeding accompanied by pain or cramping, seek immediate medical attention.
Pay attention to your symptoms and describe them to the doctor in detail. For example, you can count your contractions and note the severity of the bleeding and the color of your blood.