Does Early Pregnancy Bleeding Mean a Miscarriage?

What Bleeding Can Mean at Different Stages of Pregnancy

First things first: If you're pregnant and you're experiencing vaginal bleeding, take a deep breath. It's scary and worrisome, but vaginal bleeding during early pregnancy doesn't always mean miscarriage—especially if it's light. Here’s a look at what bleeding or spotting can mean at different points in your pregnancy. Remember that with any case of bleeding or spotting in pregnancy, the best thing to do is to call your doctor for advice.

During the First Trimester

Bleeding during the first trimester isn't as uncommon as you might think. Research shows that 15 percent to 25 percent of women experience some sort of bleeding during this time. Though it’s undeniable that bleeding or spotting in the first trimester may mean an impending miscarriage (a type of pregnancy loss), it can signal other issues too.

About half of women who have first-trimester vaginal bleeding have a miscarriage. That might sound terrifying, but keep in mind this also means that half of the women who have bleeding don't miscarry.

So if you're not miscarrying, what else could be going on?

Other Causes

Other reasons you may be bleeding or spotting can include:

  • Cervical sensitivity: Light, brown-tinged spotting can happen after a pelvic exam or sexual intercourse because your cervix may be more tender and inflamed, but this type of spotting should stop within a day or so.
  • Implantation bleeding: Some women have implantation bleeding, which is spotting that occurs in the first month as the lining of the uterus adjusts to the newly implanted pregnancy.
  • Infection: A urinary tract, cervical, or pelvic infection can cause bleeding.
  • Subchorionic hemorrhage: When blood accumulates between your uterine wall and the amniotic sac, this is called a subchorionic hemorrhage or hematoma and can cause early pregnancy bleeding. This condition occurs in about 1 percent of pregnancies.
  • Molar pregnancy: Rarely, vaginal bleeding can be caused by a molar pregnancy, a kind of gestational trophoblastic disease. In a molar pregnancy, you have a cluster of abnormal tissue in your uterus rather than an embryo, usually due to chromosomal problems during conception. Your hCG level is high though, which means a pregnancy test would be positive.

    Miscarriage

    Miscarriages happen in around 15 percent to 20 percent of all pregnancies and usually occur during the first 12 weeks of pregnancy. First-trimester vaginal bleeding is more likely to be the result of a miscarriage if it's heavy and red, and if the quantity gets heavier rather than lighter.

    Other signs of a miscarriage include:

    • Lower abdominal cramping that's worse than what you may experience during your period
    • Tissue, clots, or clumps in the blood
    • Feeling dizzy or faint

    Ectopic Pregnancy

    Though less common than miscarriages, an ectopic pregnancy can also cause vaginal bleeding. In this type of pregnancy, the fertilized egg implants itself somewhere other than the uterus, often one of the fallopian tubes. These pregnancies occur in around one out of every 60 pregnancies. The symptoms are similar to miscarriage as far as bleeding and cramping, but you may also notice a sharp or stabbing pain in your abdomen with an ectopic pregnancy.

    During the Second and Third Trimesters

    In some cases, vaginal bleeding in the second or third trimester is not serious, but a serious condition must always be ruled out.

    Vaginal bleeding in the second or third trimester means that you need to see your doctor right away, particularly if the bleeding is heavy and red or accompanied by other symptoms like abdominal pain or contractions.

    Light bleeding or spotting could occur for similar reasons as first trimester bleeding, such as from slight irritation of the cervix after sexual intercourse or a medical exam or because you have some growths on your cervix. However, you need to see your doctor.

    Bleeding in the second or third trimester could indicate a serious condition, such as:

    • Placental abruption is when all or some of the placenta suddenly separates from the uterus after week 20 of gestation. It's a rare condition, occurring in about one out of every 100 pregnancies, usually in the third trimester, and it can trigger preterm delivery or stillbirth. You may feel contractions and abdominal pain along with the bleeding.
    • Incompetent cervix happens in around one or two out of 100 pregnancies. It's when your cervix starts to dilate way before it should, which can result in miscarriage or pre-term birth. An incompetent cervix is responsible for nearly 25 percent of miscarriages that occur in the second trimester.
    • Placenta previa is a condition in which the placenta is low-lying and either somewhat or totally covers your cervix. It can cause growth restrictions in the baby and fatal hemorrhaging (blood loss) in the mother, among other complications. If you're diagnosed with placenta previa, you will likely have to go on bed rest, often in a hospital. Placenta previa is also rare, occurring in approximately one out of every 200 pregnancies.
    • Placenta accreta is when the placenta grows too deep into your uterine wall to be released after the baby is born. This condition can become life-threatening if it's not found before you deliver your baby because it can cause you to hemorrhage. It can also cause late-pregnancy bleeding. Placenta accreta is usually found during an ultrasound and means that you will need a very careful delivery and possibly a hysterectomy, the surgical removal of your uterus, once your baby is born.
    • Preterm labor occurs when you go into labor before the 37th week of pregnancy. Before labor starts, you'll pass your mucus plug, which usually looks bloody and watery. This can happen several weeks before you actually go into labor, but if it's too soon, it may be a sign that you're going into preterm labor. Other symptoms may include cramping, abdominal pain or pressure, lower back pain or pressure, diarrhea, and contractions.

    What to Do

    If you experience bleeding or spotting during the first trimester, use a panty liner or pad to monitor how much there is. Also, pay attention to the color: Is it pink, bright red, or brown? Take a mental note of any activities you might have done in the past day or two that could have caused the bleeding such as a pelvic exam, Pap smear, or sexual intercourse.

    Don't use a tampon during pregnancy or put anything else in your vagina if you're bleeding, including having sexual intercourse, until your doctor gives you the all clear.

    Vaginal bleeding during pregnancy can have lots of different causes—some serious and some not. Since it's hard to know the difference, always call your doctor immediately for advice if you experience bleeding at any point during your pregnancy. Be sure to tell your doctor about any other symptoms you have too.

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    Article Sources
    • American Pregnancy Association. Bleeding During Pregnancy. Updated August 2015. http://americanpregnancy.org/pregnancy-complications/bleeding-during-pregnancy/
    • American College of Obstetricians and Gynecologists. Bleeding During Pregnancy. Frequently Asked Questions: Pregnancy, FAQ038. Published July 2016. https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy
    • American Pregnancy Association. Incompetent Cervix: Weakened Cervix. Updated August 2015. http://americanpregnancy.org/pregnancy-complications/incompetent-cervix/
    • Mayo Clinic Staff. Bleeding During Pregnancy: Causes. Mayo Clinic. Updated January 11, 2018. https://www.mayoclinic.org/symptoms/bleeding-during-pregnancy/basics/causes/sym-20050636