Spotting During Pregnancy

Spotting, or light bleeding, is often (but not always) harmless and temporary

Spotting can occur in viable pregnancies and does not necessarily mean anything is wrong. However, it's normal to worry that it means a miscarriage is happening. The term "spotting" means very light vaginal bleeding during pregnancy or between periods. This is different from bleeding in pregnancy, which is a heavier, more sustained flow of blood and is more likely to be a sign of a problem with the fetus or pregnancy.

Spotting is usually light and brown, although heavy spotting can be red. A person who is spotting might need only a panty liner rather than more absorbent menstrual supplies to manage the flow.

It's estimated that approximately 25% of pregnant people experience spotting at some point during pregnancy. Anyone experiencing spotting should call their doctor if they are concerned and let their medical provider know they have been spotting at their prenatal care visits.

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Causes of Spotting

pregnant woman holding her abdomen worried about bleeding

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There are many causes of spotting in early pregnancy, some serious, others not. Certainly, miscarriage is a common one. Spotting may also result from an ectopic pregnancy, in which an embryo implants in the fallopian tubes, meaning it is not viable. This is a medical emergency and requires treatment.

However, there are many possible reasons for spotting in a normal, healthy pregnancy. These include the following.

Irritation of the Cervix

The cervix can become irritated and bleed following sexual intercourse, a recent pelvic exam, or a transvaginal ultrasound. The cervix becomes very vascular during pregnancy and can sometimes bleed with minimal contact.

This bleeding is not dangerous, other than making you fear that something could be wrong. It is not necessary to avoid intercourse (or pelvic exams or ultrasounds) in early pregnancy.

Implantation Bleeding

When the fertilized egg implants in the uterine wall, spotting may occur (see below). This is also not a cause for concern.

Cervical Ectopy

Cervical ectopy is the invasion of cells that are normally present in the uterus or cervical canal to the surface of the cervix. These delicate cells have a tendency to bleed with very little irritation. Ectopy is more common in pregnant people who have experienced vaginal childbirth in the past and those who have used birth control pills for an extended period of time. This type of spotting is also harmless.

Cervicitis

Infection of the cervix (cervicitis) refers to inflammation of the cervix and is most commonly caused by infections. These can be sexually transmitted infections (STI) such as chlamydia, gonorrhea, trichomonas, or genital herpes, or non-sexually transmitted infections such as bacterial vaginosis. Cervicitis may also be caused by irritation from a diaphragm​ or an allergy to the latex in condoms.

If cervicitis is caused by an infection, it's important for that to be treated. If STIs are allowed to progress, they can become harmful to your fetus and pregnancy.

Often, other symptoms will also be present with STIs, such as fever, a burning sensation or bumps or blisters in or around the vaginal area, or a foul-smelling vaginal discharge. Contact your doctor if you have any of these symptoms or if you are concerned you may have an STI or other infection.

2nd and 3th Trimester Causes of Spotting

When spotting occurs later in pregnancy (in the second and third trimesters), often the cause is not known and the spotting does not indicate any problems, particularly if the spotting is light and temporary. However, particularly in the second half of pregnancy, spotting, especially if it progresses to heavier bleeding, can be concerning.

More serious conditions that may include spotting include:

  • Placenta previa occurs when the placenta is placed over the opening to the cervix. A C-section delivery may be necessary unless the placenta moves away from the cervix.
  • Placental abruption: Separation of the placenta from the uterine wall before delivery often results in very heavy bleeding, but at times the bleeding is contained above the placenta and only spotting occurs. This can result in preterm birth or other pregnancy complications, including pregnancy loss.
  • Labor: When the cervix begins to dilate in early labor. it is common to have a "bloody show." So, if you're close to term and have spotting, labor may be starting.

What Spotting Looks Like

Generally, the term spotting is used for very light bleeding at any point in pregnancy. It is usually a small quantity and lasts for a short duration of time. The blood may be red, pink, or light brown in appearance.

Spotting may result in redness on your underwear or require you to wear a panty liner. Bleeding that is heavy enough to require a menstrual pad is usually referred to as vaginal bleeding rather than spotting, and should be evaluated by your doctor.

Does Spotting Mean Miscarriage?

Many people fear that spotting in early pregnancy is a sign of miscarriage, but this isn't always the case. Roughly half of the pregnant people who experience spotting in early pregnancy do miscarry. This means that half of them do not miscarry. Spotting later in pregnancy is often less serious, but there are times when it is very serious.

Between 10% and 30% of people who deliver full-term, healthy babies report that they had spotting at some point during pregnancy. However, anyone who experiences spotting during their second or third trimester should contact their doctor right away to rule out any more serious pregnancy complications.

Is It Implantation Bleeding?

Implantation bleeding may occur very early in the pregnancy, around the time that you would otherwise expect your menstrual period, but the quantity of blood is minimal, and bleeding does not last a long time.

Implantation bleeding occurs when the fertilized egg implants in the uterus, around 10 days after ovulation. Most often women notice only a tinge of red on their panties or on toilet paper, though sometimes it may be heavier.

People who ordinarily have light periods may mistake implantation bleeding for a period and not realize that they are pregnant.

What to Do If You're Spotting and Worried

If your bleeding in early pregnancy is very minimal and you otherwise are not having any symptoms, you may wish to wait until your next appointment to talk to your doctor. But if you experience spotting along with severe cramping, fever, unusual or foul-smelling vaginal discharge, or pain, you should contact your doctor right away.

If you are feeling at all concerned, give your OB/GYN's office a call. Pregnancy can be a stressful time, and being able to talk to your doctor about your symptoms can be very reassuring.

7 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Bever AM, Pugh SJ, Kim S, et al. Fetal growth patterns in pregnancies with first-trimester bleedingObstet Gynecol. 2018;131(6):1021-1030. doi:10.1097/AOG.0000000000002616

  3. DeVilbiss EA, Naimi AI, Mumford SL, et al. Vaginal bleeding and nausea in early pregnancy as predictors of clinical pregnancy lossAm J Obstet Gynecol. 2020;223(4):570.e1-570.e14. doi:10.1016/j.ajog.2020.04.002

  4. Velez Edwards DR, Baird DD, Hasan R, Savitz DA, Hartmann KE. First-trimester bleeding characteristics associate with increased risk of preterm birth: data from a prospective pregnancy cohortHum Reprod. 2012;27(1):54-60. doi:10.1093/humrep/der354

  5. Kim SM, Kim JS. A review of mechanisms of implantationDev Reprod. 2017;21(4):351-359. doi:10.12717/DR.2017.21.4.351

  6. National Institute of Health. What are some common signs of pregnancy?.

  7. National Institute of Health. What are the symptoms of pregnancy loss (before 20 weeks of pregnancy)?.

By Krissi Danielsson
Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage.