Spotting During Early Pregnancy

Even though spotting can occur in viable pregnancies and does not necessarily mean anything is wrong, it's normal to worry about miscarriage. The term "spotting" means very light vaginal bleeding during pregnancy or between periods.

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

It's thought that up to 30% of women experience spotting at some point during pregnancy. Anyone experiencing spotting should call her doctor if she is concerned.

Causes of Spotting

pregnant woman holding her abdomen worried about bleeding

Istockphoto.com/AndreyPopov

There are many causes of spotting in early pregnancy. Certainly, miscarriage is one, but there are many possible reasons for spotting in a normal, healthy pregnancy. These may include:

  • Irritation of the cervix following sexual intercourse, a recent pelvic exam, or a recent 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, and it is not necessary to avoid intercourse (or pelvic exams or ultrasounds) in early pregnancy.
  • Implantation bleeding: When the placenta implants in the uterine wall, spotting may occur (see below).
  • Cervical ectopy, which 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 women who have experienced vaginal childbirth in the past and those who have used birth control pills for an extended period of time.
  • Infection of the cervix (cervicitis) refers to inflammation of the cervix and is most commonly caused by infections. These can be sexually transmitted infections 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.
  • Ectopic pregnancy: Spotting may result from an ectopic pregnancy, in which an embryo implants in the fallopian tubes. This is a medical emergency.

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. Conditions that can cause spotting include:

  • Placenta previa occurs when the placenta is placed over the opening to 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.
  • Labor: When the cervix begins to dilate in early labor. it is common to have a "bloody show."

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 women who experience spotting in early pregnancy do miscarry. This means that half of women who spot in early pregnancy 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 women who deliver full-term, healthy babies report that they had spotting at some point during pregnancy. Anyone who experiences spotting during their second or third trimester should contact their doctor right away.

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.

Women 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 tell your doctor right away.

If you are feeling at all concerned, give your doctor'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.

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