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Bleeding During Pregnancy

By Helen Hurst, DNP, RNC, APRN-CNM

Bleeding During Pregnancy

Bleeding during pregnancy can scare moms-to-be, however, not all bleeding during pregnancy is a sign that something is wrong.

As many as 1 in 4 women experience bleeding at some point in pregnancy. Understanding the different types of bleeding and possible causes may put your mind at ease and help you know when to call your nurse midwife or doctor.

Early Pregnancy Bleeding: 1st Trimester (12 weeks or less)

Spotting: Spotting is typically a small amount of blood or blood-tinged mucous that you only see when you wipe with tissue after going to the bathroom, or you may see a few spots on your underwear.

In early pregnancy, spotting may mean the embryo is implanting into the wall of the uterus (implantation bleeding). It often occurs about 2 weeks after you miss your period and shouldn’t continue or progress to bleeding. Also, a vaginal infection that irritates your cervix or vaginal tissues can cause spotting, as can normal changes in cervical cells due to pregnancy hormones.

You may also notice pink or brown mucous-like spotting up to 12 hours after intercourse with your partner. Pregnancy hormones make your cervix soft; the blood vessels can become engorged and bleed easily.  If you report spotting, you’re pregnancy provider will likely ask you when you last had sex.

Miscarriage: Bleeding in early pregnancy can be a sign of miscarriage. This type of bleeding is usually bright red and heavier, more like a period, and may be painful, crampy. Any bleeding that’s accompanied by cramping needs further evaluation; please call your pregnancy care provider and describe what you’re seeing and experiencing.

Ectopic pregnancy: An ectopic pregnancy occurs when an embryo implants outside of the uterus, usually in a fallopian tube. If you have an ectopic pregnancy, you may see light or heavy bleeding, and this bleeding is often accompanied by pain or cramping on one side of your abdomen. The cramping can be mild or severe. But you may have no evidence of bleeding. You’re at greater risk for an ectopic pregnancy if you became pregnant with an IUD in place, have had pelvic infections, a previous ectopic pregnancy or having had surgery on your fallopian tubes.

Other causes for early pregnancy bleeding: Another possible cause of 1st trimester bleeding is subchorionic hemorrhage or hematoma, which is bleeding between the membrane of the placenta and uterine wall. While it can be serious, it doesn’t always lead to miscarriage. You may also see a persistent dark brown discharge in early pregnancy; let your healthcare provider know if this persists as your pregnancy progresses.

Middle to Late Pregnancy Bleeding: 2nd & 3rd Trimesters

Middles to later pregnancy bleeding (often after 20 weeks) is usually due to placenta previa or placental abruption. Know the symptoms so you can immediately call your healthcare provider if you experience either of these problems.

Placenta previa

Placenta previa occurs when the placenta implants in the lower part of your uterus. In doing so, it may cover part or all of your cervical opening, which is called the cervical os. Bright red, painless bleeding may signal a placenta previa.

Your healthcare provider will use ultrasound to check for previa. Typically, a placenta previa will resolve without problems. The bleeding usually subsides and the pregnancy continues in about 90% of cases. If the bleeding becomes severe, your healthcare provider may request you receive care and support in the hospital.

If you have a placenta previa, avoid sex, particularly intercourse and orgasm, as these activities can stimulate contractions and cause bleeding. With a previa, nothing should be placed in the vagina and your providers should not perform vaginal exams.

Placental abruption

Placental abruption is rare and requires urgent care; it occurs in about 1% of pregnancies. Placental abruption is just like it sounds—some or all of the placenta separates from the wall of your uterus. It can be life-threatening for you and your baby.

You may see dark or bright red vaginal bleeding and have moderate to severe abdominal pain. Your abdomen may feel very tender or hard to the touch; you may feel like you’re having constant contractions. If you experience these symptoms, contact your healthcare provider or call 911 and go the hospital. Depending on the extent of the abruption and bleeding, you may need an emergency cesarean. If it isn’t severe, you may be able to continue your pregnancy with more frequent visits and ultrasounds.

If you’ve had either a placenta previa or placental abruption in a past pregnancy, you’re at a greater risk in future pregnancies. Share this important fact with your healthcare provider if you become pregnant again.

Burst: If you experience bleeding, your healthcare provider will want to determine why you’re seeing blood, and if you need urgent care.

Did you know? Vaginal bleeding affects about 25% of pregnancies.

 Spotting or Bleeding?
Spotting
is a few drops of blood, often lighter in color than your period, that you see when you wipe with a tissue.
Bleeding is heavy enough to soak through a panty liner or pad.

Helen Hurst, DNP, RNC, APRN-CNM, is an expert advisor to Healthy Mom&Baby.


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