Bleeding During Pregnancy
So you’re on the road to pregnancy. You’ve given up drinking, you’ve started cutting back on caffeine, and you’ve devoured every piece of fertility information out there. You’ve picked out the best prenatal vitamin on the market, your doctor has given you their blessing, and you feel as prepared as you’ll ever be. You. Are. Superwoman.
What people forget to mention among all the articles about ovulation and when to have sex is one of the things that can cause the most stress throughout a pregnancy: vaginal bleeding.
In this article:
- How common is bleeding during early pregnancy?
- Implantation bleeding
- Bleeding In Early Pregnancy
- Bleeding In Late Pregnancy
- When To See A Doctor
How Common Is Bleeding During Early Pregnancy?
Believe it or not, vaginal bleeding is ultra-common in ALL stages of pregnancy (like 20-40% of women common!). Popular culture has conditioned us to expect a vaginal-bleeding free pregnancy. In the movies, if a woman is pregnant and starts bleeding, she has officially Lost The Baby. Not always true in real life! We’ll go through different types of bleeding in detail so that you know what is normal, expected bleeding versus bleeding that requires a doctor’s attention.
If you've been crossing your fingers for a missed period that might mean a new pregnancy, the return of bleeding can be discouraging. Before you assume you're not pregnant and pick up that bottle of rosé, let’s go over implantation bleeding vs. a regular period.
“Implantation bleeding”... sounds scary, right? No need to freak out; doctors call it this because it happens 6-12 days after sperm meets egg, which is typically when implantation occurs. Reminder: implantation is when a fertilized egg finds a nice cozy spot to start growing in your uterus.
Unfortunately for women trying to become pregnant, implantation bleeding can be super confusing. Why? Because implantation bleeding can happen right when your next period was supposed to start. Researchers still don’t know the exact cause of implantation bleeding, but they do agree that it’s common, happening in up to a third of women who conceive!
There will be some differences from your regular period, especially if you normally have a heavy flow. Implantation bleeding is SUPER light. More like spotting, really. You may see it on toilet paper, but you likely won’t need anything more than a light pantyliner to deal with it. It will also be lighter in color than your typical period blood and should only last 1-3 days.
Bleeding In Early Pregnancy
Congratulations! You’ve got a positive pregnancy test. Now begins the 9-10 months that are supposed to be ‘glowing’ and special as you grow your child from scratch. Understandably during this time, not many people talk about how common bleeding is throughout all stages of pregnancy.
In many cases, the cause of bleeding during your first trimester is hard to pinpoint. Your body is going through a massive change. As with all changes, weird things can happen. Remember that you’re definitely not alone if bleeding happens to you. Statistically in the first trimester, many women (remember, 20-40%!) report some sort of bleeding.
Okay, now you know it’s common to have some bleeding throughout pregnancy, but why? What is going on in there that’s causing something so distressing? Isn’t pregnancy tough enough already?
Reasons For Bleeding During Early Pregnancy
Here are the most common four causes: implantation bleeding, inflammation or distress of your lady parts (cervix, vagina, or uterus), early pregnancy loss, or ectopic pregnancy.
Let’s break this list down, shall we?
We’ve already covered implantation bleeding and how bewildering that can be!
If you experience vaginal bleeding a few weeks into your pregnancy, it might be an infection or inflammation. Since everything ‘down there’ is extra sensitive during pregnancy, you’ll be way more prone to bleeding than usual. Yes, even normal sex can cause spotting. (Don’t let that stop you from getting it on, though!)
Unfortunately, what doctors call ‘threatened early pregnancy loss’ is one of the most common causes of bleeding. If threat of pregnancy loss is a possibility, your doctor will evaluate your cervix, do an ultrasound, search for a fetal heartbeat, and check several other things. Pregnancy loss before 20 weeks happens in up to 15-20% of women, even if everything is done ‘right’. Still, the take-home point is that bleeding doesn’t necessarily mean you’re no longer pregnant; there are a ton of other factors that go into diagnosing a miscarriage.
You may have heard the term ‘ectopic pregnancy’ thrown around, but what the heck does it mean? This is definitely one of the more serious causes of bleeding. Fortunately, it’s relatively rare compared to everything else we’ve talked about. An ectopic pregnancy happens when the fertilized egg implants somewhere other than your uterus, usually in the fallopian tube (also known as the egg highway from your ovaries). Why is this such a big deal? Your uterus is super stretchy, made to handle big changes in size. The fallopian tube, on the other hand, is not so flexible. It can burst and cause serious complications or even death - which is why treating an ectopic pregnancy immediately is so important.
When you talk to your doctor and report bleeding in your first trimester, they’ll likely ask you a ton of detailed questions. This is good, it means your doctor cares about you! Questions might include: How heavily are you bleeding? Is there enough to soak through your clothes, are you passing clots? Any lightheadedness or severe cramping? Have you passed anything that doesn’t look like a blood clot?
All of these questions will help them figure out what could be causing the bleeding. Even if your bleeding is painless and light, they’ll likely want to check things out and make sure everything is normal.
Bleeding In Late Pregnancy
Late pregnancy is usually considered anything past 20 weeks. At this point, vaginal bleeding is more likely to be a sign of something serious. This makes sense, because your fetus and uterus are further along in the pregnancy process. After 20 weeks, your body has undergone some major growth and change!
Reasons For Bleeding During Late Pregnancy
The cause of vaginal bleeding in second and third trimesters can still be caused by things like sex and inflammation. Other causes, however, can be life-threatening!
Some of these super serious conditions involve your placenta, which is the structure that surrounds and nourishes your baby as it develops. Because the placenta is so full of essential blood vessels, any damage to it could be extremely serious.
In late pregnancy, ‘placenta previa’ is one of the conditions that your doctor will want to rule out. Essentially, it means that the placenta is situated over the opening in your cervix. Placenta previa puts you at a much higher risk of bleeding from your placenta, which is potentially life-threatening to you and your baby. Many times, this can be seen on an ultrasound in your second trimester, so your doctor will be able to formulate the safest plan for you. Fortunately, this only occurs in about 0.4% of women without certain risk factors.
Placental abruption is another relatively rare but serious possibility, happening in less than 1% of all pregnancies. As with a lot of conditions, it can range from mild to severe. Mild abruption would cause some bleeding but might just need to be monitored. Severe abruption means that the placenta has separated from the uterus too early in the process of pregnancy, causing severe bleeding that requires emergency medical attention.
The uterus, which surrounds the placenta, is another source of bleeding during late pregnancy. Your chances of uterus related complications are even less than placenta related ones, but your doctor will still want to rule it out. When you get to your late third trimester, it’s totally standard to have weekly (or more frequent!) appointments to make sure everything is hunky-dory with your uterus, placenta, and baby.
When To See A Doctor
As you've probably guessed by now, you should ALWAYS contact your medical care team about vaginal bleeding that happens during pregnancy.
Light spotting that happens around the very beginning of pregnancy, like implantation bleeding, usually isn’t a big deal. Even so, reach out to your doctor if you’ve had a positive pregnancy test. Be sure to note the dates of bleeding and describe it at your pregnancy confirmation appointment!
After your pregnancy is confirmed, your doctor WANTS to know about any vaginal bleeding you have. In most early pregnancy cases, it’s likely harmless. If you do have vaginal bleeding, practice self-care by letting your care provider know about it as soon as possible.
In late pregnancy, vaginal bleeding could still be nothing, but it’s more likely than early pregnancy to be a medical emergency.
If you experience vaginal bleeding during pregnancy, you’re not alone! Many other women struggle with this; doctors are very experienced in figuring out whether or not your particular case is serious.
Remember: there’s a good chance it’s nothing to worry about, but only a qualified medical professional can tell you for sure.
MedlinePlus, Ectopic pregnancy, January 2018.
American College of Obstetricians and Gynecologists, Bleeding During Pregnancy, 2016.
National Institutes of Health, National Library of Medicine, Patterns and predictors of vaginal bleeding in the first trimester of pregnancy, July 2011.
National Institutes of Health, National Library of Medicine, Pregnancies complicated by placenta praevia: what is appropriate management?, September 1996.
- Lindsey Hippe