Disclosure: The information in this article is meant for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions or concerns about your health or pregnancy.
Shortly after I learned I was pregnant with my first child, I was using the washroom at work when I noticed some blood on the toilet paper. I panicked. I left work and immediately went to my OBGYN, terrified that the end of this pregnancy was inevitable.
To my surprise and relief, my doctor was not overly concerned. She told me that it wasn’t uncommon for bleeding to occur in early pregnancy, and that while we should take it seriously, it doesn’t mean the worst has happened.
She took a blood test, followed by another a few days later, and informed me that my pregnancy hormones were continuing to rise at a normal rate. She did an ultrasound which confirmed the baby was developing as expected, and that I was not experiencing an ectopic pregnancy, in which the fertilized egg implants outside the uterus.
A second ultrasound two weeks later showed my baby had a strong heartbeat and was right on track for growth. Still, I kept noticing blood on the toilet paper on and off. Because it wasn’t a lot of blood, my doctor told me to take it easy and wait and see, but it wasn’t an immediate danger.
My 12-week ultrasound went perfectly. I saw my baby bouncing around the screen, waving, even mooning my husband. Everything looked great.
The next day, I began having strong cramping and heavier bleeding, with some small clots. I was sure this time I was miscarrying. At the hospital, they did an ultrasound and my baby was completely fine. They told me I was experiencing a threatened miscarriage, meaning that I could miscarry or I could go on to have a healthy pregnancy. There was no way to predict it.
The woman in the bed next to me was experiencing the same thing I was, and I thought of her often in the following months.
By the time I reached 15 weeks, the bleeding had stopped entirely. My mid-pregnancy ultrasound showed no concerns, and I went on to have a full-term, healthy (even easy!) pregnancy, and gave birth to a healthy baby boy, who is now a teenager.
At my final ultrasound around 35 weeks, I glanced down the hall to see a very pregnant lady waddling towards to imaging department. It was the woman from the next bed over. Her threatened miscarriage had turned into a viable pregnancy too.
While bleeding during pregnancy is frightening for anyone, it doesn’t always mean something dangerous. “Many times, nothing terrible comes from the bleeding,” says Dr. Felice Gersh, a physician board-certified in OB-GYN and Integrative Medicine, and medical director of Integrative Medical Group of Irvine.
How Common is Bleeding During Pregnancy?
According to The American College of Obstetrics and Gynecologists (ACOG), bleeding during the first trimester occurs in 15-25% of pregnancies.
Some studies show that number could be as high as 40%.
Is Bleeding During Pregnancy Always Dangerous?
About half of people who experience bleeding in the first trimester go on to miscarry, and about half do not miscarry, indicating that the sight of blood does not necessarily mean the pregnancy is not viable.
The type and severity of bleeding also matters. Whether pregnant or not, the scale for vaginal bleeding is:
- Spotting: Minimal bleeding, or a few drops of blood.
- Mild bleeding: Soaking less than 1 pad in more than 3 hours.
- Moderate bleeding: Soaking more than 1 pad in 3 hours.
- Severe bleeding: Soaking through your usual pads each hour for 2 or more hours. This is severe whether a person is pregnant or not.
Spotting is more common and less concerning than heavier bleeding.
What Can Cause Bleeding During Pregnancy?
Bleeding during pregnancy can be caused by a number of things, and sometimes the cause is never determined.
Some of the more common causes of bleeding during early pregnancy include:
“Spotting in the first trimester is usually related to a subchorionic hematoma or SCH,” says Dr. Daniel Roshan, a physician board certified in obstetrics and gynecology, and renowned maternal-fetal medicine specialist. “SCH is an accumulation of blood that settles between the pregnancy and the lining of the uterus.”
While SCH can increase the risk of miscarriage during the first 20 weeks, it is common for people with a SCH to go on to have a healthy pregnancy.
“Sometimes, this blood leaks out and presents as vaginal spotting or bleeding,” says Dr. Roshan. “Other times SCH is an incidental finding on ultrasound and is reabsorbed as the pregnancy progresses.”
Symptoms of SCH can include:
- Light to heavy bleeding
- Bleeding that may be pink to red or brown
- Lower stomach pain
About 6 to 12 days after fertilization, the fertilized egg implants in the uterine wall. This can cause some spotting, often around the time your period is due. It is often mistaken for a light period.
This spotting is usually considered normal and not a concern.
“Some light spotting as pregnancy progresses following intercourse or pelvic exams by your OB is also very common,” says Dr. Roshan. “When only light spotting is noted, this is not usually cause for alarm but is commonly the result of increased vessels and blood flow to the cervix during pregnancy.”
This bleeding should resolve on its own fairly quickly.
These growths are usually benign (don’t cause cancer), but can get irritated and bleed.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. As the pregnancy progresses, this can become dangerous or life threatening. Always see a healthcare professional if you suspect an ectopic pregnancy.
Symptoms may or may not appear, with the ectopic pregnancy found during a routine exam.
If there are symptoms, they usually develop between the 4th and 12th weeks and can include:
- Typical symptoms of pregnancy
- Abdominal pain low down on one side
- Vaginal bleeding or a brown watery discharge
- Pain in the tip of your shoulder
- Discomfort when using the washroom
A molar pregnancy is an abnormal growth of placental tissue that develops from a fertilized egg instead of a fetus.
Molar pregnancies are usually diagnosed via ultrasound.
Pelvic infections like bladder infections, urinary tract infections, and yeast infections can cause problems in pregnancy such as bleeding and should be treated promptly.
What If It Is a Miscarriage?
While bleeding during pregnancy is not always an indication of miscarriage, it can mean a miscarriage is happening. Bleeding that is bright red and gets heavier instead of lighter over time is more likely to suggest a miscarriage.
Some signs of miscarriage include:
- Bleeding – Light bleeding
- Brown discharge (may look like coffee grounds. This is old blood that has been in the uterus for a while and is coming out slowly)
- Spotting, bright red bleeding or clots
- Passing tissue out of the vagina
- A gush of clear or pink vaginal fluid
- Abdominal pain or cramping
- A decrease in pregnancy symptoms such as breast tenderness
- Dizziness, lightheadedness, or feeling faint
What Can Cause Bleeding After the First Trimester?
While some causes of bleeding that occur in the first trimester, such cervical sensitivity, can also happen later in pregnancy, bleeding after the first trimester can indicate a more serious condition.
“Moderate to heavy bleeding or bleeding in pregnancies with known placental concerns or other special circumstances should be evaluated by their OB immediately,” says Dr. Roshan.
Some potentially serious causes of bleeding in later pregnancy include:
- Placenta Previa: When the placenta is low in the uterus and covers or nearly covers the cervix
- Placental Abruption: When the placenta partially or completely detaches from the uterine wall
- Placenta Accreta: When the placenta grows too deeply into the uterine wall
- Incompetent Cervix: When the cervix begins to dilate too early
- Preterm Labour: Labour that begins before 37 weeks gestation (Other symptoms can include vaginal discharge, pressure in your pelvis or abdomen, a dull backache, cramps, contractions, and your water breaking.)
Some bleeding as the mucus plug is discharged is called “show” and is normal leading up to or at the beginning of labour in a healthy, full-term pregnancy.
What Should You Do If You Notice Bleeding?
While bleeding may be nothing to worry about, it is still an indication to contact a healthcare provider.
“Always contact the doctor or healthcare provider when bleeding occurs,” says Dr. Gersh.
“Because each pregnancy is different, it is important that any new onset or increase in spotting or bleeding during pregnancy be evaluated by your OB provider,” adds Dr. Roshan.
Some questions your healthcare provider might ask include:
- What colour is the blood? (Is it pink, brown or red?)
- Are there any clots in the blood?
- When did the bleeding start?
- What were you doing when the bleeding started?
- How heavy is the bleeding? (Spotting the size of a quarter? Do you need to use a pad? Are you soaking your pad or underwear?)
- Did it happen after intercourse or a vaginal examination?
- Are you having cramps, pain, or any other symptoms?
- Does it stop and start, or is it a steady flow?
- Does the blood have an odor?
- Do you feel weak or tired? Faint or dizzy?
Particularly in early pregnancy, there is often nothing specific that can be done to stop or prevent bleeding unless a cause is known and that cause has treatments, such as infection.
“Investigating the cause of the bleeding during pregnancy is the most important step to preventing further bleeding,” says Dr. Roshan.
Your healthcare provider will likely advise you to rest. They may also give directions such as:
- Take time off work
- Stay off your feet
- Refrain from sex (called pelvic rest)
- Never douche (this should never be done during pregnancy, with or without bleeding, and is recommended against even when not pregnant)
- Don’t use tampons or insert anything into the vagina unless directed by a healthcare provider
If bleeding is heavy or a serious problem is suspected, measures such as bed rest, a hospital stay, medication, or other medical procedures may be necessary.
When Is Bleeding During Pregnancy an Emergency?
- Heavy bleeding
- Bleeding with pain or cramping
- Dizziness and bleeding
- Pain in your abdomen or pelvis
- Discharge with clots or tissue
- Severe pain
- Intense cramping
- Severe nausea
- Fever of 100.4°F (38°C) or higher
Whether heavy bleeding or light spotting, the sight of blood during pregnancy is always scary – but it isn’t always dangerous. Many people – like me – experience bleeding at some point in their pregnancy without harm to themselves or their baby.
If you notice bleeding, don’t panic. Contact your healthcare provider (even if the bleeding has stopped) and discuss next steps. There is a good chance everything is fine.