Bleeding and spotting from the vagina during pregnancy

Bleeding and spotting from the vagina during pregnancy are common. Up to 1 out of 4 (up to 25%) of all pregnant women have some bleeding or spotting during their pregnancy.

Bleeding and spotting in pregnancy don’t always mean there’s a problem, but they can be a sign of miscarriage or other serious complications. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.

Call your health care provider if you have any bleeding or spotting, even if it stops. It may not be caused by anything serious, but your provider needs to find out what’s causing it.

What’s the difference between bleeding and spotting?

Bleeding or spotting can happen anytime, from the time you get pregnant to right before you give birth. Spotting is light bleeding. It happens when you have a few drops of blood on your underwear. Spotting is so light that the blood wouldn’t cover a panty liner. Bleeding is when the blood flow is heavier, enough that you need a panty liner or pad to keep the blood from soaking your underwear and clothes.

What should you do if you have bleeding or spotting during pregnancy?

Call your health care provider if you have any kind of bleeding during pregnancy and do these things:

• Keep track of how heavy your bleeding is, if it gets heavier or lighter, and how many pads you are using.
• Check the color of the blood. Your provider may want to know. It can be different colors, like brown, dark or bright red.
• Don’t use a tampon, douche or have sex when you’re bleeding.

Call your health care provider right away at any time during pregnancy or go to the emergency room if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis

What causes bleeding or spotting early in pregnancy?

It’s normal to have some spotting or bleeding early in pregnancy. Bleeding or spotting in the first trimester may not be a problem. It can be caused by:

• Having sex
• An infection
• Implantation. When a fertilized egg (embryo) attaches to the lining of the uterus (womb) and begins to grow.
• Hormone changes. Hormones are chemicals made by the body.
• Changes in your cervix. The cervix is opening to the uterus that sits at the top of the vagina.
• Certain types of testing during pregnancy like an amniocentesis or Chorionic villus sampling (CVS).  These are tests that are done to check for genetic abnormalities in your baby. Genetic abnormalities are changes in the genes that are passed down to a baby from mom or dad. These genetic changes can cause health problems for a baby.
• Problems related to smoking. If you smoke, it’s best to stop before pregnancy or as soon as you know you’re pregnant.

Sometimes bleeding or spotting in the first trimester is a sign of a serious problem, like:

• Miscarriage.  Almost all women who miscarry have bleeding or spotting before the miscarriage.
• Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
• Molar pregnancy. This is when a mass of tissue forms inside the womb, instead of a baby. Molar pregnancy is rare.

What causes bleeding or spotting later in pregnancy?

Bleeding or spotting later in pregnancy may be caused by:

• Labor
• Having sex
• An internal exam by your health care provider
• Problems with the cervix, like an infection, growths, inflammation or cervical insufficiency. This is when a woman’s cervix opens too early. Inflammation of the cervix is when it may be painful, swollen, red or irritated.

Bleeding or spotting later in pregnancy may be a sign of a serious problem, like:

• Preterm labor. This is labor that happens too early, before 37 weeks of pregnancy.
• Placenta previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix.
• Placenta accreta.  This is when the placenta grows into the wall of the uterus too deeply.
• Placental abruption. This is when the placenta separates from the wall of the uterus before birth.
• Uterine rupture. This is when the uterus tears during labor. This happens very rarely. It can happen if you have a scar in the uterus from a prior cesarean birth (also called c-section) or another kind of surgery on the uterus. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

How are bleeding and spotting treated?
Your treatment depends on what caused your bleeding. You may need a medical exam and tests.

Most of the time, treatment for bleeding or spotting is rest. Your provider may also suggest treatments like:

• Take time off from work and stay off your feet for a little while
• You may need medicine to help protect your baby from Rh disease. Rh disease is when your blood and baby’s blood are incompatible (can’t be together). This disease can cause serious problems — even death — for your baby.
• Don’t have sex, douche or use tampons
• If you have heavy bleeding, you may need a hospital stay or surgery

Last reviewed April 2020