Pregnancy Bleeding: Causes, Concerns and Care

Pregnancy can be a time of joy—but it can also be a time of worry: Is everything OK in there? Is my baby healthy?

Perhaps nothing is more concerning than experiencing bleeding during pregnancy. Vaginal bleeding during pregnancy can occur during any trimester—and for a variety of reasons. Roughly 25 percent of pregnant people experience bleeding at some point during pregnancy.

Yes, some bleeding can indicate a serious problem, but that’s not the case in every situation. Spotting or bleeding in early pregnancy is more common and generally less concerning than bleeding later in pregnancy. But if you experience bleeding at any point while you’re pregnant—especially if it’s accompanied by pain or other symptoms—call your doctor or seek other medical attention right away for a more clear diagnosis.

Here’s a rundown of the common causes and different types of bleeding during pregnancy.

Types of Pregnancy Bleeding

First, understand spotting and bleeding during pregnancy are not the same thing.

“Spotting is if you see a little spot or a few dots on your underwear or toilet paper,” says Christine Greves, M.D., F.A.C.O.G., an OB-GYN at Orlando Health Women’s Institute Center for Obstetrics & Gynecology. “Bleeding is where you need to wear a pad.”

Spotting early in pregnancy is not uncommon. Implantation bleeding can occur when the fertilized egg implants into the uterine wall and typically lasts for about a day or two. Even though it’s called implantation bleeding, it’s more like spotting. It may just be a few drops of blood.

Spotting or light bleeding can even occur after sexual intercourse or a pelvic exam.

Even though spotting is generally less concerning than bleeding, you should still let your physician know if you’re experiencing it. This helps them stay well informed about the progress of your pregnancy. Plus, they can let you know if any evaluation or intervention is needed.

Heavy bleeding that resembles menstrual bleeding in terms of volume is more concerning, especially if you’re also experiencing pain. Don’t wait. Get medical attention right away.

“If you experience heavy vaginal bleeding or abdominal pain, go to an emergency department for an evaluation,” Dennis says.

Common Causes of Pregnancy Bleeding

There are lots of reasons for vaginal bleeding during pregnancy. While bleeding doesn’t always mean something is wrong, sometimes it can indicate a problem with the pregnancy. In some cases, the pregnancy will end. In other situations, treatment can help maintain the health of the mother and baby.

Miscarriage: Miscarriage is defined as a loss of pregnancy up to 20 gestational weeks. It’s common, with roughly 10 percent to 20 percent of known pregnancies ending in miscarriage. This number is probably higher when factoring in early losses in mothers who didn’t even know they’d been pregnant. Most miscarriages occur because the embryo is unable to develop properly.

Vaginal bleeding or spotting is usually one of the first signs of miscarriage. Pain or cramping often occurs, as well. But again, experiencing spotting or light bleeding in the first trimester does not automatically mean the pregnancy will end.

The bleeding could also mean a “threatened” abortion or miscarriage, Greves says. “That’s the medical term for, it’s threatening because there’s blood but the cervix isn’t open so you’re not in the process of miscarrying.”

Ectopic pregnancy: If there’s bleeding in the first trimester—especially if it’s accompanied by pain or cramping—a doctor will need to rule out an ectopic pregnancy. This happens when an embryo attaches to a fallopian tube or someplace other than the uterus. Medical intervention is required, as a ruptured fallopian tube from an ectopic pregnancy can be potentially life-threatening for the mother.

Placenta previa: Placenta previa is when the placenta partially or fully covers the cervix. Bleeding can occur, but the pregnancy is usually not in danger.

“If there is a placenta previa early on, the placenta still has time to ‘migrate’ up the uterus as the uterus grows, so placenta previas can resolve on their own,” Dennis says.

In some cases, patients must be put on bed rest at home or in a hospital.

Placental abruption: This occurs when the placenta detaches from the wall of the uterus during the pregnancy.

“The most common symptom is painful vaginal bleeding,” Dennis says. “The uterus can feel like it is having contraction after contraction and not relaxing in between.”

When to Be Concerned

Greves says: “If there is bleeding, yes, it could mean that a miscarriage may occur, but it doesn’t always. Some people just have spotting during pregnancy. That’s why it’s important to be connected with an OB-GYN.”

But if that spotting or bleeding is accompanied by pain, Greves says, seek medical care right away. Don't wait if you experience heavy bleeding, either.

Pay attention to any pain in the first trimester. “Don’t wait on an appointment a few weeks out,” Greves says. “If you have pain, you need to make sure you seek medical treatment in case it could be an ectopic pregnancy.”

But pain at any point during a pregnancy is not normal, Greves says. “Call your doctor’s office to see what you should do,” she says. “Everything should be personalized based on your history.”

Diagnostic Procedures

Bleeding in the early weeks of pregnancy will likely be diagnosed with lab work to check HCG levels and an ultrasound.

Ultrasound will be used to determine the cause of bleeding further in the pregnancy, as well. In some situations, a pelvic exam with a speculum is needed.

In some rare cases (as with placenta accreta, when the placenta remains attached to the wall of the uterus), an MRI may be required, Dennis says.

Management and Treatment

Ectopic pregnancies are not viable and pose a serious threat to the mother’s health. If an ectopic pregnancy is detected, the embryo will need to be removed from the fallopian tube through medication or surgery.

Miscarriages may also require further intervention with medication or surgical procedures.

Placenta previa is manageable, and most of these pregnancies continue. But to protect the pregnancy, Greves says, “there should be nothing in the vagina: no sex, no digital exams.” It’s likely a c-section delivery will be required with this condition.

Depending on the volume of blood loss and the baby’s gestational age, placental abruption may be managed by staying off your feet as much as possible, bedrest “or delivery can be recommended urgently,” Dennis says.

Emotional Support

“Pregnancy can be stressful with the fear of pregnancy loss or preterm delivery,” Dennis says. “I recommend that mothers take care of their mental health along with physical wellbeing.”

She suggests working with a pregnancy support team. These professionals may include mental-health providers, doulas or midwives, to complement the care provided by your OB-GYN.

Precautionary Measures

There’s no guaranteed way to prevent bleeding during pregnancy, but you can lower your risk.

“Actively maintain chronic medical conditions before and during pregnancy,” Dennis says. “Avoid alcohol and illicit drugs and maintain a close to ideal body weight.”

A history of these conditions also puts you at greater risk for developing them in later pregnancies, so be sure to keep in close communication with your doctor.

Experts

• Melissa Dennis, M.D., M.H.A., F.A.C.O.G., an OB-GYN and chief medical officer at Partum Health

• Christine Greves, M.D., F.A.C.O.G., an OB-GYN at Orlando Health Women’s Institute Center for Obstetrics & Gynecology