Understanding Pregnancy Spotting: Causes, Concerns, and Care

Finding a few drops of blood in your underwear when you're pregnant would concern anyone. However, spotting during pregnancy is common, particularly in the first trimester. Roughly 15 percent to 25 percent of pregnancies have some spotting early in pregnancy.

Pregnancy spotting can happen for a variety of reasons—and it doesn't always mean there's a severe problem or complication. Even so, the simple rule is to let your doctor know.

Here's what you should know about pregnancy spotting, plus how to take care of yourself if you experience it.

What is Pregnancy Spotting?

"Spotting can happen at any time during the pregnancy," says Rikki Baldwin, D.O., board-certified OB-GYN and attending physician, Memorial Hermann Medical Group in Cypress, Texas. "It can be something benign or something more serious."

Spotting and bleeding are not the same. Spotting is very light bleeding and lasts for a short time—usually a day or two. It shouldn't require more than a panty liner. If it's heavy bleeding—enough where a regular pad or tampon is needed—that's not spotting.

Usually, the blood will be bright red, but it can even be dark brown. Regardless, let your OB-GYN know. If it's early in the pregnancy, your doctor will need to rule out an ectopic pregnancy, which is not viable and can pose a danger to the mother.

Causes of Pregnancy Spotting

Dr. Baldwin says doctors consider in which trimester the spotting occurs to help them gauge its potential severity and understand the cause.

There are numerous reasons why you may experience spotting while pregnant. Some common causes of pregnancy spotting:

Implantation bleeding

It occurs when the fertilized egg implants into the wall of the uterus at the beginning of pregnancy. It lasts for a day or two. "It will resolve spontaneously with no other issues," Dr. Baldwin says.

Subchorionic hematoma

Also called a subchorionic hemorrhage is a blood clot that forms between the uterus and the outermost layer of the amniotic sac. "Either your body will absorb that clot or blood, or you'll bleed it out, and everything will be completely fine with your pregnancy," Dr. Baldwin says, "or that hemorrhage or hematoma can continue to increase in size and increase the risk of a miscarriage.

Intercourse, pelvic exams or ultrasounds

More blood flows to the uterus and cervix during pregnancy. "Anytime there's any contact with the cervix, it can start to bleed," Dr. Baldwin says.

Hormonal changes

A drop in progesterone can also cause spotting or bleeding early in pregnancy.

Infections or S.T.I.s

Spotting can also be caused by vaginal, cervical or sexually transmitted infections, such as chlamydia or gonorrhea.

Miscarriage

Spotting can also indicate a threatened miscarriage—meaning a miscarriage may occur but hasn't started—or pregnancy loss.

When to Be Concerned

Seeing any amount of blood while you're pregnant is undoubtedly alarming. Your doctor can determine the cause of the spotting and whether it indicates a serious complication with the pregnancy.

Spotting may indicate a problem with the pregnancy, including a threatened miscarriage or the start of a miscarriage in the first 20 weeks of pregnancy.

Spotting can be a sign of problems with the cervix or the placenta later in the pregnancy. One example of a placental abnormality is placenta previa, which occurs when the placenta partially or fully covers the cervix. Another one is placental abruption, which occurs when the placenta detaches from the uterus before delivery.

If you're experiencing heavy bleeding, pain or fever, don't wait for an appointment with your OB-GYN—go to a hospital emergency department for evaluation.

Seeking Medical Attention

"If you experience vaginal bleeding, you should contact your provide for guidance," says Melanie Belt, M.D., F.A.C.O.G., chief OB-GYN officer at Texas Children's Hospital North Austin and assistant professor of obstetrics and gynecology at Baylor College of Medicine. "They can help determine if you need to be seen, though the answer is often yes.

A physician will want to know how far along you are in the pregnancy when the spotting started and how heavy it is. Noting how much blood is on a panty liner and whether you've had to change it can help you measure this. The doctor will likely want to know what you were doing before the spotting began.

Tips for Managing Pregnancy Spotting

"There are no guaranteed ways to reduce or prevent the risk of spotting," Dr. Belt says.

Staying off your feet, limiting strenuous exercise and activity, and avoiding lifting heavy objects may help reduce spotting. If you experience spotting after intercourse, abstaining from sex for a few days should help alleviate the spotting.

Adequate rest and hydration are crucial during pregnancy, even if you're not experiencing any spotting.

Experts

• Melanie Belt, M.D., F.A.C.O.G., chief OB-GYN officer at Texas Children's Hospital North Austin and assistant professor of obstetrics and gynecology at Baylor College of Medicine
• Rikki Baldwin, D.O., board-certified OB-GYN and attending physician, Memorial Hermann Medical Group in Cypress, Texas