If you experience bleeding during pregnancy it can be frightening.
According to the American College of Obstetricians and Gynecologists, around 15-25% of pregnant women experience vaginal bleeding during early pregnancy.
However, a vaginal bleed in early pregnancy doesn’t always mean you’re experiencing a miscarriage.
Vaginal bleeding during pregnancy
Vaginal bleeding is any loss or discharge of blood from the vagina. It can happen any time from when the egg is fertilized to the end of your pregnancy.
To help you access more information about bleeding or spotting during pregnancy, you might like to read Spotting During Pregnancy – How Much Spotting Is OK?
Does bleeding mean a miscarriage?
Vaginal bleeding when pregnant doesn’t automatically mean you’ll experience a miscarriage.
In most cases, in the first trimester of pregnancy, bleeding might last only about three days.
Although most women have one experience of bleeding, a small number will bleed throughout the entire pregnancy.
It can take the form of spotting, streaking, or period-like bleed, with or without clots.
7 causes of vaginal bleeding during pregnancy
Below are seven of the most common possible causes of bleeding during pregnancy. As you will see, it’s not always sinister.
It’s also possible to feel some mild cramping or stretching sensations during a healthy pregnancy.
#1: Implantation bleeding or streaking
When a fertilized egg implants in the uterine lining, it can result in light bleeding or streaking (streaks of blood) called implantation bleeding.
Usually, it lasts a couple of days in the first trimester and occurs around the time of implantation or when your period would have been due.
Some mothers mistakenly think they have simply had a light period and don’t realize they are pregnant.
For more information please read Implantation Bleeding – Everything You Need To Know.
#2: Breakthrough bleeding
Some mothers experience what’s known as ‘breakthrough bleeding’. This happens during the times when a period would normally be due.
This means bleeding appears at around 4, 8, and 12 weeks of pregnancy, and is usually accompanied by the feeling you would normally have when your period is about to begin.
During pregnancy, hormones prevent your period from occurring. If the levels of these hormone aren’t yet elevated enough to stop your period, breakthrough bleeding occurs.
Breakthrough Bleeding And Pregnancy | Causes And What To Expect has more information.
#3: Threatened or actual miscarriage
A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. Most often a miscarriage happens because the fertilized egg has complications that mean the pregnancy won’t continue.
It’s believed that 10-25% of all pregnancies end in miscarriage and 80% of these end in the first trimester. The risk of miscarriage decreases once the baby’s heartbeat has been found on ultrasound. When you enter the second trimester, the risk drops to less than 1%.
Common signs of miscarriage include first trimester vaginal bleeding or spotting, cramping, backache, and stomach pains.
For more information about miscarriage, we recommend:
#4: Bleeding after sex
Bleeding after sexual intercourse is one of the most likely causes of spotting or light bleeding in early pregnancies. However, it can occur in any trimester.
During pregnancy, the cervix has more blood supply and is quite sensitive to touch. Sexual intercourse can cause blood vessels to be irritated and bleed slightly.
Unless your doctor has instructed you to stop having sex, it’s safe to have sex. You might see some spotting afterwards.
Speak to your care provider, however, if the bleeding is ongoing, accompanied by cramping, or excessive.
For more information be sure to read Bleeding After Sex During Pregnancy.
#5: Ectopic pregnancy
An ectopic pregnancy occurs when the fertilized egg implants itself outside the uterus. In more than 90% of cases, it implants in a fallopian tube.
You might experience severe discomfort down one side of your abdomen, or generalized pain that doubles you over. You might also feel faint and nauseous.
The pain can disappear suddenly if the tube ruptures, but it will return within hours or days and you will feel really unwell.
Go to the emergency department and contact your ob-gyn.
An ectopic pregnancy that ruptures the fallopian tube will cause internal bleeding, damage to the tube, and maternal collapse.
Your fallopian tube might have to be taken out, along with the pregnancy.
For more information, read our article Ectopic Pregnancy – Symptoms, Signs, and Treatment.
#6: Bleeding from the placenta
A vaginal bleed without pain might be caused by an abnormally placed placenta. It’s quite common to have a low-lying placenta in early pregnancy.
Usually, by the third trimester, the placenta will have moved up as the uterus grows and is further away from the cervix. Sometimes, though, this doesn’t happen.
Here are three different placental problems that can result in a vaginal bleed:
Placenta previa will usually result in a vaginal bleed at some point in your pregnancy – usually after the 20-week mark.
There are different degrees of severity, but all cases of placenta previa require repeat ultrasounds for an accurate diagnosis.
If you have a placenta previa, to prevent risk to your baby, your doctor might recommend bed rest, induction, or c-section if the placenta remains over or too close to the cervix.
This article about placenta previa has more information.
Another cause of vaginal bleeding later in pregnancies is placental abruption. This is where the placenta partially or completely separates from the wall of the uterus.
Symptoms include severe pain and bleeding.
The blood might be visible or remain in the uterus, which will be tense, tight, hard to the touch and very painful.
Contact your doctor or health care professional if you have any of these symptoms and go immediately to your nearest emergency department.
Depending on the severity of the bleeding, you might be recommended bed rest, an induction, or even a c-section.
If you’ve had a previous c-section, or other procedures involving your uterus, vaginal bleeding could be caused by placenta accreta. This is when the placenta embeds too deeply into the uterus wall.
Rates of placenta accrete are on the increase as c-section rates around the world continue to go up.
This article on placenta accreta has more information.
#7: Uterine fibroids
Uterine fibroids are lumps of tight muscle and fibrous tissue, which can be found inside or outside the uterine wall.
Fibroids are best removed prior to pregnancy because they can potentially lead to ectopic pregnancy, heavy blood flow, and pregnancy loss.
However, many mothers who have fibroids are able to give birth without any problems.
Contact your health care provider for advice.
Read more in Fibroids And Pregnancy – 8 Things You Need To Know.
What kind of bleeding is normal during pregnancy?
If you’re bleeding during pregnancy, you might be wondering exactly how much vaginal bleeding is normal?
Light bleeding during the first trimester or bleeding in early pregnancy is common, and many women go on to have healthy pregnancies.
Second or third trimester bleeding or spotting isn’t normal.
Call your doctor or healthcare provider if you’re in either of those trimesters and have vaginal bleeding. Your doctor can run some tests to check for the cause, and help you make decisions about your care.
When should I be worried about bleeding during pregnancy?
All vaginal blood loss during pregnancy needs medical assessment, even if it’s ‘normal’ bleeding in the first trimester.
If you have any cramping, regular period-like pain, or fever, you should seek medical assistance quickly.
You especially need to see a doctor or midwife within 72 hours of any bleeding if you have a rhesus negative blood group (e.g. O- or A-).
This is to check whether your baby’s blood might have mixed with yours. If the blood has been mixed, and your baby is rhesus positive (e.g. O+ or A+) your body will see this as foreign matter and produce antibodies.
In the future, if you have any subsequent pregnancies, these antibodies will attack a baby with a positive blood type.
Find out more in Rhesus Factor And Pregnancy: A Must Read If You Have Rh- Blood.
Heavy bleeding during pregnancy
If vaginal bleeding is heavy (i.e. it flows out and you’re passing clots) and if it’s accompanied by cramps, backache, and period-like discomfort, contact your hospital immediately.
Keep calm and remember, it is your blood you’re seeing, not the baby’s blood.
Urgent medical assessment and intervention are important to ensure you and your baby are safe.
What should I do if I’m bleeding during pregnancy?
Seek medical advice immediately.
In order to avoid any infections, don’t use a tampon if you experience pregnancy bleeding. Always use pads or a panty liner.
You can keep them to show care providers, as they might need to see the consistency. It’s ok – your doctor or midwife has seen plenty of blood before.
If the bleeding is light, and you have no pain, contact your midwife or obstetrician to discuss.
What if I’m experiencing a miscarriage?
If you’re experiencing a miscarriage, unfortunately, nothing can prevent it from occurring if you’re not yet 20 weeks.
The important thing is to take care of yourself emotionally and physically. Be kind to yourself; you aren’t responsible for a miscarriage happening.
If you experience a miscarriage, to feel more physically comfortable try:
- Paracetamol/Panadeine/Naprogesic (a drug designed for period pain) to ease the cramps
- Hot water bottle or heat pack for your tummy
- Tea and support from your partner and others
You might feel the vaginal loss of the developing fetus and other tissue; after that, the bleeding should settle and stop.
If you continue to bleed, you might need a surgical procedure called a dilation and curettage.
Your doctor can provide medical advice, diagnosis, or treatment, as well as counseling for your pregnancy loss.