The sight of blood is never welcome when you’re pregnant.
A reassuring fact is that bleeding in pregnancy is quite common, especially in the first trimester.
Most women go on to have healthy pregnancies and babies after spotting or bleeding.
But how much bleeding during pregnancy is normal?
Let’s take a look at what level of bleeding is normal, the causes of bleeding, and when you might need to seek medical advice.
Bleeding in early pregnancy 4 weeks
Early pregnancy bleeding or spotting is quite common and doesn’t always mean something is wrong. Breakthrough bleeding sometimes happens to women around the time of their expected periods for a few months.
Early in pregnancy, spotting or light bleeding isn’t unusual. You might be experiencing implantation bleeding.
This happens when the fertilized egg implants into the lining of the uterus. It tends to be pinky-brown in appearance and is more spotting than bleeding.
You can read more in Implantation Bleeding – Everything You Need To Know.
Another reason for bleeding or spotting in pregnancy could be an ectopic pregnancy. This is when the fertilized egg implants in the wrong place. Bleeding or spotting can be either light or heavy and is usually accompanied by abdominal, shoulder, or neck pain.
If you suspect you have an ectopic pregnancy, you need to seek medical advice immediately. Call an ambulance and let your doctor know.
For more information please read Ectopic Pregnancy – Symptoms, Signs, and Treatment.
Period-like bleeding during pregnancy
Every woman’s menstrual bleed is unique to her. Some women find their periods vary from month to month.
Pregnancy bleeding or spotting can also vary, depending on the cause.
Implantation bleeding, as previously discussed, is usually short-lived. It can be enough to convince you your period is starting, however, especially as the implantation spotting can occur around the expected date of your period.
Bleeding that becomes progressively heavier needs investigation by your doctor.
If there are no signs of infection or pain associated with the bleeding, it might be due to other causes, such as placenta previa.
Bleeding in the second trimester is more likely to be related to an irritated cervix but it’s always important to speak to your care provider.
Light bleeding during the first trimester might require only a panty liner; period-like bleeding will require a sanitary pad.
For more information be sure to read Bleeding During Pregnancy – 7 Causes Of Vaginal Bleeding.
Can you bleed heavily and still be pregnant?
Bleeding during early pregnancy can be a sign of miscarriage, but miscarriage is not always the outcome of bleeding when pregnant.
It’s thought up to 30% of women have some bleeding or spotting; half of them go on to have healthy pregnancies.
1 in 4 pregnancies will end in miscarriage in the first 12 weeks. Often a woman isn’t yet aware she’s pregnant and will have what seems like a heavy menstrual period.
Miscarriage bleeding can vary and is usually accompanied by cramping and pain in the lower belly area.
If you are having a miscarriage, there can be clotty material along with other tissue. Once this is passed, the bleeding and pain will generally slow and then stop.
If you continue to bleed and have pain, medication and surgical treatment might be required.
Your doctor or midwife should provide information about bereavement support. The loss of pregnancy can be traumatic for women.
Is bleeding painful in pregnancy?
Pain is often associated with bleeding when pregnant but the level of pain will depend on what type of bleed it is. The crampy pain associated with implantation bleeding, as discussed, is usually mild and goes away fairly quickly.
Heavier bleeding can be significantly more painful, especially in a situation of miscarriage or ectopic pregnancy.
You might need simple pain relief for pain associated with light bleeding.
Seek medical advice from your doctor for excessive bleeding during the first trimester. The same advice applies if you’re in the second and third trimester.
This will require more intensive pain relief and management in the emergency room.
Again, call your doctor or midwife if you have cause for concern.
How to stop bleeding during pregnancy
Significant vaginal bleeding in pregnancy needs to be medically managed by your doctor; otherwise, it might not stop and can become life-threatening.
Medical management could mean surgery and medication, depending on the cause and how serious it is.
If the bleeding is serious and can’t be stopped, you might need to have surgery to remove the pregnancy (termination) or to give birth (placental abruption or placenta previa).
If you have light bleeding in early pregnancy, you can seek advice from your doctor, but you won’t necessarily need emergency treatment.
More likely, vaginal bleeding during pregnancy will stop on its own.
You can use some of these comfort measures:
- Take simple pain relief, such as paracetamol, as recommended by your doctor.
- Use a sanitary pad not a tampon.
- Apply a heat pack in moderation; make sure it’s not steaming hot.
When should I be worried about bleeding in pregnancy?
Any sight of blood during pregnancy is likely to cause you concern. It’s normal to worry about this and it’s always a good idea to have a chat to your doctor for reassurance.
First trimester vaginal bleeding can be very stressful, as you wait to pass the 12-week point when miscarriage risks decrease.
Heavy vaginal bleeding for women is definitely a concern, however, and needs to be taken seriously.
If you are soaking sanitary pads, this is not normal; you need to seek urgent medical treatment at your nearest emergency department.
Should I go to the hospital if I have bleeding in pregnancy?
If you’re pregnant and have severe vaginal bleeding, you most definitely need to go to the hospital.
In fact, the recommendation is to call an ambulance immediately and head to the emergency room.
Severe heavy bleeding means you are soaking pads within an hour.
Reasons for excessive bleeding might be:
- Ectopic pregnancy, where the fertilized egg attaches in the wrong place, usually in the fallopian tube. Typically, an ectopic pregnancy will rupture in the first trimester, between 6 and 16 weeks.
- Placental abruption, where the placenta detaches and starts to lift away from the wall of the uterus. This is rare and usually happens in the third trimester.
- Placenta previa, where the placenta is lying over the cervix and for some reason has started to bleed.
- Preterm labor.
When you arrive at the hospital, your doctor will start treatment quickly, as heavy bleeding can be life-threatening to you and your baby.
- Blood test. Blood is taken from a vein, usually in your arm.
- Palpation. The doctor feels your abdomen, to see whether the uterus is swollen or painful.
- Medication. This is given to make the uterus contract and close, to stop bleeding.
- Ultrasound. The scan looks for possible causes of the bleeding, and checks baby’s heartbeat and functions.
- Surgery. Depending on the cause of the bleeding, surgery might be needed to stop it. If you’re close to your estimated due date, your healthcare provider might perform a c-section.
If you have excessive bleeding with pain, at any time in your pregnancy, it’s strongly recommended to seek immediate treatment.
Call your doctor, who can give you information and follow up on your treatment.
Can you use tampons in pregnancy?
It’s not recommended to use tampons in pregnancy. There’s an increased risk of infection with tampon use and this could be harmful to you and your baby.
Infection can present with chills, fever, vaginal bleeding, and a discharge with a smelly odor.
Sanitary pads are safe to use. You can now get pregnancy underwear, which is also great for after you have had your baby.
Why do I have bleeding after sex in pregnancy?
During pregnancy, the cervix is extremely vascular, which means there’s an increased blood supply to your cervix.
This also means the cervix is more likely to bleed just by touch or contact.
Sexual intercourse is very often a reason why you will experience spotting. It is usually termed a post-coital (post sexual intercourse) bleed. It can cause light vaginal bleeding or spotting.
This isn’t a concern and will settle within a short time frame.
You can have sex while pregnant, but consider positions that have the least heavy penetration.
Pregnancy Sex Positions – 7 Ideas For Pregnant Couples has some great tips.
You shouldn’t be having sex after your waters have broken, however, as there’s an increased risk of infection.
Call your doctor if you suspect your waters have broken, especially if you haven’t reached 37 weeks.
Be sure to read Bleeding After Sex While Pregnant.
Molar pregnancy and causes of bleeding
Molar pregnancy is also known as a hydatidiform mole and is quite rare in pregnancy. Molar pregnancy can lead to a rare form of cancer.
This type of pregnancy is the result of an abnormally fertilized egg and is related to chromosomes.
Sadly, these pregnancies usually miscarry early.
Some signs are:
- Dark brown to bright red spotting or bleeding in the first trimester.
- Severe nausea and vomiting.
- The vaginal passage of grapelike cysts (in some cases).
- Pelvic pressure or pain.
Your doctor can follow this up, provide more information, and manage its impact on further pregnancies.
For further reading: Breakthrough Bleeding And Pregnancy – Causes And What To Expect.