Spotting During Pregnancy – How Much Spotting Is OK?

Have you noticed you’ve been spotting during pregnancy?

Worried about what it might mean?

Pregnancy is a time of nerves and excitement. You’re growing a precious new life and you are highly attuned to shifts in your body.

If you’re expecting your first baby, or a rainbow baby (a baby after a pregnancy loss), you might be extra concerned about pregnancy symptoms, especially when they involve blood.

For many women, the first sign of pregnancy is a missed period.  From that point on, they expect or hope to have no bleeding or spotting until after the birth.

What might come as a surprise to you is that nearly 50% of all expectant mothers experience some degree of bleeding during pregnancy.

What does pregnancy spotting look like?

Firstly, it’s important to define what spotting means, as bleeding occurs at various levels.

Spotting is very light bleeding. It’s so light you might find there’s a little bit of blood in your underwear, but not soaking through.

You might find a small amount of blood on the toilet paper after wiping or a little blood in your discharge.

If you need a liner or pad, and you have bleeding like a menstrual period, or if you see any clots, that’s considered bleeding, not spotting.

It’s common to have a little bit of blood in your discharge.

If you are experiencing heavy vaginal bleeding, contact your midwife or doctor right away.

Although many women worry about pregnancy complications, it’s very likely you will go on to have a healthy pregnancy, but your midwife or doctor will do further assessment.

What causes spotting during pregnancy?

Almost 50% of women experience bleeding or spotting during pregnancy, but it isn’t always bad news.

In some cases, we’re never really sure why the spotting or bleeding occurred. In other cases, we know why, which can be related to the stage of your pregnancy.

Spotting during pregnancy first trimester

Some reasons for early pregnancy bleeding in the first three months:

• Implantation, when the embryo attaches to the uterine lining
• Hormonal changes
• Pelvic exam by your healthcare provider
• Cervical changes or irritation of the cervix
• Infection.

Brown spotting during pregnancy first trimester

For many women, some drops of blood in the first trimester are simply due to implantation bleeding.

Implantation bleeding may occur 6-12 days after the fertilized egg implants and cause spotting in early pregnancy.

In many cases, women aren’t aware they’re pregnant when this occurs.

Implantation bleeding can take some time to travel from the uterus to the outside, so it might appear brown or rust coloured. The colour is due to the blood being old.

Spotting during second trimester

Sometimes there is light spotting that isn’t related to a specific time. There’s an increased blood flow in pregnancy, so a few drops of blood (or sometimes a bit more) is often benign.

Possible causes for bleeding in the second trimester might be:

• Pelvic exam by your practitioner
• Sexual intercourse
• Changes in, or irritation of, your cervix
• Infection
• Cervical polyps
• Ovarian cysts or fibroids
• Miscarriage or preterm labour

Always speak to your doctor if you have any concerns about spotting in the second trimester.

Spotting during third trimester

Some spotting later in pregnancy may indicate your cervix is ripening, or softening, as it prepares for labour.

Other considerations are:

• Cervical insufficiency
• Internal exams
• Preterm labour
• Changes in your cervix
• Placenta issues, including placenta previa, low-lying placenta, and placental abruption.

Although a low-lying placenta most often moves during your pregnancy, placenta previa requires closer monitoring.

Placental abruption is an emergency, usually accompanied by heavy bleeding.

Contact your midwife or doctor immediately if you experience bleeding like this in late pregnancy.

What should I do if I start spotting during pregnancy?

If you notice any light bleeding during pregnancy, it can be helpful to put on a panty liner.

You’ll be able to see whether the spotting continues, or whether it turns into bleeding, (when you need to use and change a sanitary pad within an hour).

Things to consider:

• Whether you recently had intercourse
• How many days it has been since ovulation
• Whether you had an internal exam recently.

Make an assessment of the blood colour: bright red indicates new blood, and dark brown suggests old.

When should I be concerned about spotting?

It’s a good idea to mention any light bleeding to your midwife or ob-gyn.

It’s rarely necessary to contact them after hours for some simple spotting.

If you don’t have any pain or other symptoms that cause concern, and your spotting doesn’t increase in frequency or amount, the spotting isn’t likely to be an emergency.

Although many worry about the possibility of a miscarriage, most people continue to have a normal pregnancy and a healthy baby.

Call your doctor or midwife as soon as possible if:

• Your spotting becomes bleeding (especially in the second and third trimester)
• You are cramping or leaking fluid
• You have abdominal pain or cramping
• You have pain or irritation when you urinate
• You are feeling uneasy.

You should seek medical attention immediately if the spotting is accompanied by severe localised pain, as this can be a sign of a rare but serious concern, ectopic pregnancy.

An ectopic pregnancy is when the embryo implants outside of the uterus, most commonly in one of the Fallopian tubes.

According to this study, some main risk factors are: a history of pelvic inflammatory disease; smoking; and previous ectopic pregnancies.

You should also call your practitioner if you experience heavy bleeding or if you soak through a pad in less than 1 or 2 hours.

How much spotting is ok during pregnancy?

In many cases, light spotting or bleeding in early pregnancy isn’t a concern and nothing needs to be done.

Your healthcare provider will ask you about your recent activities and symptoms.

If you have had an internal exam or sexual intercourse in the last day or two, bleeding might occur, due to cervical irritation.

In this case, a wait and see approach is taken.

If you experience spotting every time you have intercourse, your provider might recommend pelvic rest (nothing in the vagina). Or they might reassure you it’s simply a common pregnancy ailment.

If you’re experiencing any pain or discomfort, especially with urination, your provider might do a urine sample and vaginal swab.

Your provider might want to do a pap smear or speculum exam to visualise your cervix and take a sample, to test for infection.

You might be checked for other infections, such as a urinary tract infection, bacterial vaginosis, or a yeast infection.

Spotting that occurs frequently and without any known triggers might be a hormonal concern. Your health care provider might want to do some lab work to check your hCG and progesterone levels.

This can give them an idea of the cause.

If your progesterone levels are borderline low, they might prescribe progesterone supplements.

If your hCG levels or progesterone levels are off, the test might be repeated a few days later, to see how your pregnancy is progressing.

Regardless of your gestation, an ultrasound might be indicated.

During an ultrasound, a sonographer will check your placenta, your cervix, and your baby, to see if there’s a cause for the bleeding.

The next course of action will depend on the results.

Does spotting mean miscarriage?

Light bleeding during pregnancy is quite common and, for most women, little investigation or treatment is necessary.

Pregnancy is nine months long, so it’s likely many mothers-to-be will experience some spotting or light bleeding during that time.

Outside of pregnancy, many women occasionally experience spotting, often from urinary tract infections or cervical irritation.

To be on the safe side, be sure to call your doctor or midwife about any vaginal bleeding during pregnancy.

Although miscarriage is, unfortunately, a possibility of pregnancy, spotting does not always mean there is a cause for concern.

Many women who experience spotting during pregnancy go on to have a healthy pregnancy and full-term newborn.