When Moms-to-be Should Worry? – Spotting During Pregnancy

When Cynthia Corona from San Jose, Calif., contacted a Pregnancy Today site expert about her light spotting, she was, as she says, “freaking out.” Her spotting had been intermittent, just some pink and brown on the toilet tissue, but she was terrified of losing the pregnancy. An ultrasound a few weeks later calmed her fears. Not only was she still pregnant, but she was expecting twins. The spotting turned out to be just her body’s way of adjusting to a twin pregnancy.

Although very scary, especially for a first-time mother-to-be, spotting is fairly common in pregnancy, especially during the first trimester. What can ease a woman’s fears is understanding the reasons for spotting and knowing what action she should take.

Signs and Symptoms

When a woman finds anything that even remotely resembles blood when she’s pregnant, her first thought is usually of miscarriage. But according to Dr. Aneema Van Groenou, a staff physician at Kaiser Permanente in Hayward, Calif., and the author of The Active Woman’s Guide to Pregnancy: Practical Advice for Getting Outdoors When Expecting (Ten Speed Press, 2004), a miscarriage generally has some pretty specific symptoms associated with it aside from just spotting.

“Some people do spot during a typical pregnancy, especially in the first three months as your body adjusts to the hormone levels,” says Dr. Van Groenou. “It commonly happens around the time your period would be due. Sometimes people don’t even realize they’re pregnant because they bleed right on schedule.”

The first thing to do if you notice spotting is to call your doctor. Dr. Van Groenou says doctors will ask a series of questions to determine the severity of the problem, such as the following:

  • What color is the blood? Red means it’s fresh; brown means it’s old.
  • Are there clots or tissue?
  • Is there pain? Where and how bad?
  • Is there fever?
  • Did the spotting begin after intercourse or is there pain with intercourse?
  • Have you spotted previously in this pregnancy?
  • Have you already had an ultrasound that determined the pregnancy was in the uterus?

If the answer to the last question is “no,” Dr. Van Groenou’s first step is to schedule an ultrasound because, though rarely, bleeding during pregnancy is a symptom of an ectopic pregnancy, which can be dangerous to the health of the mother.

Bleeding in the First Trimester

An ectopic pregnancy is unusual, but once it’s ruled out your doctor will try to determine the reasons for the bleeding. Dr. Lonnie Smucker, a family practitioner who practices obstetrics at Providence Portland Medical Center in Portland, Ore., says sometimes the spotting has nothing to do with the pregnancy at all; it’s just a coincidence and is caused by a friable cervix, or a cervix that happens to bleed easily.

Dr. Smucker notes that other non-pregnancy-related reasons for spotting include the following:

  • Yeast infection
  • Urinary tract infection
  • Bacterial vaginosis
  • Hemorrhoids

There are also times when bleeding is related to the pregnancy but is not necessarily a serious problem, such as subchorionic hemorrhage, which sounds serious, but is just a small clot that causes bleeding and then dissolves away harmlessly. Very rarely, this can cause miscarriage. Your doctor will keep an eye on it until it disappears. Other pregnancy-related causes for spotting that are either easily treated or will resolve themselves are unstable hormones and cervical infections.

Sometimes, unfortunately, spotting in early pregnancy does indicate a miscarriage is taking place. Usually, a miscarriage is characterized by bright red bleeding with cramping pains. Painless bleeding is probably due to another cause.

Both Drs. Van Groenou and Smucker emphatically note that early miscarriages are never the fault of the mother or caused by anything she did. There is also virtually nothing that can be done to stop a miscarriage that occurs very early in the pregnancy, although sometimes rest may help.

“What I like to remind women is that miscarriage occurs in about 40 percent of all pregnancies, and the large proportion of those occur in the first five weeks or so,” says Dr. Van Groenou. “The vast majority of those women will go on to have a healthy pregnancy.”

Bleeding Later in Pregnancy

While bleeding in early pregnancy is often benign and resolves itself easily, bleeding in the second and third trimesters, especially if there has been no history of bleeding up to that point, should be taken more seriously. Any bleeding during the second and third trimesters should be immediately reported to your doctor. Some causes are listed below:

  • Placental abruption: When the placenta starts to separate from the uterus. This typically happens due to trauma such as a car accident or a fall and is definitely considered an emergency.
  • Incompetent cervix: A cervix that starts to open up early, which can be a cause of recurrent, late miscarriage. This needs to be evaluated and treated by a high-risk obstetrician.
  • Placenta previa: With this condition, the placenta begins to cover the cervix. Bleeding is usually painless and often occurs after intercourse or exertion. If you are diagnosed with this condition you will be monitored very closely and may be watched in the hospital, depending on the severity of your condition.
  • Mucous plug: As you get closer to labor and delivery, spotting may be a sign you have passed your mucous plug, which is an early sign of labor.

Regardless of the amount of bleeding and whether or not other symptoms are present, always contact your doctor if anything changes with your pregnancy or if you’re concerned about anything. “If my patient is concerned I want her to call me,” says Dr. Smucker. “My job isn’t just to examine her on a schedule; it’s to answer her questions and give her the information she needs. I want to make sure [she’s] comfortable.”

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