Bleeding and Spotting During Pregnancy

Vaginal bleeding during pregnancy is not uncommon, but it's also not normal, says Chris A. Beard, a certified nurse-midwife in Portland, Oregon. It can indicate many things, depending on whether it's heavy or light, how long it lasts, what color it is, and at what point in the pregnancy it occurs. The color of the blood is also important -- blood that's bright red is usually more worrisome than blood that's brownish.

Call your doctor or midwife immediately if you have more than a dime-size spot of blood. Bleeding is a major warning sign of miscarriage, problems with the placenta, or preterm labor. Signs that bleeding is due to one of these serious conditions include heavy bleeding (similar to menstrual bleeding), bleeding in conjunction with cramps and/or fever, or bleeding and passing some tissue.

However, there are also less serious or benign causes for spotting and bleeding. Many women who spot go on to deliver healthy babies. However, even if you suspect that your spotting is not serious, you should still call your doctor.

• Recent fertilization: If you notice a small amount of bleeding about a week to 10 days after conception, it may be due to the implantation of the egg in the lining of the uterus. This is nothing to worry about.
• Pap smear: It's not uncommon to bleed after a Pap smear or pelvic exam, which in many practices is conducted between the sixth and 12th week of pregnancy. Spotting may occur within 24 hours after the visit and usually goes away within a day.
• Having sex: During the second and third trimester, your cervix becomes swollen because of the increased blood supply in the area. As a result, vigorous intercourse may cause spotting.
• Infection: Some women have cervical bleeding because of an infection, usually a sexually transmitted disease such as chlamydia. In this case, the underlying condition needs to be treated.

When you call your practitioner, she'll decide whether she's not worried at all, wants to monitor the situation by having you stay off your feet for a few hours and call back, or wants you to come in immediately. She may order an ultrasound to see what's going on with the fetus.

Unfortunately, if the bleeding is due to a miscarriage, there's nothing that can be done.

If the bleeding is a sign of preterm labor, your doctor will take steps to prevent it, possibly recommending bed rest or medication.

If the bleeding is due to placenta previa -- a condition in which the placenta covers the mouth of the uterus -- then your doctor may put you on modified bed rest. She'll probably avoid conducting an internal vaginal exam, and will probably recommend that you have a c-section when your baby is ready to be born. A scheduled c-section is usually done at 38 or 39 weeks, but women with placenta previa often bleed in the third trimester. If this is the case, the c-section may be done earlier.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.