Why Bleeding During Pregnancy Doesn't Always Mean Miscarriage

Thankfully, period-like bleeding during early pregnancy doesn't always mean the worst has happened. Here's what you should know about this common symptom and when you should see your doctor.

An image of a pregnant woman.
Photo: Getty Images.

Toward the end of your first trimester of pregnancy, you're anxiously looking forward to sharing the happy news with family and friends on social media. You're nervous, excited, and still a little bit nauseous, but you're ready to spill the beans on Baby.

And then, one morning, you wake up to discover some blood in your underwear. Your first thought is simple—and scary—does period-like bleeding during early pregnancy mean you're having a miscarriage? Thankfully, you don't always need to assume the worst. We spoke with experts to learn more.

What to Know About Period-Like Bleeding During Early Pregnancy

If you're experiencing bleeding during early pregnancy, don't panic. Yes, sometimes bleeding or spotting while pregnant can indicate pregnancy loss. However, it doesn't always mean that a miscarriage is imminent. "Bleeding can occur in a completely healthy pregnancy," explains Zev Williams, M.D., Ph.D., OB-GYN and Chief of the Division of Reproductive Endocrinology and Infertility at Columbia University Irving Medical Center in New York City. In fact, many people experience some form of bleeding, especially in the early weeks of their pregnancies.

According to an article published in the American Academy of Family Physicians, almost 1 in 4 pregnant people will experience bleeding during their first trimesters, but only about half of those cases will result in a miscarriage.

Causes of Bleeding During Pregnancy

As many pregnant people discover after visiting their pregnancy care providers, vaginal bleeding during pregnancy can be normal and is not always an immediate cause for concern. Some types of bleeding can be caused by implantation of the embryo into the uterine wall (most commonly on the day your period is due), an infection of some sort in the body, or irritation (like from vaginal intercourse).

Elizabeth Nowacki, D.O., an OB-GYN at St. Vincent Fishers Hospital in Fishers, Indiana, explains that one of the most common causes of bleeding is "lag time" before the placenta is fully formed. Before the placenta starts forming around 12 weeks, the ovary that released the egg provides the main source of hormonal support to the pregnancy. Some spotting is common before the placenta is functional. "It always seems to happen at 2 o'clock in the morning!" says Dr. Nowacki. "If it's just light spotting or spotting with wiping, it's not a big deal, and you can wait to call your doctor in the morning."

Bleeding that occurs later in pregnancy—specifically in the second and third trimester—can also have different causes that won't result in a miscarriage, such as cervical irritation or even cervical changes (such as a growth or polyp on the cervix, for example).

"Sometimes, the outside of the cervix, which connects the uterus to the vagina, can bleed or an area of bleeding can occur in the space between the placenta and the uterus, which will usually resolve on its own," says Dr. Williams. However, slight bleeding, especially if it's tinged with a mucus-like discharge, could also be a sign of early labor.

Some bleeding during pregnancy is simply unexplained; One patient I cared for in my work as a labor and delivery nurse experienced moderate bleeding, almost as heavy as her regular period flow, throughout each of her three pregnancies—with no known cause and no need for any further treatment. She delivered three full-term and healthy infants. And who among us hasn't heard the stories of women who didn't know they were pregnant because they continued to have monthly bleeding? So, bleeding that isn't a direct indication of a miscarriage can definitely occur during pregnancy.

What You Should Do About Bleeding During Pregnancy

Although bleeding may not necessarily mean a miscarriage is inevitable, sadly, it is a possibility, particularly if the bleeding is heavy, sustained, and accompanied by other symptoms of miscarriage such as abdominal pain. This is why consistent bleeding at any point during pregnancy always needs to be evaluated by a health care provider. If you're experiencing bleeding, take the following steps:

  • Call your OB-GYN or midwife to discuss your symptoms and/or make an appointment.
  • Note when the bleeding started and any activities that may have contributed to the bleeding (for instance, did you have intercourse in the last 24 hours or have a vaginal exam performed recently?).
  • Place a pad or panty-liner (never use a tampon!) for absorption and as a means to gauge the amount of bleeding. Your health care provider may ask you how quickly you're filling up a typical overnight pad as a way to determine how much bleeding you're experiencing. Also, be sure to note the color of the blood—your doctor may need to know if it's bright red or brown.
  • While waiting to be seen by your doctor, try to sit down, put your feet up, and drink a large glass of water.
  • Ask yourself if you're experiencing any other symptoms, such as contractions, back pain, nausea, vision changes, or decreased activity of the baby.

Your medical provider will assess if you are experiencing pregnancy loss, another complication, or harmless bleeding. They will provide a treatment plan if needed.

The Bottom Line

Any bleeding during pregnancy can be scary. It's normal to worry that you're having a miscarriage. Luckily, that's not always what's happening, particularly if the bleeding is light and intermittent. However, sometimes, bleeding is due to pregnancy loss. If that's the case, look for support and give yourself grace as you heal physically and emotionally. It may help to know that this heartwrenching experience is common in the early weeks of pregnancy and is unlikely to impact your future fertility.

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