Bleeding and Spotting While Pregnant: What's Normal, What's Not

If you're five weeks pregnant and bleeding bright red, you may be feeling worried since bleeding in pregnancy can indicate a miscarriage. But, there is more than one possible reason for bleeding during early pregnancy. For instance, it's common for a small percentage of pregnant people to have spotting after intercourse, and others may experience bleeding for reasons that have nothing to do with pregnancy, such as infections or tears to the vaginal wall.

Though often worrying, bleeding from the vagina during pregnancy is actually quite common, especially during early pregnancy. The good news: Spotting or light bleeding in early pregnancy that's not heavy like your menstrual period, occurs for nearly one-third of all parents-to-be and often poses no threat to the pregnant person or baby.

"The vast majority of spotting is harmless," says Alyssa Stephenson-Famy, M.D., Maternal-Fetal Medicine Specialist at the University of Washington, Seattle. But since bleeding, no matter how scant, can be indicative of a variety of complications, including miscarriage, ectopic pregnancy, and placenta previa, it shouldn't be ignored. Plus, it can be pretty unnerving to experience, so you should know you can always reach out to your doctor or midwife when you are having any symptoms you're unsure about it.

Learn about the various reasons you may experience bleeding while pregnant, when to know whether you should call your doctor, and tips for effectively communicating your symptoms to your health care provider.

Pregnancy Bleeding Before 20 Weeks

Doctors estimate that 25% to 40% of pregnant people will experience some kind of vaginal bleeding during early pregnancy, and more often than not, the pregnancy will progress totally normally, Dr. Stephenson-Famy says. There are a number of possible benign causes of spotting or bleeding in the first half of pregnancy, including:

• Implantation bleeding: After fertilization, pregnancy officially begins when the egg implants in the lining of the uterus. Sometimes this process causes a small amount of spotting or bleeding, known as implantation bleeding, and it's nothing to worry about. If you notice a small amount of bleeding about a week to 10 days after ovulation (around the time of your missed period), implantation is likely the cause.
• Sexual intercourse: During the second and third trimesters, your cervix becomes swollen because of the increased blood supply in the area. As a result, vaginal penetration—whether with a penis, finger, or toy—may cause some light spotting during pregnancy.
• Infections: Some people can experience cervical bleeding because of an infection like chlamydia. In these cases, the underlying condition needs to be treated, so you will most likely need antibiotics from your doctor.
• Internal exam done by your obstetrician or midwife: 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.

Sometimes bleeding during the first half of your pregnancy can be a sign of a more serious condition, however, such as:

• Subchorionic hemorrhage: Subchorionic hemorrhage is bleeding around the placenta. Although it is possible to continue with a healthy pregnancy after this type of bleeding occurs, prompt diagnosis and treatment are vital. "Most subchorionic hemorrhages resolve, but it does put the woman at an increased risk for other complications such as preterm labor," Dr. Stephenson-Famy says.
• Chemical pregnancy: A pregnancy is referred to as a chemical pregnancy when an egg is fertilized but never fully grows and develops. You can still get a positive pregnancy test, but chemical pregnancies result in a very early miscarriage, sometimes even before a missed period.
• Miscarriage: Miscarriage is the general term for the spontaneous loss of a pregnancy in the first 20 weeks. Often, the bleeding or spotting that occurs during a miscarriage (either threatened or imminent) will be accompanied by other symptoms, such as cramping or abdominal pain.
• Ectopic pregnancy: Ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus, most often in a fallopian tube. It often causes bleeding. Sometimes called a tubal pregnancy, an ectopic pregnancy cannot progress normally and may be life-threatening to the pregnant person if left undiagnosed and untreated.
• Molar pregnancy: A molar pregnancy is a nonviable pregnancy that develops into a non-cancerous tumor in the uterus. Vaginal bleeding is a symptom of a molar pregnancy.

Pregnancy Bleeding After 20 weeks

Although the risk of pregnancy loss (known as stillbirth after the first 20 weeks) diminishes greatly after the first trimester, and many of the early complications are no longer a factor (such as ectopic and molar pregnancies), bleeding during the second half of pregnancy should be taken seriously, especially if it's ongoing, Dr. Stephenson-Famy says.

Causes for vaginal bleeding in the second half of pregnancy include:

• Sexual intercourse
• Cervical checks, especially late in the third trimester when they commonly become more frequent
• Placenta previa, which is when the placenta covers the cervix either partially or completely
• Placental abruption, which is when the placenta starts to come away or fully comes away from the wall of the uterus
• Preterm labor, in which vaginal bleeding is accompanied by cramping or contractions, diarrhea, pelvic pressure, or back pain before 37 weeks, could have serious repercussions for the baby if not managed. After 37 weeks, these symptoms could be a normal start to labor.

When Is Bleeding During Pregnancy Serious?

Vaginal bleeding during pregnancy isn't uncommon and doesn't always mean something is wrong. When determining the seriousness of the bleeding you're experiencing, it's important to pay attention to the qualities of the bleeding and other symptoms that accompany it, such as:

• Pain
• Any cramping or contractions
• How heavy the bleeding is
• If the bleeding is getting worse
• If there is any fluid or other discharge
• If you have a fever
• The color of the blood (such as bright red vs. brown or pink)

When to Call Your Doctor About Bleeding During Pregnancy

The answer to this is: always. If you're experiencing any bleeding during pregnancy (and especially if you have other symptoms, such as a fever, cramps, or pain), call your doctor or midwife right away to be safe, as any vaginal bleeding during pregnancy can be a symptom of a larger problem. Even if there is nothing to worry about, consulting your health provider can still give you reassurance and prepare you for the next steps.

When you do call your doctor, be prepared to answer detailed questions about the amount of blood you've lost, its color and consistency, and a description of how you're feeling overall, advises Laura Riley, M.D., author of Pregnancy: Your Ultimate Week-by-Week Pregnancy Guide. Your doctor will decide whether there's a cause for concern.

What to Expect After You Call Your Doctor

After you call your doctor or midwife about bleeding during pregnancy, a few different things might happen. They may want to simply monitor the situation or they may want you to come in to the office or go to the hospital for further evaluation. You may need an exam or an ultrasound to see what's going on with the fetus

Dr. Riley says you should insist on being seen if you have any vaginal bleeding that makes you feel faint or soaks through a sanitary pad. You should also be seen if the bleeding is persistent or accompanied by pain or a fever.

The next steps will be dedicated to figuring out the cause of the bleeding and treating it, if necessary. For example, if the bleeding is from an infection, antibiotics may be prescribed to treat it.

If the bleeding is due to placenta previa—a condition in which the placenta covers the bottom of the uterus—then your doctor may put you on modified bed rest. They will 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 pregnant people with placenta previa often bleed in the third trimester. If this is the case, the C-section may be done earlier.

If you're having bleeding as 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 an active or otherwise imminent miscarriage, on the other hand, your doctor may be able to offer you support and some options for what comes next, but there is no treatment for stopping a miscarriage.