What should I do if I notice spotting or bleeding when I'm pregnant?Call your doctor or midwife right away, even if the bleeding seems to have stopped. While it may turn out to be something minor, it could be a sign of a serious problem. You'll probably need an exam to make sure you and your baby are fine and to rule out any complications.
If you're actively bleeding or have severe pain of any kind and can't immediately reach your practitioner, head straight for the emergency room.
How is spotting different from bleeding?Spotting is very light bleeding, similar to what you may have at the very beginning or end of your period. It can vary in color from pink to red to brown (the color of dried blood).
What can cause spotting or bleeding?It's not always possible to determine the cause of prenatal spotting or bleeding. Because the blood supply to your cervix and pelvis has increased, it's not unusual to notice spotting after a Pap smear, an internal exam, or sex. Some other culprits include:
Implantation bleeding You may have some light spotting for a day or two at about the time when the fertilized egg burrows into the wall of your uterus. This is a process that starts just six to seven days after fertilization, so you wouldn't even know you were pregnant yet.
Miscarriage or ectopic pregnancy Spotting or bleeding can be an early sign of miscarriage or an ectopic pregnancy, especially if accompanied by abdominal pain or cramping. (Bleeding can also signal a molar pregnancy, a relatively rare condition in which abnormalities in the fertilized egg at conception make it impossible for the embryo to develop or survive.)
Up to a quarter of pregnant women have some spotting or bleeding in early pregnancy, and about half of these women miscarry. But if you have an ultrasound that shows a normal heartbeat between 7 and 11 weeks, your chances of continuing the pregnancy are greater than 90 percent.
Infections Spotting can also be caused by conditions unrelated to pregnancy. A vaginal infection (such as a yeast infection or bacterial vaginosis) or a sexually transmitted infection (such as trichomoniasis, gonorrhea, chlamydia, or herpes) can cause your cervix to become irritated or inflamed. An inflamed cervix is particularly prone to spotting after sex or a Pap smear. You may also spot or bleed after sex or a Pap smear if you have a cervical polyp (a benign growth).
Placental problems or premature labor In the second or third trimester, bleeding or spotting can be a sign of a serious condition such as placenta previa, placental abruption (in which the placenta separates from the uterus), a late miscarriage (between 13 weeks and midpregnancy), or premature labor (between midpregnancy and 37 weeks).
Even first trimester bleeding may be a sign of an underlying problem with the placenta. Research shows a link between early pregnancy bleeding and an increased risk of later complications, such as preterm delivery or placental abruption, particularly if the bleeding is heavy.
Normal labor A mucus discharge that's tinged with blood after 37 weeks is most likely just a sign that the mucus plug has dislodged and the cervix is beginning to soften or open in preparation for labor. You should still report any other bleeding or spotting at this point to your practitioner.
Note: If your blood is Rh-negative, you'll need a shot of Rh immune globulin if you have vaginal spotting or bleeding unless you know for sure that the baby's father's blood is also Rh-negative or it's clear that the bleeding is not coming from the uterus.