Spotting during pregnancy: What it may mean and what to do about it

Pregnancy comes with many new and exciting moments, like hearing your baby's heartbeat for the first time or feeling their first kick. But it can also come with some anxiety, worries and questions—especially if you see blood.

"'Spotting' refers to having a few drops of blood present in your underwear or occasionally when wiping after using the bathroom," says Nicole Haslett, DO, an OB/GYN specializing in gynecologic and obstetric services at Main Line HealthCare OB/GYN in Blue Bell. "There's not enough blood to cover the surface of a panty liner, and there isn't enough to soak through to your clothing."

You should always contact your obstetrician-gynecologist (OB-GYN) or pregnancy healthcare provider if you see any amount of blood during your pregnancy, but just know that spotting isn't usually concerning.

Here are some causes of spotting during pregnancy and what to do about it if it happens.

Possible causes of spotting in early pregnancy

In the first trimester, and especially in very early pregnancy, spotting can be normal. Somewhere between 15 to 25 percent of pregnant women will experience some bleeding (mostly limited to spotting) during this time.

A few reasons you might experience spotting include:

Implantation

Implantation refers to a fertilized egg burrowing into the lining of the uterus. This process can cause spotting and usually happens one to two weeks after fertilization (when the egg and sperm join).

Cervical changes

The hormonal changes that occur in the first few weeks of pregnancy cause more blood vessels to develop in the cervix (the lower end of the uterus). This makes it more likely for the cervix to bleed and for spotting to occur after sexual intercourse, Pap smears, pelvic exams or vaginal ultrasounds.

Threatened miscarriage

A threatened miscarriage (or threatened abortion) occurs when there is vaginal bleeding and/or spotting but the cervix remains closed and the pregnancy is still viable (meaning the baby can still be born and has a chance at survival). Sometimes, the spotting leads to more bleeding and miscarriage. But most of the time, women with spotting due to a threatened miscarriage go on to have a healthy pregnancy.

Ectopic pregnancies

Ectopic pregnancies are a serious, potentially life-threatening cause of spotting during early pregnancy. If a fertilized egg implants and begins to grow in a fallopian tube (one of two narrow tubes extending from the ovaries to the uterus), it can cause the tube to burst open inside your body. This can lead to internal bleeding and possible shock/death.

"If caught early, ectopic pregnancies can be treated with medication instead of surgery. If you think you may be pregnant but have not yet had an ultrasound showing that your pregnancy is "normal" (implanted in your uterus) and you experience spotting, contact your provider as soon as possible to make sure the pregnancy isn't ectopic," says Dr. Haslett.

Early pregnancy loss (miscarriage)

This type of loss refers to a pregnancy that is lost before 13 weeks. Signs include bleeding and cramping, so pay attention to if the amount of blood you see increases noticeably. Early pregnancy loss occurs in roughly 10 out of 100 known pregnancies.

Possible causes of spotting in later pregnancy

About one in 10 women experience vaginal bleeding during their third trimester of pregnancy. As with bleeding/spotting at any point in pregnancy, contact your OB-GYN or healthcare provider if you experience spotting in late pregnancy. If your provider isn't available and you experience bleeding in late (second or third trimester) pregnancy, head safely to the nearest hospital.

As your pregnancy progresses to the second and third trimesters, here are some possible causes of spotting.

Cervical growths/polyps

Cervical polyps are benign (harmless) growths in women of child-bearing age that are thought to occur due to fertility-related hormonal changes. During pregnancy, the increased blood flow to the cervix and the pressure of the growing baby may cause these polyps to bleed more easily, leading to visible spotting.

Sexual intercourse and pelvic exams

Later in pregnancy, the increased pressure and blood flow to the cervix can cause spotting, especially following sex and pelvic exams.

Labor/preterm labor

Labor may begin with light spotting and the loss of your mucus plug (the thick clump of mucus that seals a pregnant woman's cervix shut until it's time to deliver). You may also experience abdominal cramping, regular and/or frequent contractions and pelvic pressure in this case.

If labor occurs before 37 weeks gestation, it's considered preterm. Regardless of whether you are full- or preterm, contact your OB-GYN if you believe you are in labor.

Staying in touch with your healthcare provider

"While spotting may be normal and is common in pregnant women, it's wise—and sometimes comforting—to keep in contact with your OB-GYN regarding any bleeding in pregnancy," says Dr. Haslett. "Be prepared for your provider to ask relevant questions, such as how much blood there is, the color (e.g. brown or bright red) and when the spotting began."

Spotting is often normal and doesn't require treatment. Other times, your provider may recommend treatments such as bed rest or pelvic rest (not putting anything in the vagina and, sometimes, avoiding sexual activity in general).`

If you're concerned about your spotting or have any further questions, don't hesitate to reach out to your OB-GYN or medical provider. Understanding the potential causes of spotting during early and late pregnancy can empower you to be an active, informed part of your healthcare team and help ensure excellent pregnancy care.

Next steps:

Make an appointment with Nicole Haslett, DO
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