Spotting During Pregnancy: What You Need to Know About Bleeding

Chrissy Teigen’s experience ended in a tragic loss but not all bleeding in pregnancy is bad. Dr Sam Hay explains what you need to know about bleeding while expecting and what is considered fine and when to go to the doctor for a check-up.

Getting pregnant can be one of the most unbelievable achievements for any couple. Joy and a future of happiness awaits.

But as every parent will tell you, not a day goes by during pregnancy without that little bit of fear that something could go wrong. And of all the possible signs that could be given, some bright fresh blood is sure to be the worst.

Now it’s one thing for me to say that for the greatest majority of mums, the greatest majority of times, we don’t need to panic about a little bit of blood. But I’m also a realist, and I’ve been there myself, the first time we see some bleeding in pregnancy we think the worst.

So just what might be going on if you’re pregnant and you have some bleeding, and when do you really need to worry? 

Pregnancy spotting can cause great stress for mum-to-be. Image Source: iStock

Implantation bleed

When you first get pregnant and the little baby embryo starts growing, it’s kind of just floating around inside your womb. Eventually, it attaches and implants into the wall of the womb – the endometrium, which is the ‘lining’ that sheds every time you get your period. This isn’t an exact process, and sometimes a little bit of blood can leak, called an ‘implantation bleed’.

It’s really common, is seen as light ‘spots’, and last hours to a day. Importantly, mums won’t have significant pain or cramping.

Implantation bleeds usually occur around the time you would expect your period, which is why many mums don’t realise they’re pregnant until much later.

Miscarriage or Ectopic Pregnancy

Alright, let’s talk about the elephant in the room – miscarriage: our greatest fear.

It’s estimated that one in four-to-five pregnancies end in miscarriage. And it could even be more common as many mums miscarry before they even knew they were pregnant.

Bleeding is the most common symptom of a miscarriage. Some mums experience some cramping in the pelvis, some have no symptoms at all.

An ectopic pregnancy is one that’s developing in the wrong spot – fallopian tube, against the ovary, or anywhere in the abdomen. These are an absolute medical emergency as they can cause significant internal damage, and they present with increasing severe pelvic or abdominal pain and bleeding.

And it’s the risk of miscarriage or ectopic pregnancy that means you should have a chat with your doctor about any bleeding in early pregnancy. Your doctor will help you determine what’s simple spotting from an implantation bleed, and what needs urgent attention to exclude an ectopic pregnancy – and get you off to hospital pronto!

Before I finish, I really must give some words of reassurance. There’s basically nothing you can do to prevent a miscarriage. And if it does happen, you did nothing wrong. Look, if you had a massive bender on the party drugs or a major accident – sure, that may trigger things. But ultimately, we can only blame bad luck, the wind, the moon, the stars – things just didn’t come together well enough to grow little baby. If you experience several miscarriages your doctor can refer you to a fertility specialist to explore underlying medical or genetic factors, or other issues that may be increasing your risk.

Fast facts: miscarriages have been shown to be more common for older mums, and mums who drink more than 5 coffees a day – so cut back if that’s you.

Late pregnancy spotting

In the later stages of pregnancy, bleeding means different things. It’s certainly common to have a little bit of ‘spotting’ from time to time, as the blood vessels of the placenta can leak a little blood. But that still warrants a chat with your obstetric team.

A ‘show’

Not a Phil Collins concert.

The most common cause of bleeding late in pregnancy occurs close to labour when things start hotting up! As the cervix starts to change in preparation for baby, a little plug of mucous can dislodge, often triggering a little bleeding.

A check with your GP, midwife, or obstetrician will help put your mind at ease.

Image Source: iStock

Cervical changes

As the weeks roll on through your pregnancy, the cells lining your cervix can become fragile. Bleeding can occur, especially after sex. If your doctor has a look inside they may see harmless changes to the cervix called a ‘cervical ectropion’.

Placenta previa

The placenta is the baby’s lifeline to mum. Growing about the size of a dinner plate, it provides a connection of blood vessels between baby and mum, allowing for all the nutrients baby needs to grow. Usually, the placenta grows nice and high up the womb, but sometimes it is ‘low lying’, causing a partial or complete blockage to the cervix. This is usually picked up at the 18 week ‘morphology’ scan.

Mums with placenta previa need to be watched closely – very closely. Regular small amounts of bleeding are common, but there’s always a risk of catastrophic bleeding. The obstetric team may advise that a caesarean section is the safest delivery option for mum and baby.

Placental abruption

This terrifying condition, whilst not common (about 1 in 100 pregnancies), occurs close to the due date. It presents with intense stomach pains, but not always bleeding, and occurs because the placenta starts to peel away from the wall of the womb.

Thankfully not every case is an emergency, but mum and baby need to be monitored closely to ensure bleeding stops, and baby continues to get the oxygen and nutrients they need.

Bleeding at any stage of pregnancy needs attention, but reassuringly it’s usually nothing to panic about. Your GP or obstetric team may need to do some blood tests, a vaginal examination, or order an ultrasound to really get to the bottom of it.

Sometimes, they can’t find any cause, so they may advise a ‘watch, wait, and see’ approach. If they do, please listen to their instructions, and if pain or bleeding gets worse, then return, or head into the emergency department for a check.

If you’re worried about any of your pregnancy symptoms, please speak to your local GP for advice. 

This article is republished in KidSpot and republished on theAsianparent with permission.

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