Pregnancy Spotting Questions and Answers
Worried About Spotting in Pregnancy
Is It Normal to Spot During Pregnancy?
Up to 33% of pregnant mothers will experience slight bleeding during the first 2-3 months of their pregnancy. This slight bleeding is known as "spotting." Sometimes, the spotting is due to the implantation of the embryo into the uterine lining. Unfortunately, sometimes bleeding does indicate an impending miscarriage.
50% of women who have some bleeding in early pregnancy will go on to have healthy babies. The remaining 50%, unfortunately, will proceed to miscarry. Signs of abnormal bleeding in early pregnancy include heavy bleeding, blood that contains tissue and clots, or bleeding with painful cramps. Women should report all bleeding or spotting to their obstetrician, so that appropriate monitoring, ultrasounds, and blood work may be completed.
Spotting in pregnancy should always be reported to your healthcare provider. Signs of an impending miscarriage include the loss of pregnancy symptoms, cramping and bleeding, or the passage of clots. A physician will be able to perform some simple blood work and an ultrasound to determine if the pregnancy is viable, or if a miscarriage will occur.
What Causes Spotting During Early Pregnancy?
There are several normal events in early pregnancy that may trigger some spotting.
- Implantation bleeding may cause some pink or brown discharge as the embryo embeds itself into the uterine lining. This spotting may cause a few streaks of bloody discharge, but will not resemble a menstrual period in any way. Significant amounts of bright red blood should be mentioned to an obstetrician immediately. Implantation bleeding occurs approximately six days after the egg has been fertilized.
- Spotting may occur after a couple has engaged in sexual relations, as the cervix has an increased blood supply.
Sometimes spotting does indicate an impending problem in a pregnancy, particularly if the scant amount of bloody discharge turns into frank bleeding. A woman should contact her health professional immediately if there is heavy bleeding, significant cramping, or the passage of clots. Abnormal causes of bleeding in pregnancy include:
- An impending miscarriage. Early miscarriages are usually caused by genetic problems in an early embryo, though other causes (like low progesterone) may also be at play.
- A completed miscarriage. In this scenario, the miscarriage has happened and an obstetrician should be contacted to determine if a procedure called a D&C is required.
- Ectopic pregnancy. This pregnancy is usually accompanied by severe pain and is a medical emergency. A doctor's ultrasound will reveal the location of the implanted embryo: if the embryo has implanted in the Fallopian tube, abdomen, or any location other than the uterus, the pregnancy is considered ectopic.
- Blighted ovum. An ultrasound will show a sac, but no embryo. This is sometimes called a "missed miscarriage," as the woman may begin to spot several weeks into her pregnancy. Most blighted ova are caused by genetic defects.
What Causes Bleeding During Late Pregnancy?
Bleeding in the second and third trimesters is a medical emergency. There is no routine cause for bleeding in the third trimester - a woman experiencing frank bleeding should get to the nearest emergency room and call her obstetrician. The causes for bleeding in late pregnancy are different from bleeding observed in early pregnancy. The following conditions can cause bleeding in the third trimester:
- Vasa Previa: in rare cases, a baby's umbilical cord will lie over the cervix, because the cord has attached to the baby's amniotic sac rather than the placenta. This can cause the blood vessels in the umbilical cord to rupture.
- Placenta Previa: in normal pregnancies, the placenta is high in the uterus and safely away from the birth canal. In placenta previa, the placenta covers the cervix and heavy bleeding will occur when the cervix starts to dilate and efface. Most babies with placenta previa will need to be delivered by Caesarian Section.
- Placental Abruption: the placenta is normally firmly attached to the uterine wall until after the baby is born, when it detaches and is delivered as the after-birth. In some women, the placenta begins to detach prematurely, causing bleeding. A woman with a premature placental abruption will often be placed on bed rest and will be monitored very closely for the remainder of her pregnancy.
- Rupture of the uterus: this serious condition is caused when the uterus literally rips apart, and the baby is ejected from the womb into the abdomen. A woman is at higher risk of uterine rupture if she has had more than four pregnancies or prior surgery involving the uterus (including prior Caesarean Section).
Spotting in Pregnancy: A Poll
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Is Cramping Normal in Early Pregnancy?
Cramping during early pregnancy is often normal, as the uterus expands and the embryo implants into the uterine wall. As long as the cramping is slight and not accompanied by bleeding, it is likely normal. Report any cramping to a healthcare professional, as sometimes cramping can be a sign of a serious problem.
Causes of cramping in early pregnancy may include:
- Round ligament pain - the ligaments suspending the uterus are stretched and pulled as the uterus grows.
- Implantation of the embryo.
- Ovarian cysts.
- Miscarriage (if accompanied with bleeding).
Cramping with bleeding is not normal and should be reported immediately.
What is a Threatened Miscarriage?
A threatened miscarriage is diagnosed if there is bleeding in early pregnancy, but the cervix remains closed and the gestational sac (or embryo) is still visible on ultrasound. A threatened miscarriage does not mean that a miscarriage will definitely occur. It simply implies that there is an increased likelihood for a miscarriage.
A physician may order a blood test to check for beta hCG levels, which should double every 48-72 hours. If the hCG levels are increasing at the proper rate, the likelihood of a miscarriage is reduced. hCG levels that stagnate or fall, however, indicate a failing pregnancy.
Empty Gestational Sac
What is an Impending Miscarriage?
Bleeding and cramps accompanied by an open cervix generally indicate an impending miscarriage. This means that miscarriage is unavoidable, and will happen in the near future.
Women may opt to miscarry naturally, or have a procedure called dilation and curettage (D&C) performed. With a D&C, the physician dilates the cervix and manually removes any remaining tissue from the miscarriage. Most D&C's are carried out under general anesthesia, though some are performed with local anesthetic only.
Is Spotting During Pregnancy Normal?
What is an Incomplete Miscarriage?
In an incomplete miscarriage, some of the fetal tissue is expelled from the womb. Some of the tissue remains behind, and can cause a bleeding and infection risk. Women who have had an incomplete miscarriage will generally require a D&C to remove all tissue from the uterus.
A related condition, a "missed miscarriage," causes no spotting or bleeding. The embryo does not develop or dies in the womb, but is not miscarried. The death is generally found on a first trimester ultrasound. The lack of a heart beat after a certain gestational age (approximately 6 - 7 weeks, allowing for varying conception times) is usually the defining feature. Sometimes there is a blighted ovum, where the egg was fertilized but never developed an embryo at all - only an empty sac will be visualized via ultrasound.
Antibiotics may be required to prevent infection after the procedure is carried out.
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