Bleeding During Pregnancy: Causes, Diagnosis And Treatment

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Spotting when pregnant or vaginal bleeding during pregnancy is common, especially during the first and late third trimesters (1). This event could occur due to different factors and usually does not imply a serious issue, especially in the first trimester. However, bleeding later in pregnancy may have a more severe underlying cause (2).

This post discusses the difference between vaginal bleeding and spotting, the various causes of vaginal bleeding during different trimesters, and how it can be diagnosed and treated in pregnant women.

What Is The Difference Between Vaginal Bleeding And Spotting During Pregnancy?

During the early stages of pregnancy, you may experience some light bleeding, known as spotting, where a few drops of blood may appear on your underwear occasionally. It is not enough to cover a panty liner.

Bleeding is a heavier flow of blood, necessitating the use of a sanitary pad or pantyliner to prevent your clothes from becoming soaked in blood (1) (3).

Moreover, heavy bleeding episodes (as heavy as or heavier than normal period flow) are more likely to cause pain, be of a longer duration, have bright red blood, and occur multiple times. Meanwhile, spotting episodes are more likely to occur in isolation, be of shorter duration, and be painless (4).

What Are The Causes For Bleeding In Pregnancy?

The underlying cause of vaginal bleeding during pregnancy may or may not be serious and can differ in various trimesters.

Bleeding in the first trimester

During early pregnancy or the first trimester, bleeding or spotting is common with an incidence rate of one in four pregnant women (up to 25%) and may occur due to the following factors (1) (2) (3) (5).

  • Implantation (when the fetus plants itself in the uterine wall)
  • Sexual intercourse
  • Pregnancy-related hormonal fluctuations
  • Normal changes in the cervix
  • Pap test
  • Pelvic exam by your obstetrician
  • Genetic testing procedures, such as amniocentesis or chorionic villus sampling (CVS)
  • Smoking

However, bleeding and spotting during early pregnancy may also be a sign of the following serious conditions (1) (3) (4) (6).

  • Pelvic cavity or urinary tract infections
  • Ectopic pregnancy (pregnancy outside the uterus) can be fatal if left untreated
  • Threatened miscarriage or miscarriage (pregnancy loss)
  • Molar pregnancy (where tissue grows inside the womb instead of a fetus)
  • Subchorionic hemorrhage or hematoma (bleeding between the uterus wall and placental membrane)

Bleeding in the later stages of pregnancy

In the later stages of pregnancy, you may experience light bleeding because of the following reasons (1).

  • Sexual intercourse
  • Labor (in the third trimester)
  • An internal examination by your obstetrician
  • Growths on the cervix or cervical infections or inflammation

However, heavy bleeding in the later stages of pregnancy may be due to serious conditions, including (1) (2) (5):

  • Preterm labor (labor starts before 37 weeks of pregnancy)
  • Placenta previa (the placenta lies too low in the uterus and covers the cervix)
  • Placenta accreta (the placenta grows too deeply into the uterus wall and does not detach)
  • Placental abruption (the placenta detaches from the uterus wall before/during birth)
  • Uterine rupture during labor
  • Vasa Previa (the umbilical cord blood vessels pass through the cervical membranes)

When To Call A Doctor?

If you experience bleeding or spotting while pregnant, it is recommended to visit your doctor. However, contact your doctor soon if you experience (1) (6):

  • Heavy bleeding
  • Bleeding with cramps or pain
  • Bleeding and dizziness (lightheadedness)
  • Abdominal pain or pelvic pain with bleeding
  • Bleeding in the second or third trimester of pregnancy

How Are The Causes Of Vaginal Bleeding Diagnosed?

Even if your vaginal bleeding has stopped, contact your healthcare provider for a diagnosis. Your doctor may inquire about any other symptoms you may be experiencing with bleeding. Additionally, they may suggest the following tests (5).

  • Vaginal or pelvic examinations
  • Ultrasonography
  • Human chorionic gonadotropin (hCG) blood testing to measure the hormonal level

How Is Vaginal Bleeding During Pregnancy Treated?

Vaginal bleeding is treated depending on its underlying cause and severity. If your symptoms and bleeding are not severe, or your due date is far, you may be asked to closely monitor yourself at home. In severe circumstances, your doctor may suggest hospitalized observation. You may be required to stay overnight or until your baby is born so that you both can receive immediate medical attention (5).

Usually, adequate rest is sufficient to treat the condition. Other treatment options may include (1) (7):

  • Taking some time off from work
  • Staying off your feet for a little while
  • Avoiding sex
  • Not douching (using vaginal cleansing products) or using tampons
  • Taking a folic acid-fortified prenatal vitamin
  • Abstaining from smoking, consuming alcohol, and using illegal drugs
  • Surgery, in case of heavy bleeding due to serious complications

Frequently Asked Questions

  1. Is vaginal bleeding a symptom of pregnancy?

Yes, vaginal bleeding is a common symptom of early pregnancy. You may experience light bleeding (spotting) 1–2 weeks after fertilization when the egg implants in the uterus, also known as implantation bleeding.

  1. Can an orgasm cause vaginal bleeding when pregnant?

According to the American College of Obstetricians and Gynecologists (ACOG), spotting and cramps are normal after having sex or orgasm during pregnancy. Further, a study also suggests that orgasms during late pregnancy may reduce the risk of preterm delivery (8). However, if you have heavy bleeding or persistent cramps after sex, you should contact your doctor (9).

  1. Should I worry if my vaginal discharge contains more than blood?

During pregnancy, you may experience vaginal bleeding, usually without blood clots or tissues. However, if you notice something other than blood, contact your doctor. While visiting the emergency room, it is advised to take a sample of your vaginal discharge in a small jar or plastic bag for examination. Your provider may conduct blood tests to ensure there is no pregnancy loss. However, in case you have miscarried, your doctor will provide additional care and will perform surgical procedures such as dilation and curettage (D & C) (3) (7).

Vaginal bleeding and spotting during pregnancy are common, especially during early pregnancy. However, they could be a sign of pregnancy complications. Hence, consult your doctor if you notice any bleeding or spotting, even if the bleeding has stopped. Taking adequate rest and relaxing your body can also be useful.

References:

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Reshmi Das

Reshmi Das has over three years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction. She writes health and wellness articles for children and pregnant and lactating women. Reshmi has completed her Master’s degree in Biotechnology. She is currently pursuing an Executive... more