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Bleeding During Pregnancy When to Worry about a Miscarriage

Updated on January 26, 2010

Congratulations! You're Pregnant!

20 week ultrasound photo of unborn baby girl
20 week ultrasound photo of unborn baby girl

When Bleeding Occurs During Pregnancy

A positive pregnancy test is one of the happiest days of many women's lives. You're pregnant! The beginning of a life is growing inside you! So when spotting or bleeding occurs after a positive pregnancy test, it can be one of the most terrifying things a woman endures.

There are reasons for bleeding and spotting during pregnancy and not all bleeding will end in a miscarriage.

At the time the fertilized egg implants in the uterus, there can be a small amount of bleeding. Most women experience this bleeding as a tiny amount of spotting while some will experience a heavier flow, though this is unusual. This bleeding happens a few days prior to the expected period and some women may mistake the bleeding for their period and not realize they are pregnant at first.

Approximately 20% of all pregnant women will bleed or spot during the first trimester, many of which will go on to have a healthy pregnancy. While the number of miscarriages is high - about 1 in 4 pregnancies - the majority of these losses occur at or around the expected period and most women will not realize they are pregnant before they lose the baby.

Another cause for spotting or bleeding during early pregnancy is an ectopic pregnancy. Often spotting or bleeding in early pregnancy is the first symptom of an ectopic pregnancy, followed typically by severe pain.

Understanding an Ectopic Pregnancy

Spotting or Bleeding During Pregnancy

Understanding the difference between bleeding and spotting can make a big difference in understanding the risks to the pregnancy.

Spotting is light, does not require the use of a pad or panty liner, and can be pink, brown or red. Pink or brown spotting is a sign of old blood. Bright red spotting can occur when there is fresh blood making its way out of the body.

Bleeding is often qualified as "like a period" and requires a pad or liner to protect underpants. Bleeding like a period indicates an active bleed spot either at the cervix (irritated cervix from recent intercourse or an exam for example) or in the uterus (which would indicate a threatened miscarriage).

Heavy bleeding accompanied by cramps and possibly clots is a huge red flag for a miscarriage. While some spotting may be normal during pregnancy, and some cramping is considered normal during pregnancy, the occurrence of bleeding/spotting and cramping at the same time can be a concern.

Symptoms of a miscarriage can vary from one person to the next, and from one miscarriage to the next. Typically a miscarriage will include painful cramping and heavy bleeding with clots. Some miscarriages, though, can include mild cramps and spotting.

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Miscarriage and Stillbirth

When a baby dies before 20 weeks gestation, it is called a miscarriage. In a spontaneous miscarriage, where the body expels all tissue matter and no medical intervention is required, it is also called a spontaneous abortion.

When a baby dies after 20 weeks gestation, it is called a stillbirth. Still births are much less common than miscarriages, and symptoms include bleeding and decreased fetal movement.


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