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Spotting or bleeding in early pregnancy

Updated on September 5, 2015
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The author is a midwife and a nurse, and has been working with women and newborn babies since 2003. B.sc. in Nursing, Cand.Obst in Midwifery

Early bleeding is usually harmless

Bleeding in a pregnancy can be an unnerving event and it can put your emotion roller-coaster on full speed. The first thing you need to know is that bleeding in pregnancy is very common and is in most cases not an indication of a miscarriage.

Recent studies show that a little bleeding lasting 1-2 days is usually harmless and does not have an effect on the outcome or health of the baby. (Association Between First-Trimester Vaginal Bleeding and Miscarriage)

In this hub I will try to clarify the different types of bleeding in early pregnancy and explain some of the common language midwifes and doctors use when they ask you about your symptoms.


What is a bleeding during pregnancy

  • Bleeding is a bloody discharge from you vagina.
  • It can be faint, pink, red and brown.
  • The amount can vary from a few drops to cups. To explain over the phone you can use visual measurements of the blood stain. For example like a small coin, could fill a teaspoon, a tablespoon or a small cup. You can also describe the amount over time, how many hours does it take to stain or fill a sanitary pad.
  • Be sure to notice that the bleeding comes from the vagina before you contact a midwife or a doctor, because blood can also come from your behind if you are having hard bowel movements and/or haemorrhoids.

Bleeding can be associated with cramps

by James Palinsad
by James Palinsad | Source

Where does the bleeding come from

The causes for a bleeding are various. The most common source of bleeding is from the vagina wall or the inner lining. When you get pregnant, the body changes the flow of the bloodstream and the small arteries or capillaries get filled with blood. That’s why it’s more likely to have some bleeding in areas with mucosa like the mouth and the vagina. Only small irritation can cause a small bleeding, some of them you notice and some you don’t. This is the reason for most post-sex bleeding for example. This type of bleeding is harmless and will be a small amount, 1-2 tablespoons the most, and is most likely faint, pink or brown.

The most common time for women to have a small bleeding, is around the time they should be expecting to get their period, or around 4-5 weeks of pregnancy. This is called implantation bleeding.

A bleeding from the cervix is also common. The cervix is located deep inside the vagina, a tube shaped organ that will get thinner and dilate when the baby is born. The cervix like the uterine lining is rich in blood flow during pregnancy and can bleed after irritation like after an examination and sex.


Causes for moderate or heavy bleeding

In some women the cervix or the endometrial lining of the vagina can have small growths called polyps, which rupture easily and cause some blood to be shown. It is totally benign in most cases, even though the amount of blood can be alarming. The only way to know if you have polyps is during a vaginal examination of a midwife or a doctor.

When the cervix starts to dilate, there will also be a bloody show. A dilated cervix early in pregnancy is a sign of threatened or imminent miscarriage. For women with repeated miscarriages because of cervical opening it can be possible to get a cervical cerclage (stitches) that closes the cervix temporarily. The state of the cervix can be examined by with a transvaginal ultrasound equipment that most OB/GYN have in their practice and in hospitals.

  • A definite sign of miscarriage would be heavy cramps that don’t go away with rest, bleeding that continue through the day and night filling a sanitary pad in a few hours and then a sight of tissue or clots of blood passing.

Source

How to react ?

  • If you experience a small bleeding, a few drops of red or some brownish discharge, no reaction is needed. It might be a sign to slow down a bit, take a day off work, house chores and exercise. It’s important to listen to your body when pregnant, rest and re-evaluate the next day.
  • If the bleeding is constant and small, light or brown, with no or mild cramps it might be wise to contact your caregiver in a few days if the bleeding is still coming.
  • If the bleeding is moderate and you are having bad cramps, a miscarriage is possible. In the first trimester there are no methods to stop a miscarriage when it is happening. The only thing to do is rest and see what happens.

Advice on early bleeding from NHS

How to make sure everything is alright

The only way is to check if there is a heartbeat.

  • For the first 6 weeks, you will have to wait and see.
  • From the 6 week of pregnancy (6 weeks since the start of your last menstrual cycle) you can see the heartbeat in transvaginal ultrasound at the OB/GYN office.
  • From the 8 week a heartbeat can be seen on a regular ultrasound.
  • From week 10-12 it might be possible for your midwife to hear heartbeat with a doppler.

These are rough estimates, and can be different between practices.

Contact your midwife, doctor or hospital as soon as possible if:

  • The bleeding is heavy and seems to be increasing over time (a sign of incomplete miscarriage)
  • You have bad cramps on one side of your stomach that don’t go away with rest, with bleeding or not (a sign of ectopic pregnancy)
  • If you get a fever and chills (a sign of infection)
  • If you get unusually tired, dissy, stiff stomach or pain in your right shoulder (signs of blood loss and internal bleeding)

A few last words from me to you

In the end, pregnancy is a roller coaster ride of emotions. Thankfully most of the times, these worries are only that, worries. Its normal to be a little anxious for the life you carry. On the other hand, when we get hints or signs that something is wrong, its important to listen. Slow down a little bit, rest in the middle of the day and cut down on stress. Ask your family and friends for help with your kids or other chores and take good care of yourself.

When the alarming bleeding is indeed a sign of miscarriage, you have a choice. If the cramps are bearable, the bleeding is moderate and you can see that the embryo or fetus is gone, you don't have to get examined. On the other hand, most women do seek help with a professional, to make sure they are ok and to get advice on how to continue. A loss of pregnancy can be difficult and for many it is a loss of the child that could have been and should be respected as such. Seek help from your loved ones, your spiritual guide or a health professional.

© 2015 Harpa Ósk

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