Is bleeding in pregnancy normal? What are the causes?

By (gynecologist), (embryologist), (embryologist) and (psychologist).
Last Update: 03/10/2022

If a woman has bleeding during pregnancy, it may be a cause for concern. At the beginning of gestation, it is normal for a slight leakage to occur, called implantation bleeding, but in other situations, bleeding may indicate a problem implantation bleeding but in other situations, bleeding may be indicative of a problem.

However, it is important for the pregnant woman to know that light bleeding does not always mean that there is a serious problem. For this reason, it is important to pay attention to the characteristics, intensity, and duration of the bleeding, in order to be able to inform the specialist correctly.

Spotting or bleeding?

It is important to know how to distinguish between spotting and vaginal bleeding, as this can help the woman not to worry excessively.

Vaginal spotting presents as occasional drops of blood released from the vagina so that spots appear on the underwear. The intensity of the color is usually slight, as well as the quantity (it does not soak a sanitary pad).

On the other hand, vaginal bleeding is more abundant, intense, and continuous over time. In case of bleeding, it will be necessary for the woman to use a compress so that the blood does not soak her clothes.

Also, at this point, it is important to say that spotting or bleeding during pregnancy does not always mean that there is a problem for the pregnant woman or her baby.

Causes of bleeding during pregnancy

Vaginal bleeding or leakage usually occurs in the first trimester of pregnancy, although bleeding or hemorrhage may also occur in the second and third trimesters of pregnancy.

However, the main causes of vaginal bleeding during pregnancy may be different depending on when it occurs.

Bleeding in the first trimester

During the first trimester of pregnancy, spotting or bleeding may occur for the following reasons:

  • Implantation bleeding: this is bleeding at the beginning of pregnancy when the embryo attaches to the endometrium. The woman may bleed lightly for a short period (from a few hours to about 2-3 days intermittently) and the bleeding is usually brownish or pinkish and lighter in appearance than menstruation. This happens about 10 days after fertilization, although this bleeding does not always occur.
  • Ectopic pregnancy: occurs when the embryo implants in a place other than the mother's uterus, such as a fallopian tube. This pregnancy is not viable and may produce symptoms in the woman such as bleeding.
  • Molar pregnancy or hydatidiform mole: in this type of pregnancy, the trophoblastic tissue, which should give rise to the placenta, develops and grows abnormally and may cause bleeding during the first trimester, among other symptoms. In addition, vaginal expulsion of tissue resembling a bunch of grapes is also possible.
  • Miscarriage: is the involuntary loss of pregnancy before the 20th week of gestation. Normally, in this case, the bleeding is accompanied by severe abdominal pain.
  • Intrauterine hematomas: these are more frequent in the first trimester of gestation and are sometimes diagnosed because the patient comes to the office because of vaginal bleeding.

Although in the case of implantation bleeding there is no problem for gestation, it is prudent to always inform the specialist of any spotting or bleeding during pregnancy. Thus, the gynecologist will be able to assess the possible causes as soon as possible and evaluate if there is any risk for the woman or the baby.

Bleeding in the second or third trimester

In the second and third trimester of pregnancy a woman may have bleeding for different reasons, among which are the following:

  • Cervical insufficiency: in this case, the cervix opens prematurely and may result in miscarriage or premature delivery.
  • Placenta previa: painless, brightly colored bleeding usually occurs. The placenta is too low in the uterus, partially or completely blocking the birth canal.
  • Placental abruption: it may present with dark bleeding and is more frequent in the last trimester of pregnancy.
  • Premature delivery with bleeding.

Therefore, if spotting or bleeding occurs in the second or third trimester of pregnancy, the patient should be evaluated by a specialist as soon as possible.

On the other hand, a bloody discharge in late pregnancy may be the expulsion of the mucus plug. This is a secretion located in the cervix that prevents the entry of microorganisms from the vagina into the uterus during pregnancy.

Its expulsion may be bloody, brownish, or pinkish in color and is an indication that the pregnancy is coming to an end. Therefore, losing the mucus plug is not a cause for concern, as long as the expulsion is not accompanied by other symptoms such as bleeding or too early (when the pregnancy has not reached term). In this case, the woman should see a specialist as soon as possible.

However, the mucus plug can also be expelled prematurely after a gynecological examination or if sexual intercourse takes place. This, in principle, does not pose any risk to the baby, as it would still be protected by the amniotic sac.

Bleeding at any time during pregnancy

Similarly, bleeding may occur at the beginning, middle, and end of pregnancy due to trauma to the cervix, from sexual intercourse, or after a gynecological examination. In these cases, the amount of bleeding is usually small.

On the other hand, another possible cause of bleeding during pregnancy is an infection in the cervix.

What should I do if I have bleeding in pregnancy?

In case of any bleeding or spotting during pregnancy, the woman should inform the specialist in charge of her pregnancy. However, in the event of heavy vaginal bleeding, severe pain, sharp pain in the abdomen, dizziness, etc., a doctor should be consulted promptly.

It is important to observe the characteristics of the bleeding: duration, if it is light or abundant, color, odor, if it is presented with other symptoms, etc. All this information will help the specialist to investigate the possible causes of the bleeding. In this way, once the diagnosis has been made, the gynecologist will be able to propose a treatment according to each particular situation.

In any case, the woman should avoid sexual intercourse until the cause of the bleeding is known. Likewise, pregnant women should not use tampons while bleeding.

FAQs from users

What can spotting in the second month of pregnancy indicate?

By Óscar Oviedo Moreno M.D. (gynecologist).

Spotting is very common in the first trimester of pregnancy. Any spotting in the first trimester is considered a threat of miscarriage.

Spotting can be due to different causes. The most important thing to do is to see your gynecologist to find out the origin of the spotting. Possible causes include hematoma, low insertion placenta, polyp in the cervix, etc.

Is it bad or normal for a pregnant woman to bleed?

By Sara Salgado B.Sc., M.Sc. (embryologist).

It will depend mainly on the reason for the bleeding. Generally, light bleeding is not a cause for concern, it is considered normal. However, if it is heavy, painful or prolonged, it may be indicative of a pregnancy complication and it is advisable to see a doctor.

What should I do if I have heavy bleeding during pregnancy?

By Sara Salgado B.Sc., M.Sc. (embryologist).

In the event of heavy bleeding, the woman should see a doctor immediately. The same happens when severe pain appears or bleeding extends over time.

Can bleeding during pregnancy be menstruation?

By Sara Salgado B.Sc., M.Sc. (embryologist).

No, menstruation does not occur when a woman is pregnant. The period only occurs when fertilization and implantation have not taken place, because if the embryo manages to implant in the endometrium, the pregnancy hormone is produced, which prevents the period from occurring.

If menstruation were to occur while the woman is pregnant, the baby would not be able to develop, since the placenta and the sac containing the baby would be detached from the uterus and expelled through the vagina.

How many days can you spot while pregnant?

By Sara Salgado B.Sc., M.Sc. (embryologist).

Bleeding that is within the normal range is of short duration and is usually only light spotting. When the cause is out of the ordinary or severe, the bleeding may be prolonged, so it is important to see a doctor to control the bleeding.

How to stop bleeding in pregnancy?

By Silvia Azaña Gutiérrez B.Sc., M.Sc. (embryologist).

When a woman has bleeding during pregnancy, the first thing to do is to inform the specialist. The specialist will assess whether the situation requires the woman to go for an in-person check-up. However, if the bleeding is heavy or accompanied by abdominal pain or dizziness, the pregnant woman should go to the emergency room as soon as possible.

The obstetrician-gynecologist will investigate the possible causes of the bleeding and will tell the woman how to proceed, since the possible treatment and indications to stop bleeding in pregnancy will depend on the diagnosis that has been established.

In any case, the woman should avoid sexual intercourse and the use of tampons while bleeding and it may be common to be advised to rest. However, it will be the specialist who will give the appropriate indications after having obtained a diagnosis.

If you want to learn more about implantation bleeding, you can visit the following link: What is implantation bleeding - Characteristics and symptoms.

If, on the other hand, you are interested in reading more about ectopic pregnancy, we recommend reading this article: What is ectopic pregnancy - Types, symptoms, and diagnosis?

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FAQs from users: 'What can spotting in the second month of pregnancy indicate?', 'Is it bad or normal for a pregnant woman to bleed?', 'What should I do if I have heavy bleeding during pregnancy?', 'Can bleeding during pregnancy be menstruation?', 'How many days can you spot while pregnant?' and 'How to stop bleeding in pregnancy?'.

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Authors and contributors

 Óscar Oviedo Moreno
Óscar Oviedo Moreno
Bachelor's Degree in Medicine & Surgery from the University of Caldas (Colombia). Specialist in Internal Medicine by the Pontificia Universidad Javeriana of Bogotá. Degree standardized in Spain in 2003. Specialist in Gynecology & Obstetrics from the Complutense University of Madrid, with residence at Hospital Clínico Universitario San Carlos de Madrid. Expert in Reproductive Medicine and Certification in Obstetric-Gynecologic Ultrasound (levels I, II and III). More information about Óscar Oviedo Moreno
License: 282858310
 Sara Salgado
Sara Salgado
B.Sc., M.Sc.
Degree in Biochemistry and Molecular Biology from the University of the Basque Country (UPV/EHU). Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid (UCM). Certificate of University Expert in Genetic Diagnosis Techniques from the University of Valencia (UV). More information about Sara Salgado
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV
Adapted into english by:
 Cristina  Algarra Goosman
Cristina Algarra Goosman
B.Sc., M.Sc.
Graduated in Psychology by the University of Valencia (UV) and specialized in Clinical Psychology by the European University Center and specific training in Infertility: Legal, Medical and Psychosocial Aspects by University of Valencia (UV) and ADEIT.
More information about Cristina Algarra Goosman
Member number: CV16874

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