Missing your monthly period is often the first indication that you might be pregnant. So experiencing any early bleeding or spotting after a positive pregnancy test might have you wondering if something is wrong. The information below may be helpful in determining the answer to that question; however, it is always a good idea if you are concerned to talk with a doctor.
Spotting or bleeding during pregnancy is more common than you might think. Research shows up to 20-25% of women may experience bleeding of some sort during their pregnancy (with many proceeding to have healthy pregnancies). Some causes may indicate need for alarm and seeing a doctor, while some may not.
In order to help make this determination it is important to know the following: the difference between spotting and bleeding, possible causes (both concerning and normal), and when you should definitely get checked out by a doctor.
How to tell the difference between bleeding and spotting:
The difference between spotting and bleeding usually comes down to the amount and shade (color) of the blood.
| Color | Amount |
| Spotting: Typically, dark brown or light pink |
Spotting: Typically, considered to be a small amount of blood that may be seen in your underwear in the morning or when you wipe with toilet paper. You might wear a panty liner but it does not fill and you should not need to change it throughout the day. It may last for a few days before resolving on its own.
|
| Bleeding: Typically, bright red, or may have clots | Bleeding: Typically, a heavier flow requiring more than a panty liner and may need to be changed throughout the day like during your monthly menstrual cycle. |
**Any question around if you are just spotting or bleeding should be addressed by your physician or other medical provider
Likely causes:
Spotting (light bleeding) may be a result of the following:
- Implantation Bleeding– may happen when the embryo attaches to the uterine wall; usually occurring about 6-12 days after conception. This can sometimes last for a few days but will be lighter than a normal period. It may occur around the same time as your regular cycle and be mistaken for a light period.
- Cervical irritation- your cervix is tender due to hormone changes and engorged with blood vessels. Things such as sex, pelvic exams/pap smear, vaginal ultrasounds can all be a mild irritate and cause some light bleeding and spotting after. If you are concerned about this please contact your provider.
- Infection- an infection in the vagina or cervix (such as an STI/STD) can cause irritation and inflammation and spotting or bleeding.
- Subchorionic bleed- blood that accumulates next to the placenta, or between the uterus and placenta, causing light to heavy spotting. In most cases it resolves on its own and does not affect the pregnancy.
Period-like bleeding: can signal that something is up and should always be evaluated by a provider
- Ectopic pregnancy- pregnancy outside the uterus (typically in the tubes); can be life threatening for the mother and needs immediate evaluation. Associated with severe cramping (typically one-sided) and heavy bleeding.
- Molar Pregnancy- rare occurrence when a noncancerous tumor forms in place of the placenta resulting in an unviable pregnancy.
- Miscarriage– pregnancy loss during the first 12 weeks, associated with period like cramping/bleeding.
2nd/3rd trimester bleeding may also be caused by:
- Placental issues (previa, accreta, abruption)
- Previa- the placenta is covering part or all of the cervix and can cause issues with delivery
- Accreta- the placenta grows into the wall of the uterus too deeply
- Abruption– the placenta separates from the wall of the uterus before birth
- Preterm Labor– labor prior to 37 weeks
- Uterine Rupture- this is rare but occurs when the uterus tears during labor
How do I know when to go to a doctor?
Any time you are concerned about any spotting or bleeding it is a good idea to talk with a physician or seek medical care. Light spotting is often normal and can resolve on its own without anything to worry about. Some women spot off and on for their entire pregnancies while others do just for a day or two, but if it is ongoing you should talk about it with a provider who can evaluate if there is need for concern.
If you experience the following situations, you SHOULD call/visit a physician’s office or Emergency Room:
- Bleeding with cramping or lower abdominal pain
- Heavier bleeding that soaks through a pad
- 2nd-3rd trimester bleeding: even light bleeding
The best thing to do is “When in doubt, check it out.” Seeing or speaking with a provider is the only way to alleviate concerns you may have. A great resource available are nurse lines at physician offices. They can talk with you about concerns and relay messages to the doctor if needed.
If you are newly pregnant and have any questions/concerns, we would love to meet you. We offer confirmatory pregnancy test and ultrasounds at no cost. Please call or text 336-629-9988 for an appointment.