Bleeding and spotting from the vagina during pregnancy

Out of every 10 women who are pregnant, two or three have some bleeding early in pregnancy. Bleeding doesn't always mean there's a problem, but it can be a sign of miscarriage or other serious complications. It's very important to be aware of how you're bleeding so that your provider can tell if it's dangerous to you or your baby. Keep track of whether the bleeding is increasing or decreasing and how many pads you are using. Don't ever use a tampon, douche, or have sexual intercourse while you're bleeding.

First trimester
Light bleeding in the first trimester is common. There are many different reasons you could be spotting.

Implantation bleeding
You may bleed a little when the embryo attaches to the lining of your uterus. This may occur 10-14 days after fertilization. Although this spotting is usually earlier and lighter than a menstrual period, some women don't notice the difference, and don't even realize they're pregnant.

Changes in the cervix
Your cervix changes during pregnancy to prepare for delivery. More blood flows to your cervix while you're pregnant, so the area is sensitive. You may have some light bleeding after sex or after a pelvic exam.

Miscarriage usually happens during the first 12 weeks of pregnancy. Bleeding doesn't always mean miscarriage. At least half of women who have spotting or light bleeding early in pregnancy don't miscarry. Other signs of miscarriage include cramps (stronger than menstrual cramps) and tissue coming out of the vagina. If you think you may have had a miscarriage, call your health care provider. For more information, read Miscarriage.

Molar pregnancy
This is a rare condition in which tissue grows in the uterus, but the embryo is abnormal or missing. With molar pregnancy, bleeding may be dark brown in color. Other symptoms include severe nausea and vomiting and cramping in the belly. If you have any of these symptoms, call your health care provider right away. For more information, read Molar Pregnancy.

Later in pregnancy
Bleeding later in pregnancy can be caused by many things. Tell your health care provider immediately if you have bleeding in the second half of pregnancy.

Bleeding later in pregnancy may be caused by a number of health conditions.

Cervical problems
An infection, inflammation, or growths on the cervix can cause vaginal bleeding. For a few women, light bleeding is a sign of cervical insufficiency (CI), also known as cervical incompetence, in which the cervix opens without warning. This can result in preterm labor and delivery. Cervical insufficiency or incompetence is most common between 18-23 weeks. It requires immediate medical attention.

Preterm labor
Light bleeding may be a sign of preterm labor. If you have any of the following signs or symptoms, call your health care provider right away:

  • Contractions (your abdomen tightens like a fist) every 10 minutes or more often
  • Change in vaginal discharge (leaking fluid or bleeding from your vagina)
  • Pelvic pressure—the feeling that your baby is pushing down
  • Low, dull backache
  • Cramps that feel like your period
  • Abdominal cramps with or without diarrhea

Miscarriage usually happens in the first trimester, but it can occur at any time before 20 weeks of pregnancy.

Placenta previa
Heavy bleeding late in pregnancy may be a sign of placenta previa. If you have heavy bleeding, go to the hospital right away. With placenta previa, the placenta is attached too low in the uterus. It partly or completely covers the birth canal. This is a serious condition. The main sign is painless, bright red vaginal bleeding. The bleeding may stop on its own, but then come back a few days or weeks later.

Placental abruption
A few pregnant women have placental abruption, in which the placenta separates from the wall of the uterus before birth. This leads to bleeding within the uterus. The woman often also has pain in her belly. Placental abruption usually occurs in the last 12 weeks of pregnancy. If you have heavy bleeding, go to the hospital right away.

Uterine rupture
For women who've had a previous c-section, a tear in the scar in the uterus may cause bleeding. This opening is very dangerous. The woman will feel intense pain and tenderness in her belly.

A sign of normal labor
"Bloody show" is normal at the very end of pregnancy. If you have thick discharge that is pink or slightly bloody 1-2 weeks before your due date, your body is probably taking the first step to prepare for labor.
Other causes of bleeding may be unrelated to the pregnancy itself.

When to call your health provider
Contact your health care provider if you have:

  • Unusually strong cramps
  • Severe pain in your belly
  • Heavy blood flow
  • Continual bleeding for more than 24 hours straight
  • Fever or chills
  • Contractions, even if they're not painful (your belly tightens like a fist)
  • Discharge containing tissue

May 2007

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).