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An Explanation of Bleeding & Spotting During Pregnancy

Susannah Birch is a certified birth doula, journalist, and owner of Trimester Talk, a leading pregnancy website.

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Pregnancy is accompanied by many new feelings, pains, and changes, which include a lot of strange things happening down below. It can be scary to have bleeding or strange discharge during pregnancy, but most of the time this is completely normal. As long as you're informed on what to expect, and know when to see a medical professional, you won't have any problems. If you notice any spotting or bleeding, wear a panty liner or pad to help you better gauge the color, amount of discharge, and any presence of mucus. This will help you explain your symptoms to a doctor.

According to OB-GYN Dr. Tami Prince, MD, "the top three most common reasons for bleeding during pregnancy are miscarriage (especially in the first trimester), spotting after implantation of the fertilized egg into the uterine lining, and spotting after intercourse. Another cause is an infection (either urinary tract, vaginitis such as bacterial vaginosis or yeast, and sexually transmitted disease)."

Below you'll find an explanation of the above causes and ones that you may experience close to going into labor. Remember that your doctor is there to help you through your pregnancy, so don't be afraid to ask questions or bring up concerns, even if they seem minor.

What Is Spotting?

Spotting is quite common in early pregnancy and is used to describe any type of very light bleeding that there doesn't appear to be a specific reason for. Sometimes spotting may occur following sex or overexertion, or it may happen without any obvious reason. Some pregnant women experience spotting or bleeding throughout their pregnancy while others experience light bleeding for the first few months (when their periods were due) as their body adjusts to pregnancy.

Although spotting can just be your body's normal adjustment to pregnancy and increasing blood flow in your body, you should always talk to a medical professional if it continues for more than a few hours or turns into heavy bleeding.

Is White/Cream Discharge Normal?

During pregnancy, normal discharge increases, and some women find it easier to wear a panty liner to accommodate it. Normal discharge can range from clear to white or cream and at some times during your pregnancy it can occur in quite large amounts.

In addition, if you notice a small amount of pinkish-brown discharge or blood-tinged discharge, don't panic. This is likely normal.

What Is Considered Abnormal Discharge and Bleeding?

If you experience any of the following, it's important to see a medical professional as soon as possible:

  • Yellow/Green discharge: This may indicate a urinary tract infection, a yeast infection, an STD, or bacterial vaginosis.
  • Pain or itching down below or when urinating: Another indication of a urinary tract infection or thrush.
  • Bright red blood: Bright red blood is usually fresh and can indicate a hemorrhage, miscarriage, or other problem.
  • Clots or heavy blood flow: This may indicate a miscarriage, problem with the placenta, or some other issue.
  • Continual Bleeding: If you experience bleeding that continues for more than a few hours or spotting that occurs for more than a day, it's time to seek medical help asap.

Causes of Bleeding or Spotting in Weeks 37-39

There's likely little cause for concern of spotting after week 37. However, more than just a little spotting can sometimes signal that the placenta has separated from the uterus, so call your doctor if you notice anything unusual or more blood than expected.

During these few weeks, you'll likely notice an increase in vaginal discharge when you're getting close to labor since your hormones are shifting and helping your body prepare for labor. When the cervix is opening and thinning out, some women might notice a light, bloody discharge.

Here are causes of spotting or bleeding during weeks 37-39.

Losing Your Mucus Plug

  • The mucus plug is a jelly-like mass of yellow cervical mucus and small amounts of blood that block the cervix to protect the baby from bacteria or other outside entities before labor begins. The plug may be clear, slightly pink, or blood-tinged in color and is rather small (4-5 cm long). Sometimes, it's stringy mucus or sticky discharge that goes unnoticed since there is an increase in discharge during pregnancy.
  • Usually, the loss of the mucus plug begins around 37 weeks. Although losing the mucous plug is quite common in the weeks leading up to birth, it is not a definite sign that your baby is ready to arrive. If you lose your mucous plug too early, it can actually regrow itself.
  • You may lose it in small pieces or in one large chunk. Some women do not lose the plug until they are in labor.
  • If you lose your plug, you may want to let your medical caretaker know, but you don't need to rush to the hospital or assume labor is beginning unless it's accompanied by contractions that are consistently 3-5 minutes apart. .

The Bloody Show

  • The bloody show occurs when mucus can be seen coming out of the vagina when you’re either about to go into labor or are having some pretty significant cervical changes.
  • The bloody show occurs as the blood vessels in your cervix dilate and open up. A bloody show is the name given to a small amount of blood lost near the end of pregnancy (generally after 37 weeks). When you visit the toilet and wipe, you may find a small amount of blood on the paper, and this is a bloody show. This is a normal occurrence as your body prepares itself to give birth.
  • The show is sometimes brown, but it's also not unusual for it to be red. You only need to worry if it's a large amount of blood or has a flow similar to a period—if so, you should go to a hospital immediately.
  • Although this is a common symptom that labor has started or is about to start, it is not a definite sign that your baby is ready to arrive, although it does indicate that your body is preparing itself. You may want to alert your midwife to the fact you've experienced the bloody show, however, as it can mean labor may be imminent and in some cases, you'll be checked at the hospital.
  • Keep in mind that some women who are pregnant with their first child won't always experience this—it takes a little longer for your body to get ready for labor, so it might not occur until your doctor has induced labor.

Placenta Previa

  • According to Dr. Prince, "placenta previa is the abnormal implantation of the placenta near or completely covering the internal cervical os. It represents 20% of third trimester bleeding and usually presents [itself in the form of] painless, bright red bleeding."

Placental Abruption

  • This rare condition (1% of all pregnancies) can happen anytime after 20 weeks, but it usually happens in the third trimester.
  • This is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have serious bleeding.
  • The abruption can be partial or complete but both are considered dangerous, so it's important to seek medical attention immediately. A complete abuption requires immediate delivery.
  • The main symptom is painful bleeding with contractions.

Uterine Rupture

  • This is a rare event—usually occurs in women who have never had a c-section, other uterine surgery, or a previous rupture—in which there is a sudden tear in the wall of the uterus. It can also be caused by excessive labor-inducing methods, mid-pelvic use of forceps, and weakened uterine muscles.
  • These ruptures usually occur during labor, but it can sometimes happen at the onset of labor.
  • If you experience a uterine rupture, the baby will need to be delivered via c-section.
  • This is a sudden event that is difficult diagnose because the symptoms are nonspecific. If you at all suspect that you're experiencing a uterine rupture, seek medical attention immediately.

Intercourse

  • Bleeding after intercourse can occur at any time throughout your pregnancy but is common in the second and third trimesters.
  • This is due to an increased blood supply to the cervix and vaginal walls, which means that blood vessels are more likely to break during intercourse, especially on the surface of the cervix.

What Is the Difference Between the Bloody Show and the Mucus Plug?

Although the mucus plug or the bloody show can occur at the same time or close together, they are different things. The bloody show is caused by the expanding cervical blood vessels while the mucus plug is what seals the inside of the cervix.

Why Is There Blood After I Urinate or Wipe?

First Trimester CausesSecond/Third Trimester Causes

egg implantation bleeding (common)

Sexual Intercourse (common)

infection or STD (common)

Cervical problems (depends on the issue)

cervix changes (common)

placenta previa (about 1 in 200 births)

pelvic exam (common)

Preterm labor (about 12% of all pregnancies)

subchorionic hemorrhage (rare)

uterine rupture (rare)

molar pregnancy (1 in 1,000 pregnancies)

placental abruption (1% of all pregnancies)

miscarriage (10-25% of all clinically recognized pregnancies)

 

ectopic pregnancy (1-2% of all pregnancies)

 

Why Am I Having a Period When I'm Pregnant?

Don't worry, you're not actually having your period. Vaginal bleeding in pregnant women is actually quite common and can sometimes resemble a period. According to The American College Obstetricians and Gynecologists, 15-25% of women will experience bleeding in the first trimester.

Sometimes there is no clear reason for bleeding during pregnancy, especially in the first trimester. Below are some common causes. As always, call your doctor if you're concerned or have any questions.

Egg Implantation Bleeding

  • Implantation bleeding occurs when the fertilized egg implants into the uterine wall after making the journey down from the ovaries.
  • The bleeding can range from just a few spots of blood (either pink or brown) to a heavier bloody discharge—although it's generally quite a bit lighter than a normal menstrual period. It's also short-lived–usually only lasting no more than 24-48 hours. Implantation bleeding does not contain blood clots, which often appear during menstruation.
  • This type of bleeding occurs generally between 7-10 days after the date of conception. However, some women never experience it at all or in some cases mistake it for a light period.
  • When to call your doctor: If you experience heavy bleeding (more than a typical menstruation flow) either alone or combined with fever, chills, or cramps that don't subside or get worse.

Placenta Implantation Bleeding

  • When the placenta grows and implants into the uterine wall, loss of brown blood or spotting is not uncommon.
  • Unlike egg implantation, placental implantation generally occurs after six weeks of gestation and can occur anywhere up to 14 weeks.

Cervical Changes

Infection or Sexually Transmitted Disease

  • An infection of the cervix, vagina, or a sexually transmitted disease can cause bleeding in your first trimester.

Am I Having a Miscarriage?

Symptoms of Normal Pregnancy SpottingSymptoms of a Miscarriage

Light blood flow that might be mistaken for a light period

Heavy bleeding that resembles menstruation

Some pain might occur, but it shouldn't be intense

Dull and aching pain or period-like cramping

Bleeding usually only lasts for a few hours or a few days

Weight loss

 

White-pink mucus

 

True contractions

 

Tissue with clot like material passing from the vagina

Sources

  1. "Vaginal Bleeding and Blood Clots During Pregnancy?", WebMD. Accessed April 25, 2018.
  2. "Bleeding During Pregnancy", American Pregnancy Association. Accessed April 25, 2018.
  3. Mayo Clinic Staff, "Bleeding During Pregnancy", Mayo Clinic. Accessed April 25, 2018.
  4. Mayo Clinic Staff, "Molar Pregnancy", Mayo Clinic. Accessed April 25, 2018.
  5. "Miscarriage: Signs, Symptoms, Treatment, And Prevention", American Pregnancy Association. Accessed April 25, 2018.
  6. Melissa Conrad Stöppler, MD, "Ectopic Pregnancy (Symptoms, Signs, Treatment)", MedicineNet. Accessed April 25, 2018.
  7. "Placental Abruption", March of Dimes. Accessed April 25, 2018.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Naseera on April 24, 2019:

I suspect I am 5 weeks pregnant. I havent tested because my period was 11 days late and then it started. I have had a light period for four days now, cramps and mood swings. I will be testing as soon as the bleeding stops or can i test while i am still bleeding and still get an accurate result?

Unknown on September 16, 2018:

If u r one month and two weeks pregnant and when u urinate and wipe u see blood what is the cost of it?

ashley N turner on June 29, 2018:

What does it mean if I am lightly bleeding at 39 weeks and 4 days

Elsie Hagley from New Zealand on October 12, 2015:

Wish I had articles like this to read fifty years ago. I nearly lost my life because I had an ectopic pregnancy which ruptured, I had an operation sixteen hours after.

I never even knew I was pregnant, even though I have been to a doctor because of all the bleeding, he just gave me pills to stop the bleeding.

Thanks, I'm sure this will be very helpful to many women.

K on November 15, 2012:

This was a great idea for an article! I think so many women are confused by these terms (especially mucous plug and bloody show) I wish I would have read this when I was researching all these terms years ago!

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