Spotting During Pregnancy

Spotting during pregnancy, or the appearance of small spots of blood from the vagina, can be scary. Whether it's serious or not depends on the stage of pregnancy and the cause of the bleeding. However, any time you see vaginal bleeding during pregnancy, you should call your doctor. The cause may not be serious, but in some cases it can be life-threatening.

Causes of spotting during pregnancy vary according to trimester. Early on, bleeding is not uncommon. Spotting is less likely during the second and third trimesters. If it does happen, it may be a sign of a dangerous problem.

As many as 30% of women have some bleeding during the first trimester. Causes include:

• Implantation bleeding. This happens when the egg implants into the uterine wall. It's usually slight and lasts only a day or two. It may occur near the time your period was due.
• Miscarriage. As many as half of all early pregnancies end in miscarriage. Miscarriage in the first trimester may begin with spotting and then proceed to vaginal bleeding that looks like a heavy period. Sometimes miscarriage happens so early that it is mistaken for a late period.
• Threatened miscarriage. In some cases, spotting is a sign that miscarriage might happen. About half of threatened miscarriages go on to become true miscarriages.
• Ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg doesn't reach the uterus, but instead implants in the fallopian tube wall. As the egg grows it will rupture the fallopian tube, causing severe bleeding. Spotting during pregnancy can be the first sign of an ectopic pregnancy.
• Molar pregnancy. In a molar pregnancy, there is no fetus. Instead, the egg develops abnormally and, in some cases, can even become a form of invasive cancer.
• Injury. Bleeding from a vaginal injury can look like spotting during pregnancy. Tears in the vaginal wall can happen during rough sex.
• Infection. Yeast infections and some STDs can cause spotting, especially if the vaginal tissue or the cervix becomes inflamed.

During the second and third trimesters, the likely causes of spotting during pregnancy are different. For example:

• Placenta previa. The placenta is a collection of blood vessels and tissues that connect your baby to your uterine wall. Nutrients pass through the placenta to the baby, allowing him/her to grow. Sometimes, the placenta attaches low in the uterus, actually covering the cervical opening. As the uterus thins and stretches in preparation for labor, the placenta can be damaged and start to bleed.
• Placental abruption. Occasionally, the placenta separates from the uterus before it's time for the baby to be born. The separation causes bleeding within the uterus which can range from mild to life-threatening. There may also be mild to severe abdominal pain. Spotting during pregnancy can be a sign of abruption.
• Infection. STDs, yeast infections, and other vaginal infections can cause spotting.
• Injury. Injury to the vaginal or cervical tissues can lead to spotting.

Treatment depends on the cause of spotting during pregnancy.

• Miscarriage or threatened miscarriage. There is no treatment for threatened miscarriage. Usually, your doctor will simply have you wait to see if the bleeding stops or miscarriage occurs. If miscarriage does happen, you may not need any physical treatment. Or, you may need a procedure to remove the pregnancy tissue. Early miscarriages often happen because there was something wrong with the developing baby. They are rarely due to anything the mother did or didn't do.
• Infection. Your doctor can prescribe treatments that are safe during pregnancy.
• Ectopic pregnancy. Ectopic pregnancies must be terminated. It's extremely rare for a baby to develop normally outside the uterus, and it is very dangerous for the mother to let an ectopic pregnancy continue. Early on, medicine can be used to end the pregnancy. If the fallopian tube has ruptured, surgery is usually necessary.
• Molar pregnancy. A molar pregnancy will not develop into a baby. The abnormal tissue must be removed, and chemotherapy may be needed.

• Placenta previa. Placenta previa requires careful monitoring. Vaginal delivery can cause severe bleeding, so your doctor will likely recommend a C-section.
• Placental abruption. Placental abruption is a potential emergency. Internal bleeding can be severe, even if there is minimal vaginal spotting. If the bleeding can not be controlled, the baby must be delivered immediately.
• Infection. As in the first trimester, infections can usually be eliminated easily with antibiotics or antifungals. However, certain infections can involve the baby. These infections may require more intensive treatment.

Always call the doctor if you notice spotting during pregnancy. Your doctor or midwife can help you determine the cause and decide what to do. More substantial bleeding is a reason to go straight to the emergency room.

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