In this article
What is spotting and is it normal in pregnancy?Spotting is light bleeding from the vagina. It's similar to, but lighter than, a period. The colour of the blood can be anything from red to brown.
Rest assured that in the early weeks of pregnancy, a little spotting or bleeding is very common. As many as one in five mums-to-be with a continuing pregnancy have some sort of bleeding in the first trimester (van Oppenraaij et al 2009).
You're slightly more likely to have spotting if you conceived with the help of IVF, or similar fertility treatment. If two embryos were put into your uterus (womb), one may stop developing (Anderson-Berry and Zach 2012) (a vanishing twin) (Anderson-Berry and Zach 2012, De Sutter 2006). This may trigger some bleeding.
Sometimes, though, spotting can be a sign of something more serious, such as miscarriage. This is why it's always best to be checked by a doctor.
What's the most likely cause of light bleeding in pregnancy?In early pregnancy, spotting and light bleeding is often harmless. It usually happens at about the same time that your period would have been due, and may last for a day or two. You may only notice it after you have been to the toilet and wiped.
Though experts aren't sure why this bleeding happens, it may be due to:
- Hormones that control your menstrual cycle triggering bleeding (breakthrough bleeding). You may have this more than once.
- The fertilised egg embedding into your uterus lining, causing bleeding (implantation bleeding). Though this is less likely to be the cause than breakthrough bleeding.
What else can cause light bleeding?There may be other things going on inside your body that have caused some bleeding:
- Irritation to your your cervix. Pregnancy hormones can change the surface of the cervix, making it more likely to bleed, such as after you have sex (Symonds 2009:323).
- Fibroids, which are growths in the lining of your uterus. Sometimes, the placenta embeds where there is a fibroid (Ouyang et al 2006).
- A small, harmless growth on your cervix (cervical polyp) (Symonds 2009:323).
- A cervical or vaginal infection (Gracia et al 2005, Symonds 2009:325).
- An inherited disorder, such as Von Willebrand Disease, which makes it more difficult for your blood to clot (Shahbazi et al 2012).
What are the more serious causes of bleeding in pregnancy?Unfortunately, bleeding in early pregnancy can be a sign of a miscarriage or an ectopic pregnancy. In both cases, you also usually develop tummy or pelvic pain and cramps.
Early miscarriage usually happens when a baby is not developing properly, and the bleeding becomes steadily heavier. Early miscarriage can be a heartbreaking event, but it is fairly common. Some women even have a miscarriage before they realise they're pregnant, and assume they're having a period.
An ectopic pregnancy happens when the fertilised egg implants outside of your uterus. The bleeding may continue, and be dark and watery in appearance (RCOG 2010a). An ectopic pregnancy can make you seriously ill, so must be removed quickly (RCOG 2010a).
A more unusual cause of bleeding is a molar pregnancy (RCOG 2011), which affects only about one in 700 pregnancies (RCOG 2010b, 2011). It happens when the embryo doesn't develop properly, but some of the cells that form the placenta continue to grow and multiply. A molar pregnancy must be removed as soon as possible.
It is also possible for a blow to your belly, perhaps after a fall, to trigger bleeding.
What should I do if I notice bleeding?Call your doctor, midwife or the hospital, even if the bleeding eventually stops. You may need to go to hospital for further examination.
Your doctor may gently examine inside your vagina, or she may advise you to have an ultrasound scan. A scan can rule out an ectopic pregnancy and check that your baby is well.
Your doctor may want to do a few routine tests. Blood or urine tests can check your pregnancy hormone levels (RCOG 2006: 5, 2010a). A test to check your blood group and rhesus status may also be done.
In some states, you may be referred to an Early Pregnancy Assessment Service at a hospital near you. Your GP may refer you to the service or in some cases you can make an appointment yourself. If you go to the emergency department you may be referred to the Early Pregnancy Assessment Service for a follow-up appointment. If you see your GP to get checked for vaginal spotting or bleeding ask them if there is an Early Pregnancy Assessment Service near you.
Will my baby be safe?Your baby is likely to be fine, as spotting or light bleeding is often harmless. Many pregnancies carry on, despite early bleeding problems.
If the bleeding signals a miscarriage, you'll develop tummy cramps as well, and the bleeding will usually get heavier. Spotting or light bleeding often stops on its own. It's thought that about half of mums-to-be who ask for medical help because of early bleeding go on to have their baby (van Oppenraaij et al 2009).
If you have spotting or bleeding in pregnancy, talk to your doctor or midwife, even if it stops, to make sure that you have no other symptoms that may signal a problem.
Try to stay positive. Spotting or light bleeding is likely to turn out to be no more than a worrying blip in your pregnancy (Hasan et al 2009, Poulose et al 2006) that you'll soon be able to put behind you.
Last reviewed: May 2014
ReferencesAnderson-Berry AL, Zach T. 2012. Vanishing twin syndrome. eMedicine. emedicine.medscape.com [Accessed June 2013]
De Sutter P, Bontinck J, Schutysers V, et al. 2006. First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction. Hum Reprod. 21(7):1907-11. humrep.oxfordjournals.org [pdf file, accessed April 2010]
Gracia CR, Sammel MD, Chittams J, et al. 2005. Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies. Obstet Gynecol. 106(5):993-9
Hasan R, Baird DD, Herring AH, et al. 2009. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol 114(4):860-7.
Ouyang DW, Economy KE, Norwitz ER. 2006. Obstetric complications of fibroids. Obstet Gynecol Clin North Am 33(1):153-69
Poulose T, Richardson E, Ewings P, et al. 2006. Probability of early pregnancy loss in women with vaginal bleeding and a singleton live fetus at ultrasound scan. J Obstet Gynaecol. 26(8):782-4
RCOG. 2006. The management of early pregnancy loss. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 21. London: RCOG press. www.rcog.org.uk. [pdf file, accessed June 2013]
RCOG. 2010a. An ectopic pregnancy: information for you. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [pdf file, accessed June 2013]
RCOG. 2010b. The management of gestational trophoblastic disease. Royal College of Obstetricians and Gynaecologists, Green-top guideline, 38. London: RCOG press. www.rcog.org.uk. [pdf file, accessed June 2013]
RCOG. 2011. Gestational trophoblastic disease (GTD): information for you. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk [pdf file, accessed June 2013]
Shahbazi S, Moghaddam-Banaem L, Ekhtesari F, et al. 2012. Impact of inherited bleeding disorders on pregnancy and postpartum hemorrhage.Blood Coagul Fibrinolysis 23(7):603-7
Symonds IM. 2009. Abnormalities of early pregnancy. In: Fraser DM, Cooper MA. eds. Myles Textbook for Midwives. 15th ed. Edinburgh: Churchill Livingstone, 313-32
van Oppenraaij RHF, Jauniaux E, Christiansen OB, et al, on behalf of the ESHRE Special Interst Group for Early Pregnancy (SIGEP). 2009.
Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 15(4):409-21