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Spotting during pregnancy: What does it mean, and when should you see a doctor?

It’s normal to worry about spotting during pregnancy, but it happens in up to a quarter of pregnancies and doesn’t always mean anything bad. Here, a doctor explains what spotting can mean and when to seek medical advice.

a pregnant woman in the washroom with spotting marks on toilet paper

The sight of vaginal bleeding can understandably be a cause for concern when you’re pregnant. There’s a tiny, vulnerable life growing inside you, so it’s no wonder that up to one in four women experience an anxiety disorder when they’re expecting. However, spotting — which is very light bleeding — while pregnant is actually very common and occurs in around 15% to 25% of pregnancies. So you can take comfort in knowing that if you experience it, you’re certainly not alone — and it doesn’t always mean something bad is happening.

But when should you speak to your doctor about bleeding and spotting during pregnancy? Continue reading to find out everything you need to know. 

Defining pregnancy spotting 

There’s a difference between pregnancy spotting and heavier bleeding, but you may not be clear on exactly what that is. Spotting is light bleeding that can last for a few hours to a couple of days, which you might notice in your underwear or on your tissue when you wipe after peeing. If it’s spotting, you’ll have less blood than you might expect with a light period, and it will be a red, pink, or brown color.  

When might spotting occur in pregnancy?

Spotting can happen at any point throughout your pregnancy, as Dr. Nazaneen Homaifar, obstetrician and gynecologist, Washington, DC, US, explains. “Some people might notice spotting at the very beginning of pregnancy,” she explains. “The most common time to have spotting is in the first trimester, [but] you could have it in the second trimester or even in the third trimester. When people are in labor and their cervix is starting to dilate and open up and stretch, they might notice a little bit of spotting then as well.” 

Generally, while it may not necessarily mean anything bad, any spotting or bleeding during pregnancy is something you should see your health care provider about. Try to remember that it could have a multitude of causes, and do your best to keep as calm as you can in this situation. Know that by reaching out, you will be in good hands.

Causes behind spotting during pregnancy 

As we know, seeing blood during pregnancy can cause worry, which is natural. So it can help to understand a little more about what causes spotting in each trimester and what it can tell you about what’s happening inside your body.

First trimester 

Spotting could actually be one of the very first signs that you’re pregnant. This might be due to implantation bleeding, which is the name given to light spotting in early pregnancy that appears around the time you’d normally expect to have your period. Despite what you might assume at the time, this isn’t actually a period arriving during your pregnancy

Implantation bleeding doesn’t happen for everyone (it’s thought to occur in around a quarter of pregnancies). But when it does, it’s as a result of the fertilized egg burrowing into the lining of the uterus, and it can happen as early as 10 days after a baby is conceived. Unsure whether you might be pregnant? Try Flo’s pregnancy test calculator to see whether it’s time to take a test and find out.

However, there can also be other causes of spotting during the first trimester. “People can develop what’s called a subchorionic hematoma,” Dr. Homaifar says, “which is a little bit of a bleed in the gestational sac [the area that surrounds an embryo during its early development].” But try not to worry — this isn’t as scary as it sounds. According to studies, it’s a common cause of first-trimester bleeding and is found in at least 3% of all pregnancies. This kind of bleeding happens when blood collects between your uterine wall which is a thick layer that protects your baby and your chorionic membrane, which is next to your uterus and part of the gestational sac. Most subchorionic hematomas will go away on their own without any issues, but it’s still worth getting spotting checked by a doctor just in case.

Dr. Homaifar adds: “You might also have bleeding from the cervix because its surface is more sensitive [during pregnancy]. So if you’re having a lot of sexual intercourse or exercise, some people might notice a little bit of spotting.” This is nothing to worry about unless any of your activities are causing you pain, in which case it’s wise to alter them and get checked out by a doctor.

spotting on a pregnant woman’s underwear

Second trimester

Spotting can occur after your first trimester, too, for a couple of different reasons. As your pregnancy progresses into the second trimester, you may experience bleeding due to placenta previa, which is a condition where the placenta attaches itself to the lower part of the uterus and covers the opening. “People can develop spotting or bleeding from this, which comes from the placenta. It typically presents as painless bleeding,” reassures Dr. Homaifar. 

The good news is that this only affects around 1 in 200 pregnancies and is usually noticed during a second-trimester ultrasound exam. Fortunately, placenta previa can also resolve itself without any issues, so you’ll be closely monitored by your health care provider if you have it. If the placenta doesn’t move on its own, you’ll likely have a cesarean section scheduled for between 36 and 37 weeks (as opposed to a vaginal birth) to minimize the risk of excess blood loss during labor

And remember what we said about sex possibly causing spotting in early pregnancy? Well, the same applies to the second and third trimesters, too, so bear this in mind. 

Third trimester 

The third-trimester milestone is certainly a special one, and you may notice new changes beginning to happen as your body prepares for the arrival of your baby. “In the third trimester, you might have bleeding from the cervix dilating or opening up,” says Dr. Homaifar. 

You may have heard people talk about preterm labor, which is when your cervix opens and you start to give birth before 37 weeks of pregnancy. One of the symptoms of this is spotting, alongside contractions, cramps, and lower backache. This could lead to premature birth, which is pretty common; in fact, 1 in 10 babies born in the US in 2021 was premature. Unfortunately, preterm labor can cause health risks for both you and your baby, but know that you will both be closely monitored if it happens to you until you gain full strength. Be sure to contact your doctor if you have any specific concerns about going into preterm labor, and seek immediate medical help if you think you have gone into preterm labor already.  

We touched on how issues with the placenta can lead to spotting in the second trimester, and this can also be the case as you approach the end of your pregnancy; you can use Flo’s due date calculator to determine when this is if you’re unsure. Placental abruption is one example of this.

Dr. Homaifar explains: “Sometimes people can experience a placental abruption, which is a condition where a little bit of the placenta comes off the side of the uterus and bleeds.” Similar to preterm labor, if you’re spotting or bleeding because of placental abruption, you’ll likely also feel abdominal pain, backache, and contractions. This most commonly happens in the few weeks before you’re due to give birth and is considered a medical emergency; if left untreated, it can cause complications. Thankfully, this is rare and only affects around 1% of pregnancies. If you think you’re experiencing either placental abruption or preterm labor, reach out to your health care provider as soon as possible.

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What should you know about blood spotting colors during pregnancy?

When it comes to the color of spotting during pregnancy, what can you expect to see? “The color can range anywhere from dark brown, which is usually old blood, to a bright red to sometimes a pinkish color,” says Dr. Homaifar. 

When should you see a doctor about pregnancy spotting? 

If you see blood in your underwear and your mind instantly goes to a fearful place, this is perfectly normal. Try to keep calm, and speak to a health care professional sooner rather than later. 

As a general rule, it’s always best to contact your doctor whenever you have any concerns about your pregnancy. “I think it’s always a good idea to bring up spotting with your health care provider,” says Dr. Homaifar. “Depending on the amount and whether you’re having other symptoms or if the spotting is ongoing, then a physician will want you to be evaluated.”

Spotting during pregnancy: The takeaway

We hope you’re now reassured in knowing that spotting is a common part of pregnancy for many people and is often harmless. But if it feels more like heavy bleeding than spotting, it’s worth seeking help as soon as you can. Always do whatever you feel is right for yourself and your baby — after all, nobody knows your body better than you. But never feel bad for erring on the side of caution if you notice any bleeding and want to get it checked out.

On that note, we’ll leave you with this final bit of advice from Dr. Homaifar. “I don’t want people to get too worked up and anxious about spotting during pregnancy, but I want them to seek the proper care,” she says. “You don’t have to go to the emergency room for some spotting, but you should try and speak to someone within the day.”

Written by Carly Lewis-Oduntan

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