Worried pregnant woman

Is this bleeding normal?

Bleeding during pregnancy may not be a sign of a miscarriage. But how can you tell the difference?

You’re just about finished with your first trimester and feeling great — your appetite is back, your boobs are starting to feel semi-normal (although still nicely perky!), and you feel like you might actually make it through the day without a nap again. And then, one morning, you see it... blood in your underwear.

What does bleeding during pregnancy mean?

“Although bleeding is never normal in pregnancy, it doesn't mean that a miscarriage is inevitable,” explains Dr. Renee Horowitz, an OB/GYN in Farmington Hills, Michigan. According to the American College of Obstetricians and Gynecologists, (ACOG) bleeding during pregnancy can mean one of several things:

  1. Bleeding from “normal” causes. Many pregnant women, especially women in their first trimesters of pregnancy, simply experience “spotting” or light bleeding that is not dangerous or a sign of an underlying problem. Frequently, sex can irritate the cervix (which is chockfull of sensitive blood vessels) and cause bleeding afterwards. One patient I cared for had period-like bleeding throughout her entire pregnancy without any complications.
  2. Infection. A urinary tract infection, kidney infection or a cervical infection could result in bleeding, especially if you aren’t sure if the bleeding is occurring with urination.
  3. Ectopic pregnancy. An ectopic pregnancy is a pregnancy that results when a fertilized egg implants somewhere else in the body instead of the uterus, most commonly in one of the fallopian tubes. The pregnancy is not viable and will need immediate treatment to be removed. If the egg continues to grow it could rupture the fallopian tube, a potentially life-threatening condition. Bleeding from an ectopic pregnancy is usually brownish in color.
  4. Placental conditions. Usually, heavy bleeding during pregnancy indicates that there is an issue occurring with your placenta. For example, placenta previa occurs when your placenta covers the opening of your cervix and can lead to vaginal bleeding. Placental abruption is a very serious, life-threatening complication that occurs when your placenta detaches from the uterine wall and can cause heavy, intense, sudden bleeding and abrupt abdominal pain.
  5. Miscarriage. According to the ACOG, miscarriage occurs in about 15 to 20 percent of pregnancies, most commonly during the first trimester — although it can happen anytime during the first 20 weeks of pregnancy. Miscarrying is most often accompanied with other symptoms, such as cramping and abdominal or back pain.
  6. Labor. Yes, bleeding can be a sign of labor, as your cervix softens and prepares to dilate. If you are experiencing contractions, cramping, increased pressure or a change in discharge, you may be experiencing the early stages of labor.

What you should do

First of all, don’t panic. As listed above, bleeding during pregnancy does not necessarily mean that you are experiencing a miscarriage. However, bleeding will always need to be evaluated for the cause, as it can be a life-threatening condition.

"Call for help if you can, as bleeding can lead to blood loss that could cause you to get dizzy and pass out."

Call for help if you can, as bleeding can lead to blood loss that could cause you to get dizzy and pass out. Use a super-absorbent feminine pad and call your care provider for instruction. Care “may be as simple as resting and following up in the office the next day or in the case of heavier bleeding, you may have to be seen immediately,” explains Dr. Horowitz.

Make a mental note of when the bleeding occurred, how long it has lasted, the color of blood, the amount of blood and any other symptoms you have experienced before and during the bleeding, so you can provide your health care provider with a detailed picture of what is happening.

What to expect

Your healthcare provider will most likely run some sort of testing on you. If you are over ten weeks, she may use a Doppler ultrasound to detect a fetal heartbeat or use a traditional abdominal or vaginal ultrasound to detect the fetus and placenta.

She may have to perform a pelvic exam to manually inspect the cervix for any problems and to check for dilation. And lastly, she may have blood work drawn to check your level of the hCG hormone, to rule out or confirm a miscarriage.

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