Vaginal bleeding in early pregnancy

The Difference Between Spotting and Bleeding

Spotting is when you notice a few drops of blood every now and then on your underwear. It is not even enough to cover a panty liner.

Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.

Ask your doctor or midwife more about the difference between spotting and bleeding at one of your first prenatal visits.

Should I Worry about Spotting?

Some spotting is normal very early in pregnancy. Still, it is a good idea to tell your doctor or midwife about it.

If you have had an ultrasound that confirms you have a normal pregnancy, call your health care provider the day you first see the spotting.

If you have spotting and have not yet had an ultrasound, contact your health care provider right away. Spotting can be a sign of an ectopic pregnancy (a pregnancy where the fertilized egg develops outside the uterus). An untreated ectopic pregnancy can be life threatening for the woman.

What Causes Vaginal Bleeding?

Bleeding in the first trimester is not always a problem. It may be caused by:

• Having sex
• An infection
• The fertilized egg implanting in the uterus
• Hormone changes
• Other factors that will not harm the woman or baby

More serious causes of first-trimester bleeding include:

• A miscarriage, which is the loss of the pregnancy before the embryo or fetus can live on its own outside the uterus. Almost all women who miscarry will have bleeding before a miscarriage.
• An ectopic pregnancy, which may cause bleeding and cramping.
• A molar pregnancy, in which the pregnancy does not form properly.

When to Call the Doctor

Call or go to your doctor or midwife right away if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis 

If you cannot reach your health care provider, go to the emergency room.

If your bleeding has stopped, you still need to call your doctor or midwife. Your health care provider will need to find out what caused your bleeding.

• You may need an exam and tests to check on your pregnancy.
• You may need a shot of medicine to protect your pregnancy, depending on your blood type.

What Will My Doctor Need to Know?

Your doctor or midwife may need to know these things to find the cause of your vaginal bleeding:

• How far along is your pregnancy?
• Have you had vaginal bleeding during this or an earlier pregnancy?
• When did your bleeding begin?
• Does it stop and start, or is it a steady flow?
• How much blood is there?
• What is the color of the blood?
• Does the blood have an odor?
• Do you have cramps or pain?
• Do you feel weak or tired?
• Have you fainted or felt dizzy?
• Do you have nausea, vomiting, or diarrhea?
• Do you have a fever?
• Have you been injured, such as in a fall?
• Have you changed your physical activity?
• Do you have any extra stress?
• When did you last have sex? Did you bleed afterward?

Treatment for Vaginal Bleeding

Most of the time, the treatment for bleeding is rest. Your doctor or midwife may also advise you to: 

• Take time off work
• Stay off your feet
• Not have sex
• Not douche (NEVER do this during pregnancy, and avoid when not pregnant too)
• Not use tampons 

Your doctor or midwife may also give you a shot of medicine to help you keep your pregnancy and avoid a miscarriage. 

Very heavy bleeding may require a hospital stay or surgical procedure.

What if I Discharge More than Blood?

If something other than blood comes out, call your doctor or midwife right away. Put the discharge in a jar or a plastic bag and bring it with you to your health care provider. 

Your doctor or midwife will check to see if you are still pregnant. You will be closely watched with blood tests to see if you are still pregnant. 

If you are no longer pregnant, you may need more care from your health care provider, such as medicine or possibly surgery.

Update Date: 8/23/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.