An Ob-Gyn Explains If Spotting During Pregnancy Is Normal

When you’re pregnant and notice spotting, it can cause fear and panic to set in, but is it normal to spot during pregnancy?

Here, an obstetrician-gynecologist will discuss spotting during pregnancy, what can cause it, what it may indicate, if it’s normal and when you should reach out to your health care provider.

What is spotting during pregnancy?

Spotting during pregnancy is simply a small amount of vaginal bleeding, usually just a few drops. You can have light spotting during pregnancy or heavier spotting, but both are slightly different from bleeding during pregnancy, according to the Cleveland Clinic. Bleeding is a heavier flow of blood that will fill up a panty liner or require a sanitary napkin, whereas spotting will just leave a few drops of blood on the panty liner.

Spotting can happen at any time throughout your pregnancy, said Dr. Erin Higgins, an ob-gyn at the Cleveland Clinic. She explained that it may appear as bright red or brown spotting during pregnancy. “Bright red bleeding is new blood, brown bleeding or brown spotting is old blood,” she noted.

What causes spotting during pregnancy?

According to the American College of Obstetricians and Gynecologists, spotting during pregnancy can happen because of:

• The fertilized egg implanting into the cervix (conception)
• Blood vessel development in the cervix
• Infection
• Ectopic pregnancy, which is the implantation of the fetus outside of the uterus, typically in a fallopian tube
• Early loss of pregnancy (miscarriage) during the first 13 weeks
• Preterm labor
• Problems with the placenta, including placenta previa, placenta accreta and placental abruption

Some of these issues cause spotting during early pregnancy, some cause spotting during late pregnancy and still others can cause spotting to occur at any time during gestation. Their timing can help your doctor better understand the care you need. For example, if you’ve been diagnosed with placenta previa (a placenta that sits low in the uterus), spotting at 35 weeks pregnant could indicate it won’t resolve on its own.

“Later in pregnancy, if you still have a placenta previa or there's concerns for how the placenta is attached, those don't always go away on their own and may require delivery by C-section,” Higgins explained.

Is spotting normal during pregnancy?

“The way I always explain it to patients is that it's not normal, but it's very common and there's lots of reasons that are not concerning reasons that we say, 'Oh, OK, that's fine. You can just kind of watch it,'” Higgins said. “But then there are also more serious reasons. So, whenever it happens, we do recommend reaching out to your provider to find out is this one of those normal or one of those less concerning reasons.”

She said that some reasons for spotting in early pregnancy are the fertilized egg implanting into the uterus during conception, an ectopic pregnancy or a miscarriage.

“[In early pregnancy], there can [also] be what's called a subchorionic hematoma, and that's an issue with the placenta,” Higgins said. “That usually goes away, but you can have spotting from that.”

In later pregnancy, Higgins said spotting can be a sign of early cervical change or dilation. The Cleveland Clinic notes that miscarriage, placental abruption, placenta previa, preterm labor and your body’s preparation for labor may all be reasons for spotting or bleeding in your second and third trimester as well.

So, is bleeding normal during pregnancy even if none of these issues exist?

“Throughout pregnancy, you can have spotting from… just kind of cervical inflammation,” Higgins emphasized. “The way I explain it is that the cervix is just a little more sensitive in pregnancy due to the hormonal changes. And so [during] increased activity, you may notice some spotting [such as] after intercourse or a pelvic exam, patients may notice some spotting and that can happen really throughout pregnancy.”

When to call your health care provider

“I always tell my patients, we'd rather you call and have us say, 'Oh no, no, that's fine, don't worry' than somebody sit at home and be like, 'Oh, I don't want to be a bother,'" Higgins said. "I would say you're never wrong to call your doctor for spotting or bleeding in pregnancy at any time, day or night, and early in pregnancy, middle or late in pregnancy.”

Resources

Erin Higgins, MD, ob-gyn, Cleveland Clinic

Cleveland Clinic: Bleeding During Pregnancy

Cleveland Clinic: Subchorionic Hematoma

American College of Obstetricians and Gynecologists: Bleeding During Pregnancy: Frequently Asked Questions