Women's Healthcare Topics

Early Pregnancy Bleeding, Implantation Spotting or Miscarriage?

Reviewed by James Brann, M.D.

Causes of Bleeding in Early Pregnancy

Vaginal bleeding early on in your pregnancy can alarm you. You may have just discovered you were pregnant and you’ve been overwhelmed with excitement and joy. Now you are bleeding. What does this mean? Have I lost my baby?

Early pregnancy bleeding can be caused by a number of factors, including implantation bleeding, a threatened miscarriage, vanishing twin, vaginal infections, genital warts, swollen labia, cervical polyp, uterine fibroid, and sexual intercourse.

Implantation - Around the time that may be expecting your period, you may experience some implantation bleeding—blood that results from the fertilized egg attaching to the lining of your uterus. Because of the timing, you may confuse this with your menstrual blood, which is heavier in blood flow. When in doubt, a trip to your doctor’s office will confirm you are pregnant.

Threatened Miscarriage - Bleeding is a common sign that a miscarriage may occur. Your physician will diagnose you with a threatened miscarriage if you have vaginal bleeding accompanied with mild cramping, but an ultrasound exam shows that the baby is still moving and has a heartbeat.

If you have a threatened miscarriage, you may have a few spots of bright red blood, followed by brown, coffee-ground looking material.

To reduce your discomfort, your doctor may recommend you avoid having sex and get extra rest. Be warned—these measures have not been proven to prevent miscarriage.

If you experience heavy bleeding and think you have passed fetal tissue, place it in a clean container and take it to your physician. He or she will do a pelvic exam to see if your cervix has opened and if a miscarriage has occurred.

Vanishing Twin - The term “vanishing twin” is used to describe a pregnancy that started out with two babies, but one of the babies has died early in pregnancy. You may experience some spotting (light bleeding) and cramping with this phenomenon. In most cases, the remaining baby is fine and the pregnancy will continue as normal.

Vaginal Infections - Vaginal infections are very common during pregnancy. These infections can make your vaginal tissue swollen and inflamed, causing it to be very delicate and bleed easily after a wipe or sexual intercourse. All vaginal infections, including your common yeast infection, need to be treated. Once the infection is treated, the bleeding should disappear.

Genital Warts - Genital warts tend to increase in size and number during pregnancy. Pre-pregnancy, you may have noticed a few small bumps on the outside of the vagina. During your pregnancy, these will grow quite large and bleed easily. You may be concerned about the bleeding if you don’t recognize that it is coming from the warts. Warts can be treated during pregnancy, and the irritation and bleeding associated with them will be minimized.

Swollen Labia - Your vagina and the labia swell during pregnancy. Even the smallest amount of trauma to this area can cause it to bleed. Most often, this type of bleeding occurs from blunt trauma, such as riding a bike, or during normal sexual intercourse. Scratching can also cause your labia to bleed. Blood from your swollen labia will not harm your baby.

Cervical Polyp - A cervical polyp can cause bleeding during your pregnancy. These polyps are fingerlike growths within or near the surface of your cervix. During pregnancy, these polyps can enlarge and cause bleeding during sex. Although cervical polyps will not harm your baby, your physician may take a tissue sample from it to ensure that it is not cancerous.

Uterine Fibroid - Uterine fibroids, which are non-cancerous tumors that grow on the wall of your uterus, can cause bleeding during pregnancy. If you experience mild bleeding but no cramping from the fibroids, you will need to be observed by a doctor but no additional treatment is required. In this case, the risk to your baby is very minimal. The blood you may see is light and brownish in color, like old coffee grounds.

If your fibroids are large, or if your baby is implanted close to the tumor, you may have a slightly increased chance of miscarriage.

Sexual Intercourse - Some pregnant women complain that they experience vaginal bleeding after sex, and they are worried that the blood is coming from the baby. Don’t be alarmed if you experience this—the blood is actually coming from your cervix (the opening to the womb).

During pregnancy, the surface of the cervix tends to bleed easily when touched. So you can experience light bleeding after sex, but this vaginal bleeding will not harm your baby. You may continue to have sex safely unless the bleeding bothers you.


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