Understanding First Trimester Bleeding

Bleeding in the first trimester, when miscarriage is most common, can be terrifying. Roughly a third of pregnant women experience some degree of bleeding in early pregnancy. Fortunately, only about half of those women actually have miscarriages. Understanding what different types of bleeding can mean and what may cause bleeding during pregnancy can provide a measure of reassurance for expectant mothers. Still, it’s important to check in with your obstetrician or midwife immediately if you notice anything unusual. 

When to Worry

Many women experience a type of vaginal bleeding called “spotting” and still have a perfectly normal pregnancy. Spotting is very light bleeding that may range from barely noticeable on toilet paper to significant enough to require a panty liner. The color can range from pinkish orange to brown. Spotting may occur during ovulation, as well as the first few months of pregnancy. Your doctor can help assess how serious your bleeding is over the phone to determine if you need to come in.
If you notice bright red bleeding that fills more than a pad an hour or bleeding that’s accompanied by cramping, you can either call your doctor immediately for further instruction or go straight to the hospital. These symptoms don’t always mean you’re miscarrying, but medically, this level of bleeding is categorized as “threatened miscarriage.” 

Implantation Bleeding

The menstrual cycle is designed to get a woman’s body ready for motherhood. Part of that process is lining the uterus with blood and tissue. When the egg burrows into your uterus, bleeding is common. Implantation bleeding occurs when the fertilized egg “implants” into the prepared lining of the uterus. This type of bleeding is most common six to twelve days after ovulation, but it can take as long as, or more than, 2 weeks.

Intercourse and Infection

A pregnant woman’s cervix is a very blood rich environment. Any agitation to the vaginal or cervical area could result in bleeding. This includes intercourse or an internal exam, particularly a pap smear. Additionally, certain infections can cause inflammation of the cervix, leading to bleeding. A physician can screen for infections of concern. Primarily, urinary tract infections (UTI’s) can be dangerous in early pregnancy and should be treated promptly.

Subchorionic Hemorrhage

This refers to active bleeding between the placenta and uterine wall. The cause isn’t known, and while it slightly increases the risk of miscarriage, many women still have healthy pregnancies and healthy babies.

Abnormal Pregnancies

Ectopic pregnancy is the term used for a pregnancy that forms in the fallopian tube instead the uterus. Unfortunately, these pregnancies are never viable and require surgical removal. Ectopic pregnancies usually cause a significant amount of pain and can be diagnosed by ultrasound. Additionally, molar pregnancy occurs when there’s an incomplete fertilization of an egg. The tissue designated to become an embryo becomes a mole instead. Symptoms include excessive nausea and rapid uterine frequency.

Blighted Ovum

A blighted ovum occurs when the fertilized egg doesn’t progress into an embryo. The gestational sac develops normally, and expected hormone levels progress for the first few weeks, causing the expected signs of pregnancy. An ultrasound, however, will show an empty sac, or embryo that hasn’t developed past the first few weeks. Chromosomal abnormalities are a likely cause, which unfortunately means it’s assumably unpreventable. Experts believe blighted ovums may account for as many as half of miscarriages. 
Last Updated: November 03, 2017