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First Trimester Bleeding - 5 Causes

Dr. Anju Ahuja 91% (562 ratings)
DGO, MBBS
Gynaecologist, Delhi  •  34 years experience
First Trimester Bleeding - 5 Causes

Seeing spots of blood during pregnancy is usually a cause for concern. However, it is not uncommon. The light bleeding, which is known as spotting may occur for a number of reasons.

Bleeding during the first trimester:
Spotting is most likely to happen during early pregnancy and the reasons could be many, such as:

  1. Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you conceive as the fertilized egg implants itself in the lining of the uterus. Some women don't realize they are pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts from a few hours to a few days.
  2. Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns with first trimester bleeding. However, first trimester bleeding does not necessarily mean that you’ve lost the baby or going to miscarry. In fact, if a heartbeat is seen on ultrasound, over 90% of women who experience first trimester vaginal bleeding will not miscarry.
  3. Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can spread to other parts of the body.
  4. Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the uterus.

Additional causes of bleeding in early pregnancy include:

Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test, which cause contact with the cervix, can trigger bleeding. This type of bleeding isn't cause for concern.
Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Bleeding during the second or third trimesters:
Spotting may also occur during late pregnancy and the possible reasons are listed below.

  • Problems related to placenta like placenta previa placental abruption can also result in spotting. These are serious conditions when the placenta either covers the cervix or it gets detached from the uterine wall respectively.
  • Uterine rupture is the rare and unfortunate event when a scar from a previous surgery (like the removal of fibroid or previous caesarean scar bursts open and the baby slips into the pregnant woman's abdomen.
  • Premature labour occurs when your body is too eager to deliver the baby, usually one month before the due date of delivery.
  • Vasa Previa is another rare condition when a baby who is still developing has his blood vessels entangled in the umbilical cord or placenta-crossing the cervix. It is extremely dangerous because the blood vessels may burst open thus causing the baby to bleed and lose oxygen.

Investigating early bleeding

Your doctor is likely to begin with an internal examination to feel the size of your uterus and to look for any obvious visible sign of bleeding.

  1. Ultrasound: After about six weeks of pregnancy the baby’s heart beat can usually be seen on ultrasound. If you have been bleeding, you will likely be offered a vaginal ultrasound because it offers the best possible view of your pregnancy. A vaginal ultrasound is a narrow probe, which is put inside the vagina; it feels much like an internal examination and is quite safe.
  2. Blood tests: A blood test can measure the level of the pregnancy hormone hCG (human Chorionic Gonadotrophin), which changes depending on how pregnant you are.

Bottom line:

No matter when it occurs, any bleeding during pregnancy warrants a phone call to your doctor or midwife, even if only to confirm nothing is amiss. Be prepared to answer detailed questions about the color, amount, and timing of blood in order to best help your practitioner determine the possible cause.

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