Spotting During Pregnancy: Causes, Brown Blood and When to Call

Is spotting normal during pregnancy?

Spotting is common during pregnancy, especially in the first trimester, and in many cases it does not signal a major problem, though you should always report it. ACOG says bleeding in the first trimester happens in 15 to 25 in 100 pregnancies, that bleeding in early pregnancy is common, and that bleeding later in pregnancy can be more serious. MedlinePlus says up to 1 in 4 women have vaginal bleeding at some point in pregnancy, more often in the first 3 months and especially with twins.

ACOG says to contact your ob-gyn about any bleeding at any time in pregnancy, and March of Dimes says to call even if it stops. The NHS says bleeding in pregnancy is not always serious but can sometimes need urgent treatment.

What is the difference between spotting and bleeding?

Spotting is a few drops of blood that would not cover a panty liner, while bleeding is heavier and needs a liner or pad, according to March of Dimes and MedlinePlus.

The NHS uses three levels. Spotting means spots of pink, red or brown blood on your underwear or toilet paper, light bleeding is larger areas of blood that may need a pad, and heavy bleeding is red blood that soaks through a pad, sometimes with clots or lumps. The NHS adds that bleeding may be constant or may come and go.

What causes spotting in early pregnancy?

Many causes of spotting in early pregnancy are harmless. ACOG says light bleeding or spotting can occur 1 to 2 weeks after fertilization, when the fertilized egg implants in the lining of the uterus. MedlinePlus says light implantation spotting that does not last long is most often nothing to be concerned about, and Cleveland Clinic says implantation bleeding should stop on its own after about two days.

ACOG also says the cervix may bleed more easily in pregnancy because more blood vessels are developing there, so spotting after sex, a Pap test or a pelvic exam is not uncommon (bleeding after sex in pregnancy has more).

Other causes need checking. ACOG lists infection, early pregnancy loss and ectopic pregnancy as problems that can cause bleeding in early pregnancy, and MedlinePlus says to contact your provider right away about bleeding in the first 3 months, because it may be a sign of miscarriage or ectopic pregnancy. The NHS adds molar pregnancy, which March of Dimes describes as rare.

MedlinePlus says bleeding can also come from a collection of blood between the uterus and the placenta, called a subchorionic hematoma, and that the pregnancy can often continue. The NHS says that sometimes no cause is found. If the spotting comes with pain, see cramping in early pregnancy.

What does brown spotting mean in pregnancy?

Brown spotting has more than one cause, from implantation to an ectopic pregnancy, so it needs the same call as red spotting. The NHS counts spots of pink, red or brown blood as spotting, ACOG says to contact your ob-gyn about any bleeding, and March of Dimes says to tell your provider about any bleeding or spotting.

Cleveland Clinic says implantation bleeding is usually pink or brown and looks more like vaginal discharge than a period. The NHS says the bleeding of an ectopic pregnancy often starts and stops and may be watery and dark brown. March of Dimes suggests checking the color, which can be brown, dark red or bright red, because your provider may want to know.

Is bleeding in later pregnancy more serious?

Bleeding later in pregnancy can be more serious, and ACOG says to contact your ob-gyn right away or go to the hospital for any bleeding late in pregnancy. Light bleeding at this stage commonly comes from inflammation of or growths on the cervix, ACOG says, while heavy bleeding may come from a problem with the placenta, and any amount may signal preterm labor. MedlinePlus says one in 10 women have vaginal bleeding in the third trimester.

Among the placenta problems ACOG describes, placenta previa, where the placenta lies low and covers part or all of the cervix, often bleeds without pain, and some types resolve by 32 to 35 weeks. Placental abruption, where the placenta detaches from the wall of the uterus, most commonly causes vaginal bleeding with abdominal or back pain.

In late pregnancy, MedlinePlus says a small amount of spotting after sex or an exam, with no other symptoms, can be watched at home: put on a clean pad, check it every 30 to 60 minutes for a few hours, and call your provider if it continues. For any other bleeding, it says to contact your provider right away.

The NHS says a show, when the mucus plug comes away, sometimes with blood, can mean labor is starting. ACOG says late bleeding may be a sign of labor, which is called preterm labor if it starts before 37 weeks; the other signs are in preterm labor signs.

What will your doctor or midwife check?

Your doctor or midwife will ask about the bleeding and may examine you, do an ultrasound scan, or take blood and urine tests. The NHS says checks may include looking inside your vagina, an ultrasound scan on your belly or inside your vagina, blood tests and a urine test. MedlinePlus says your provider may want to know how much you are bleeding and its color, when it began, whether you have cramping, pain or contractions, whether you have felt dizzy or fainted, and when you last had sex.

March of Dimes suggests keeping track of how heavy the bleeding is and how many pads you use, and not using a tampon, douching or having sex while you are bleeding.

If your blood is Rh negative, ACOG recommends Rh immunoglobulin, given as a shot, if you had bleeding after 20 weeks of pregnancy. It stops your body making Rh antibodies, which ACOG says can prevent severe anemia in the fetus in a future pregnancy. The NHS says you may not need any treatment if tests find the bleeding is not serious and the pregnancy is healthy.

When should you call your doctor or midwife about bleeding?

Call your doctor or midwife right away about any bleeding or spotting in pregnancy, and get emergency help for heavy bleeding or bleeding with severe pain.

Call your ob-gyn or midwife right away, or go to the ER or hospital, if you have:

• heavy bleeding, or bleeding with pain or cramping
• bleeding with dizziness, or pain in your belly or pelvis
• any bleeding late in pregnancy
• bleeding and you have been told you have placenta previa
• bleeding with a stiff, painful belly or strong, frequent contractions, for which MedlinePlus says you may need to call 911

In the UK, the NHS says to get urgent help for light bleeding or spotting with no pain or mild pain, or with diarrhea or pain or pressure when you pee or poop. Call your maternity unit, or an early pregnancy unit if you are under 20 weeks, and NHS 111 if you cannot reach either. Spotting that has stopped still needs a call, because March of Dimes says your provider needs to find out what is causing it.