Blood loss in pregnancy

In pregnancy, the term bleeding indicates an intense flow similar to menstruation, the term spotting indicates small brown discharges.

Blood loss in pregnancy

During pregnancy, it is quite common to bleed or have small discharge (spotting).

In fact, these phenomena occur in two out of ten women during the first three months of gestation .

In most cases, they are attributable to the normal changes that occur during pregnancy.

To know when to worry and when not, it is important to know how to recognize the possible causes and various types of blood loss.

Leakage: a sign of pregnancy

Along with nausea, bloating and abdominal cramps, among the first signs of an ongoing pregnancy there can certainly be slight bleeding .

Bleeding- Implant spotting

Generally, we speak of “bleeding” to indicate any type of blood loss during pregnancy.

However, there are some differences between actual bleeding and small vaginal discharge called “spotting” (from English to spot which means to stain).

Knowing how to distinguish them and understand what the causes are is very important to be able to recognize any signs of risks. First let’s distinguish them.

Plant sporting. Spotting is the loss of small amounts of blood that can also be seen in linen. Implantation spotting is counted among the harmless symptoms of pregnancies, and occurs most commonly during the first trimester.

Bleeding. By bleeding, on the other hand, we mean that intense flow, similar to the menstrual one, which requires the use of sanitary napkins. It is often associated with abnormal conditions, or pregnancy complications.

However, in cases of blood secretion or other symptoms – painful or not painful – it is always advisable to consult your doctor, since it is not possible to assess the possible (possible) risks independently.

The causes of blood loss

Blood loss can be due to a number of causes: some harmless, others very dangerous for both mother and future baby:

In fact, however scarce they may be. Blood loss could lead to a range of complications, including abortion, ectopic pregnancy and placenta previa.

The causes, in the first trimester

(a) causes related to non-hazardous conditions

There are many possible non-dangerous causes that underlie implantation spotting or bleeding during the early periods of pregnancy. The main ones are due:

to the process of implantation (of the fertilized egg in the uterine wall)

  • This type of blood loss occurs during the third or fourth week of pregnancy, usually around the same time as the next period.
  • Slight leakage begins after the fertilized egg implants in the uterine wall, and continues for no more than a couple of days.
  • In addition, levels of ) rise until they are detectable approximately 5-6 days after implantation by a normal pharmacy pregnancy test.

intermenstrual blood loss

  • Another harmless cause of spotting/blood loss is related to the times when the menstrual cycle does not stop during pregnancy.
  • Sometimes, in fact, hormone levels do not rise enough to “silence” the menstrual cycle, and the symptoms associated with it (for example, abdominal and lower back cramps, pelvic area discomfort)(9).
  • However, intermenstrual losses are characterized by slight spotting, contrary to the stronger flow of the regular menstrual cycle.

to blood loss after sexual intercourse

  • The hormones of pregnancy make the cervix softer and cause the so-called cervical erosion, which is linked to a light brown spotting that is often found after sexual intercourse, both in the first part of pregnancy and in the more advanced stages (10).
  • This type of spotting can also be due to some vaginal/cervical infections or the (not dangerous) growth of polyps.

to a twin pregnancy

  • Because of the higher level of hormones, spotting is more common in twin pregnancies,

b) Causes due to serious problems

In the first part of pregnancy there are also more serious causes of blood loss. You may be due to:

to a miscarriage

  • A miscarriage can occur at any time during pregnancy, but is most likely during the first trimester.
  • It is one of the main causes of bleeding in the first 12 weeks.

to a chemical pregnancy

  • Chemical pregnancy refers to a very early type of miscarriage, which can occur even before the fertilized egg implants in the uterus.
  • Its main symptoms are vaginal bleeding or spotting(14).

to an ectopic pregnancy (tubal pregnancy)

  • Another important cause of bleeding occurs when the embryo implants in a location other than inside the uterus.

to a molar pregnancy

  • Abnormal fertilization of the oocyte leads to the growth of groups of sacs filled with water in the uterus thus causing considerable bleeding.

to a subchorionic hematoma

  • This condition is characterized by an accumulation of blood between the uterine wall and the placenta, or inside the placenta itself: in some cases it can lead to placental abruption.
  • In this case, however, the hematoma often remains symptomatic and, apart from a slight spotting, tends to reabsorb over time.

to a decidual tissue (a portion of the uterine mucosa)

  • Sometimes for unknown reasons, small parts of tissue detach and disintegrate, causing slight spotting.
  • This phenomenon is also called the “threat of abortion”, but it usually does not cause any particular harm to the foetus.

Other possible causes may be due to uterine fibroids, endometriosis (a pathology involving women’s health with debilitating effects), a bicornuate (heart-shaped) uterus: these conditions need medical attention .

Even the intake of some anti-nausea medicines such as Zofran® is often associated with complications such as bleeding and miscarriages.

The causes, in the 2nd and 3rd trimester

During the second and third trimesters, blood loss is not as common as in the early stages of pregnancy. They are often associated with complications of advanced stages.

Even some pressure applied to the uterus or cervix during an internal medical exam could lead to mild spotting

Other more serious causes of heavy bleeding after  the 15th week of pregnancy  can be due to several reasons including the following.

  1. A placenta previa . Sometimes the placenta partially or completely blocks the cervix, and some placental vessels meanwhile stretch and rupture, leading to bleeding
  2. A placental abruption . It is a condition in which the detachment of the placenta from the uterine wall leads to bleeding
  3. The rupture of the uterus . In this case, the blood loss is caused by the rupture of the uterine wall
  4. The vasa previa . It is a rare cause of blood loss in which the  umbilical cord  attaches to the wall of the uterus causing fetal blood vessels to pass through the birth canal
  5. Of cervical abnormalities . Other possible causes may be due to inflammation of the cervix, cervical infections, premature opening of the cervix (leading to premature labor), some growths of cervical masses  .

Some advice, in case of losses

We indicate some general guidelines to reduce the risk of complications while waiting for the doctor to establish which factors are responsible for the problem:

  • drink plenty of water in order to prevent dehydration and also to keep under control some symptoms such as constipation;
  • rest while staying in bed;
  • Keep your feet elevated when sitting or lying down
  • avoid walking, taking stairs and lifting heavy objects;
  • Avoid exercise
  • monitor the amount of blood lost so you can see if blood loss is increasing;
  • Write down the type of bleeding: if the blood is dark red, pink or brown, if there are clots (bright red blood is often more worrying than brown spotting)
  • implement anti-stress techniques such as yoga.

When a medical examination is needed

In the following situations, a medical examination is still necessary.

  • Constant bleeding (even in small amounts) for more than 24 hours, at any stage of pregnancy .
  • Vaginal bleeding with loss of tissue, accompanied by intense abdominal cramps and pain in the lower back (may indicate a miscarriage).
  • Heavy bleeding accompanied by abdominal pain, fever (more than 38°C) and chills .
  • Light but recurring vaginal bleeding (in the second trimester), which goes away on its own within a couple of hours.
  • Heavy bleeding similar to menstruation, accompanied by pelvic pain, nausea and vomiting (could indicate ectopic pregnancy) .
  • Unexplained bleeding accompanied by dizziness, fainting and tachycardia (may indicate low blood pressure)
  • Vaginal bleeding accompanied by fever, nausea, pain during intercourse, or pain in the lower abdomen (may indicate the presence of a venereal disease such as chlamydia, gonorrhea, or other diseases such as urinary tract infections or kidney infections.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform,

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