What is the difference between spotting and bleeding in pregnancy?
Often, we use ‘spotting’ and ‘bleeding’ interchangeably. Here is a clear differentiation of both:
- Blood that is visible on your underwear or the toilet paper when you wipe after urinating.
- Appears as light brown or pink spots.
- Does not require a pad or panty liner.
- Is bright red.
- Flows like in a period.
- Requires a sanitary pad to manage.
Bleeding in Pregnancy: Important First Steps to Take
If in the first trimester
- Keep track of how heavy your bleeding is, if it gets heavier or lighter, and how many pads you are using.
- Lie down and rest for 24 hours.
- Check the colour of the blood like brown, dark or bright red.
- See a doctor after 24 hours.
- Unless the bleeding is accompanied by cramping, dizziness, in which case you should see a doctor immediately.
If in 2nd or 3rd trimesters, see a doctor immediately.
Coping with Bleeding During the First Few Weeks of Pregnancy
First, let’s look at the common triggers:
- Sex: During early pregnancy, excessive indulgence in sex called the ‘Ati maithun or Vyavaya’ might lead to bleeding (Garbhsrava), as per Ayurveda. During pregnancy, the cervix is going through a major change. Pregnancy hormones may make it drier than usual and even cause the blood vessels to rupture more easily. It also has a higher blood supply now. So, any pressure on it, for example, during intercourse can also cause bleeding that looks like fresh red blood.This kind of bleeding could also occur during a physical exam like a transvaginal ultrasound or PAP smear, too.
- Implantation bleeding: It's not unusual to see some spotting at six weeks, but it should be light, not even enough to cover a small pantyliner. Implantation bleeding occurs when the fertilized egg implants in the lining of the uterus. When fertilization occurs, it happens in the fallopian tubes. Meanwhile, the uterine walls have become thick-lined with blood and tissue, preparing for a potential pregnancy. When the fertlized egg travels down the tube and attaches itself to the wall of the uterus, some bleeding might occur. Some women don't experience implantation bleeding and others don't notice it.
- Old blood: Sometimes blood that has remained in the uterus since your last period comes out as ‘brown discharge’. This may look like the sediment in a coffee mug.. This “discharge” is actually old blood that has been in the uterus for a while and is just coming out slowly. This is normal and generally resolves in a day or two.
- Infections: Other causes of bleeding in early pregnancy could be infections. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.
- Miscarriage: Vaginal bleeding during early pregnancy may sometimes indicate a serious problem which may include miscarriage. Because miscarriage is most common in the first 12 weeks of pregnancy, first trimester bleeding is a cause for worry. But, it doesn’t mean that you are going to miscarry. In fact, if a heartbeat is spotted on ultrasound, over 90% of women with first trimester vaginal bleeding will not miscarry.
When to Worry About Bleeding in the 1st Trimester
If your bleeding has lasted for more than a day, the doctor will do an ultrasound to see if the pregnancy is safe.
Remember, it can still be no cause of worry in some cases. In others, it may result in loss of pregnancy. Let’s look at the kinds of losses:
- Missed abortion: A missed abortion is also known as a missed miscarriage or spontaneous abortion. It’s a miscarriage in which the foetus didn’t form or is no longer developing, but the placenta and embryonic tissues are still in your uterus.
- Ectopic pregnancy: Your fertilized egg has mistakenly attached somewhere outside the womb, possibly in the fallopian tubes-the connections between the ovaries and the womb. An ectopic pregnancy happens in up to 2.5 percent of all pregnancies. This could lead to heavy or light bleeding.
- Molar pregnancy: Another cause of bleeding in your first trimester is a molar pregnancy. A molar pregnancy or “mole” happens when the placental tissue grows abnormally due to a genetic error during fertilization. The foetus may not grow at all. This could lead to bright red or dark brown bleeding.
Just know that there is nothing you have done to cause it and nothing you could have done to prevent it.
Signs of Miscarriage in 1st Trimester
Firstly, the colour of the bleeding is not a differentiating indicator of miscarriage.
Bleeding during a miscarriage can look like coffee sediment or it can be pink to bright red. It can alternate between light and heavy or even stop temporarily before starting up again.
If you miscarry before you're eight weeks pregnant, it might look the same as a heavy period. The blood may appear brown or bright red and may be accompanied by clots or tissue There may also be a gush of clear or pink fluid or discharge, which is actually amniotic fluid.
Look out for these signs of miscarriage:
- cramping and pain in your lower abdomen.
- a discharge of fluid from your vagina.
- a discharge of tissue from your vagina.
- no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness.
As many as one in five pregnancies ends in miscarriage, primarily due to genetic abnormalities. Other miscarriages occur for no known reason.
Vaginal Bleeding in 1st Trimester: Doctor’s Course of Action
As a first step, your doctor will will order an ultrasound and a blood test.
The ultrasound will examine the inside of your uterus to try to determine whether there is a foetus and detectable heartbeat. A blood test can measure HCG levels, also known as the “pregnancy hormone.”
The levels of HCG in your bloodstream rise rapidly during early pregnancy, and if a downward trend is detected in your blood, it could indicate a miscarriage. Remember, though, HCG levels alone are not an indicator that everything is 100% fine as they can rise and double as expected even in some cases of ectopic pregnancy. That’s why your doctor will always do an ultrasound too.
It usually takes two HCG levels to diagnose a problem with the pregnancy. While the absolute value varies greatly from one woman to the next, two tests 48-72 hours apart should show a doubling of the HCG level in the early first trimester.
Vaginal Bleeding in 2nd or 3rd Trimesters of Pregnancy: Main Causes
Bleeding in 2nd and 3rd trimesters may be slightly serious because it can signal a problem with the mother or baby. Let’s look at the causes:
- Placenta previa: This is a condition that occurs when the placenta sits low in the uterus and partially or completely covers the opening of the birth canal. This generally occurs in only 1 in 200 pregnancies. A bleeding placenta previa, which can be painless, is an emergency requiring immediate medical attention. There are different types, depending on its position, including partial, low-lying, marginal, and major or complete placenta previa. Your doctior will design a course of action to keep your pregnancy safe.
- Placental abruption: In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labour and blood pools between the placenta and uterus. Placental abruption can be very dangerous to both the mother and baby. If your placental abruption is small, your provider may put you on bed rest to stop your bleeding. After a few days, most women can go back to their normal activities in most cases. For a moderate separation, you will likely need to stay in the hospital. The doctor will monitor you closely.
- Uternine rupture: In rare cases, a scar from a previous C-section can tear open during pregnancy. Uterine rupture can be life-threatening, and requires an emergency C-section. Please know that this is a very rare occurrence.
- Vasa previa: In this very rare condition, the developing baby's blood vessels in the umbilical cord or placenta cross the opening to the birth canal. This can be very dangerous to the baby because the blood vessels can tear open, causing the baby to bleed and lose oxygen. See a doctor asap!
- Haematoma: The chorion membrane is a thin layer between your placenta and the uterine wall. Sometimes, blood collects in the folds of the chorion and results in a condition called subchorionic bleeding, or subchorionic hematoma. Subchorionic hematomas can be of different sizes, with larger ones causing heavier bleeding, but with smaller ones being the most common. Your doctor will likely order an ultrasound to screen for the presence of a hematoma. Some hematomas are accidentally detected through routine ultrasounds with no accompanying bleeding. The doctor will admit you and take the right surgical and non surgical options.
Second and third trimester pregnancy: When miscarriage happens
In uncommon and unfortunate cases, pregnancy can be lost in the later trimesters.
The signs are:
- not feeling movement of the foetus
- vaginal bleeding or spotting
- back or abdominal cramping
- unexplained fluid or tissue passing from the vagina
In case of loss, the pregnant woman may be given medication to help you deliver the foetus and placenta vaginally or doctor may decide to surgically remove the foetus using a procedure called dilation and evacuation, also known as D and E.
A second or third-trimester miscarriage requires physical and emotional care. It is advised that the woman seek support and also check with her doctor when she can return to normal lifestyle/work.
She can ask her doctor for a medical certificate to take more time off.
The doctor will advise when she can start trying to get pregnant again.
Bleeding in the 3rd Trimester: Sign of Labour
Vaginal bleeding in late pregnancy may just be a sign that your body is getting ready to deliver. During pregnancy, your body develops a mucous plug at the opening of your cervix. It helps protect your baby and uterus from bacteria.
A few days or weeks before labour begins, the mucous plug that covers the opening of the uterus will pass out of the vagina, and it will usually have small amounts of blood in it (this is known as "bloody show").
- Toward the end of your pregnancy, as your cervix begins to open, the mucous plug will pop out, and you may experience spotting. However, it looks different from typical spotting in that it’s mixed with stringy or thick mucuos.
- Some women experience the loss of their mucous plug over several days and may notice it as pink-tinged bloody spots or streaks. Other women experience the loss of their mucous plug in one go. In this case, the volume of blood will be greater and the loss of the mucous plug will be more noticeable. It can also happen without you noticing it.
- But, if you see discharge which might or might not be your mucous plug, and it is bright red in colour and not just a few drops you should contact your doctor right away, especially if you are feeling any pain.
- The loss of the mucousplug usually signals that labour is close by, though it can be up to two weeks before labour begins. Some women don’t lose their mucous plug until they’re in active labour. It is also known as bloody show.
- If bleeding and symptoms of labour begin before the 37th week of pregnancy, you might be in preterm labour also known as premature labour.
- They will check your cervix to see if it is opening too early. If it is, you may be going into premature labour or have an incompetent cervix.
- If either of these are diagnosed, they can be treated with labour-stopping medications or a cerclage (stitches).
Important: Learn to relax when stressed with pregnancy bleeding
As we saw, most causes of bleeding in early pregnancy are harmless. But, we understand the stress that they might be causing. Remember, your mind has immense powers over your body. Here are some recommendations:
- Do Shavasana with mindfulness for 30 minutes: After 1st trimester one can be in a side shavasan or supported by bolsters. Relax each body part and practice little breath awareness.
- Play soothing music of baby connection meditation or honouring oneself meditation.
- Listen to yoga nidra meditation, choosing a short 10 minute one or a longer 30 minute one, preferably after a warm shower.
Anxiety Management exercises:
- Do Pranayam, followed after gentle stretches and before meditation.
- Practice at night, before bedtime.
- Short practices can be done at any time if one feels stressed. Ideally the stomach should be empty.
- Always start with breath awareness and some simple abdominal or yogic breathing.
- Mahmrityunjay, for calming negative.
- Gayatri, for increasing energy and intelligence to the baby.
- Om, for general stress relief and peace of mind.
- Any prayers or verses from a holy book of your choice which you can concentrate on and anchor your breathing to.
Bleeding in Early Pregnancy: Ayurveda Drinks that soothe Body
Our ancient science of Ayurveda suggests these remedies for bleeding in early pregnancy. Of course, you need to consult a trained Vaid and check with your doctor, too.
- Liquorice drink: Medicated milk prepared with liquorice powder (1 glass of milk, 1 glass of water, 2 tsp of liquorice powder, boil till it reduces to half) drink twice a day. Liquorice has a cold potency and sweet taste that helps to alleviate pitta and rakta. The body feels cooler and settled.
- Indian Sarsaparilla: Medicated milk prepared with sarsaparilla powder (1 glass of milk, 1 glass of water, 2 tsp of sarsaparilla powder, boil till it reduces to half) drink twice a day. This drink is also known for it's cooling properties.
Pregnancy signals it's beginning with the stopping of monthly periods that don’t return till the baby is born. Hence, bleeding of any kind during this period is likely to make you anxious.
Do keep in mind that most cases of bleeding in early pregnancy do not end in miscarriage. Just be aware, be watchful and see your doctor.
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