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Why do I have spotting or mild bleeding in early pregnancy?

It is common to have some bleeding in early pregnancy.  It may occur in 20% (or one out of five) mums to be, and it is unlikely to be harmful to your baby.  It usually happens at about the same time that your period would have been due, and may last for a couple of days.  The bleeding is usually light (no large clots) and is not accompanied by strong period pains.

There are many different causes for bleeding in pregnancy, and in the first trimester the bleeding may be caused by:

  • Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle.  This causes some the endometrial lining to be shed.  Spotting or light bleeding may come and go for several days.
  • Implantation bleeding:  which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply.  The implantation may therefore be associated with some light bleeding.
  • Other causes:  which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix.  These cells are more prone to bleeding, especially when touched during intercourse.  It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells.  Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment.  A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy.  A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.

Bleeding in early pregnancy is common but it’s important to tell your doctor about it.  At Alana we will perform a physical examination which may include a speculum examination to see if the cervix is open or not and what the cervix looks like in general.  Depending on other symptoms we may take a vaginal swab if we think there is an infection.  We may also perform an (internal) ultrasound to measure the gestation and to determine where the pregnancy is located.

We would recommend testing your pregnancy hormone level (“quantitated HCG”) which also helps in dating the pregnancy, and we would test your blood group.

In general if the bleeding is light and settles down, and is not accompanied by bad period type pains, there is a good chance that all is well and that your baby is fine.