Spotting is usually light and brown, although heavy spotting can be red. A person who is spotting might need only a panty liner rather than more absorbent menstrual supplies to manage the flow. However, there are many possible reasons for spotting in a normal, healthy pregnancy. These include the following.
Irritation of the Cervix
The cervix can become irritated and bleed following sexual intercourse, a recent pelvic exam, or a transvaginal ultrasound. The cervix becomes very vascular during pregnancy and can sometimes bleed with minimal contact. This bleeding is not dangerous, other than making you fear that something could be wrong. It is not necessary to avoid intercourse (or pelvic exams or ultrasounds) in early pregnancy.
Implantation Bleeding
When the fertilized egg implants in the uterine wall, spotting may occur (see below). This is also not a cause for concern.
Cervical Ectopy
Cervical ectopy is the invasion of cells that are normally present in the uterus or cervical canal to the surface of the cervix. These delicate cells have a tendency to bleed with very little irritation. Ectopy is more common in pregnant people who have experienced vaginal childbirth in the past and those who have used birth control pills for an extended period of time. This type of spotting is also harmless.
Cervicitis
Infection of the cervix (cervicitis) refers to inflammation of the cervix and is most commonly caused by infections. These can be sexually transmitted infections (STI) such as chlamydia, gonorrhea, trichomonas, or genital herpes, or non-sexually transmitted infections such as bacterial vaginosis. Cervicitis may also be caused by irritation from a diaphragm or an allergy to the latex in condoms. If cervicitis is caused by an infection, it’s important for that to be treated. If STIs are allowed to progress, they can become harmful to your fetus and pregnancy. Often, other symptoms will also be present with STIs, such as fever, a burning sensation or bumps or blisters in or around the vaginal area, or a foul-smelling vaginal discharge. Contact your doctor if you have any of these symptoms or if you are concerned you may have an STI or other infection.
2nd and 3th Trimester Causes of Spotting
When spotting occurs later in pregnancy (in the second and third trimesters), often the cause is not known and the spotting does not indicate any problems, particularly if the spotting is light and temporary. However, particularly in the second half of pregnancy, spotting, especially if it progresses to heavier bleeding, can be concerning. More serious conditions that may include spotting include:
Placenta previa occurs when the placenta is placed over the opening to the cervix. A C-section delivery may be necessary unless the placenta moves away from the cervix. Placental abruption: Separation of the placenta from the uterine wall before delivery often results in very heavy bleeding, but at times the bleeding is contained above the placenta and only spotting occurs. This can result in preterm birth or other pregnancy complications, including pregnancy loss. Labor: When the cervix begins to dilate in early labor. it is common to have a “bloody show.” So, if you’re close to term and have spotting, labor may be starting.
Spotting may result in redness on your underwear or require you to wear a panty liner. Bleeding that is heavy enough to require a menstrual pad is usually referred to as vaginal bleeding rather than spotting, and should be evaluated by your doctor. Implantation bleeding occurs when the fertilized egg implants in the uterus, around 10 days after ovulation. Most often women notice only a tinge of red on their panties or on toilet paper, though sometimes it may be heavier.
