Spotting during pregnancy is a frightening event for most women, but it doesn’t always mean there’s something wrong with the pregnancy or that miscarriage is inevitable. Women spot during pregnancy for several reasons. Spotting is most common in the first three months of pregnancy and occurs in 20 to 25 percent of pregnancies; 50 percent of women who have spotting go on to have a healthy pregnancy.
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Some women have a small amount of spotting as the embryo burrows into the uterine lining. Implantation spotting usually occurs 10 to 14 days after fertilization, which is about the time of the first missed period, the March of Dimes states, and is lighter and usually lasts a shorter time than a regular period. Implantation spotting may be accompanied by cramping.
Many women have a cervix described as friable, meaning that it’s irritated and slightly inflamed. During pregnancy, blood volume is increased, which can make the cervix even more likely to bleed if irritated. Friable cervical tissue can bleed during pregnancy after sex, from a pelvic exam or just from normal daily activities. A friable cervix can also be the result of bacterial infection or sexually transmitted disease, which will need treatment. Your doctor can take vaginal swabs to diagnose the cause of a friable cervix during a pelvic exam and treat as needed.
Spotting can be the first sign of a potential miscarriage. Fifty percent of miscarriages occur because the embryo is chromosomally abnormal, and around 30 percent because no embryo has developed, the University of Washington states. Doctors often refer to spotting as a threatened miscarriage or abortion. If miscarriage is inevitable, heavy bleeding will start, and brownish or pinkish spotting will turn bright red.
Spotting may be the first sign of an ectopic pregnancy, a pregnancy that implants in the fallopian tube rather than in the uterus. If spotting is accompanied by abdominal pain, contact your doctor immediately, because the tube can rupture. This is a life-threatening emergency.
In some pregnancies, a clot develops between the uterus and the chorionic membrane, the outer sac that surrounds the fetus. This is called a subchorionic hematoma. Hematoma means a blood clot or collection of blood. Twenty percent of women with early spotting have a subchorionic hematoma, the University of Utah explains. Large subchorionic hematomas increase the risk of miscarriage, preterm delivery, placental abruption, in which the placenta separates prematurely from the wall of the uterus, and stillbirth. Small hematomas usually resolve on their own, according to the University of Utah. Followup with ultrasound will be done to ensure the area is healing.