How much blood is normal when pregnant

Many moms-to-be experience bleeding while they are pregnant. In fact, the American Pregnancy Association says studies show that 20-30 percent of women experience some degree of bleeding during early pregnancy. But how do you know how much bleeding is normal and when it’s a cause for concern? It depends on how far along you are, and how severe the bleeding is.

First, know how to tell spotting from bleeding. 

Spotting is very light bleeding. It is common in the first trimester. The blood will be light brown or pink, similar to what you see at the end of a period.

Bleeding is heavier. The blood is bright red and is more like the bleeding you experience when having your period.

If you’re thinking about it, call your doctor.

When to Call the Doctor

David McKenna, MD, a Maternal-Fetal Medicine specialist with Perinatal Partners, advises calling your doctor if you see any sign of bleeding during pregnancy and have not yet talked to your doctor about it. This is especially the case for women who are pregnant for the first time. “Explain what’s happening to your doctor. Talk about your next steps and if – and when – you should call back,” he says.

Why You May Bleed During Pregnancy

First Half of Pregnancy
Spotting during this time is common, especially after sex, a pelvic exam, or a transvaginal ultrasound. In these cases, the blood might be coming from the cervix. It becomes tender during pregnancy and could be a bit inflamed or irritated. This type of bleeding can also occur prior to a miscarriage or with an ectopic pregnancy, but most often it is not a cause for concern. 

Heavier bleeding during the first trimester can also be a sign of a miscarriage or ectopic pregnancy. This bleeding doesn’t mean a miscarriage will occur, or that you have an ectopic pregnancy. About half of pregnant women who have bleeding do not miscarry.  The most important thing you can do is to let you doctor know about any bleeding, so that you can evaluated for the cause.  

Second Half of Pregnancy
During the late second and entire third trimester, causes of bleeding can include:

• Placenta previa. This occurs when the placenta is low in the uterus and partly or completely covers the cervix. Most women notice no pain with the bleeding. Placenta previa occurs in 1 in 200 pregnancies and requires immediate attention when there is bleeding. Placenta previa often resolves on its own, especially when it is found early during pregnancy. Other times it can lead to an early delivery by Cesarean section.
• Placental abruption. This occurs when the placenta detaches from the uterine wall before or during labor. It can cause serious complications if it is not found early. It often comes with painful contractions. Placental abruptions are rare, occurring in just 1 percent of pregnant women. Risk factors for placental abruptions include maternal smoking, drug use and high blood pressure.  
• Preterm labor. Defined as labor starting prior to 37 weeks’ gestation, preterm labor might also include these signs: regular contractions, cramping, back pain and increased pelvic pressure. If you think you’re going into early labor, call your doctor right away.

Be Prepared for These Questions

If you experience bleeding during pregnancy, be ready to answer these questions when you call or visit your doctor:

• How far along are you?  
• When did you first have a positive pregnancy test?  
• Have you had an ultrasound, and if so, what did it show?
• When did the bleeding start?
• Were there any obvious causes? For example, have you recently had intercourse or a vaginal exam?
• How heavy has the bleeding been?
• Have you had any pain or other symptoms with the bleeding?

If you are asked to make an appointment, your doctor is likely to check your cervix with a speculum. You might have an ultrasound or other testing to help learn the cause of the bleeding.

Many factors can cause spotting and bleeding during pregnancy. Because of that, it’s best to talk with your doctor if you have any bleeding. The bottom line is, if you’re thinking about it, call your doctor.“That’s what we’re here for,” says Dr. McKenna.

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Source: David S. McKenna, MD; Perinatal Partners; American Pregnancy Association; The American Congress of Obstetricians and Gynecologists; Whattoexpect.com

Whether you’re early on in your pregnancy or about to pop, vaginal bleeding of any kind can be very scary and worrisome. Is this normal spotting or should you be concerned about your unborn baby?

In many cases, bleeding during pregnancy is normal. Where you are in your pregnancy and the severity of bleeding – whether light spotting or heavy bleeding – provide clues as to whether what you’re experiencing is normal or cause for concern.

Is there a difference between spotting and bleeding?

Spotting is light bleeding—the type of bleeding that wouldn’t cover a panty liner. Whereas bleeding is a flow of blood that’s greater than a drop here and there. It’s heavier in nature and would require a liner or pad to keep the blood from soaking through your underwear.

You should always let your provider know if you’re experiencing any type of spotting or bleeding, but the timing of when to seek help is key.

When should I seek help for vaginal bleeding during pregnancy?

If you notice pink, red or dark brown ‘spots’ smaller than a dime on undergarments or when you wipe, you can generally wait until your health care provider’s office opens to call and schedule an appointment.

“However, bleeding that soaks through a pad within an hour, and continues, requires urgent evaluation in the emergency room during the first trimester and early second trimester. Patients in mid-second trimester and beyond should go directly to the triage room in labor and delivery,” said Celia Valenzuela, MD, an OBGYN at Banner Health in Tucson, AZ. “Bleeding that is similar to your period in the third or mid to late second trimester always warrants evaluation.”

It’s important to know your blood type as some blood types may require special medication. If your blood is Rh negative, you’ll likely need medicine called Rh immunoglobulin or RhoGAM. Your provider can guide you through the timing of this. Learn more about Rh factor.

[Call 911 if you’re also experiencing intense cramping, a fever of 100.4 or higher, dizziness or thick vaginal discharge along with heavy bleeding.]

While it’s natural to go to worst case scenario at the sight of blood, read on to learn the potential causes for bleeding during the first trimester, second trimester and third trimester.

What are the most common causes of bleeding in the first trimester?

While seeing blood in your underwear can be unnerving, it’s not uncommon during the first trimester. While estimates can vary, about 1 in 4 pregnant people experience bleeding during the first trimester.

One of the most common causes of bleeding in early pregnancy occurs in the first few weeks during implantation, when the fertilized egg implants on the uterine wall.

“During pregnancy, pregnancy hormones can alter a person’s cervix, making it more sensitive and more susceptible to bleeding when touched,” Dr. Valenzuela said. “It’s not uncommon then to notice spotting or light bleeding after sex, insertion of a speculum, collection of a cervical specimen for pap test or culture and cervical examination for dilation.”

Problems that can cause bleeding in early pregnancy can include:

• Pregnancy loss or miscarriage: Roughly half of people who experience spotting in early pregnancy do miscarry, however this means half of women who spot, do not.
• Ectopic pregnancy: Usually, an ectopic pregnancy happens when a fertilized egg implants outside of the uterus. Symptoms of an ectopic pregnancy may include spotting or light bleeding and pelvic or belly pain. This is rare in pregnancies but is considered a medical emergency. “The amount of bleeding that you may experience can vary, though generally it is light prior to diagnosis,” Dr. Valenzuela said. “After an ectopic pregnancy is treated, you may have heavier bleeding as hormone levels decrease.”
• Molar pregnancy: A molar pregnancy is rare but occurs when abnormal tissue grows inside the uterus, instead of an embryo. You may think you’re pregnant, but an ultrasound shows no fetal heart rate. “Frequently, molar pregnancies are discovered during an ultrasound during the first trimester before bleeding has started,” Dr. Valenzuela said.
• Cervical or vaginal infections: Any infection of the cervix, vagina or a sexually transmitted infection like chlamydia, gonorrhea or herpes can cause bleeding.
• Cervical polyps: A harmless growth on the cervix that can result in bleeding during pregnancy.

“Many people frequently worry about miscarriage when they experience bleeding in the first trimester, and as a provider, we worry about this as well,” Dr. Valenzuela said. “Call your health care provider, so they can do the appropriate blood or ultrasound tests to identify the cause.”

What are the causes for vaginal bleeding later in pregnancy?

Like the first trimester, light bleeding or spotting during your second or third trimester may occur after sex or a cervical exam. It can also be due to a “bloody show,” a sign that labor is starting.

Problems that can occur later in pregnancy can be caused by placental abnormalities, such as placental abruptions or placenta previa.

“Placenta abruptions occur when the placenta separates partially from the uterine wall often resulting in very heavy bleeding,” Dr. Valenzuela said. “Placental previas occur when the placenta is placed over the opening of the cervix. Both require timely medical care.”

Bottom line

Not all spotting and bleeding are a cause for concern during pregnancy, but it’s best to get evaluated by your health care provider.

If you’re experiencing abdominal pain, cramping, unusual vaginal discharge, contractions, fever or soreness in the uterus, seek emergency care. These symptoms could be a sign of a serious problem or may even signal preterm labor.

How much bleeding is normal in early pregnancy?

How much blood is too much blood during pregnancy?

Can you bleed like a period in early pregnancy?