First trimester spotting
Even the smallest amount of blood is alarming - but never more so than during early pregnancy. So when exactly should you worry?
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Most spotting is simply that – spots of blood that can range in colour from light pink to dark brown, and it won’t affect you or your pregnancy.

The early days of pregnancy

The first trimester is a time of hormonal upheaval. The ovaries, which are used to producing oestrogen and progesterone with every menstrual cycle, must now hibernate and allow the placenta to do its work. The womb has an occupant (your baby), and that’s why you don’t experience a period or vaginal bleeding.

The womb also grows bigger. It normally leans slightly forward over the bladder, but by the end of the twelfth week, it stands upright like a light bulb so that it can grow into the abdomen where there is more space.

What causes spotting?

There are a number of causes of spotting. A common one is an implantation bleed, which is a very light bleed when the fertilised egg imbeds into the endometrium. This usually happens when a period is due.

Bright red blood, however, means trauma of some description. Because there is more blood flow to this area during pregnancy, bleeding can be caused by sex when there is slight tearing of the smaller lips covering the vagina (called the labia minora), the vagina or even the cervix. Undiagnosed fibroids in the womb may be disturbed by the changes of pregnancy.

A fibroid is a small non-cancerous growth that is usually symptomless before getting pregnant. These may bleed when the womb stretches and changes shape. More extensive fibroids could interfere with pregnancy during the second trimester or even cause premature labour during the third trimester. Continued bleeding would be symptomatic of this condition and needs to be investigated.

Brown, dark or mucous blood is a sign of old blood. This can be caused by an infection or injury higher up in the vagina. As long as there isn’t a bad smell and it does not happen again or get worse, there’s no need to worry.

When there is blood on the toilet paper after wiping, this can be confused with blood from the rectum. This may be bright red, fresh blood caused by haemorrhoids, a rectal polyp (noncancerous growth) or a tear to the rectum caused by constipation. Although you don’t need to panic, tell your doctor or midwife about this at your next visit.

A fall (no matter how insignificant) can traumatise the womb and cause vaginal spotting. Just rest for a few hours with your feet up, but if the spotting turns into bleeding, phone your doctor or midwife.

If you have an existing bleeding disorder you should tell your doctor about this before you get pregnant. You will need to be closely monitored by a specialist throughout your pregnancy.

Is it different to bleeding?

Spotting is a small amount of discharge. For example, there might be blood on the toilet paper when you wipe or you may need to wear a panty liner to avoid staining your underwear.

Bleeding, however, is when you need to wear and change a pad. Bleeding can often be confused with period blood.

Despite what women say on the television reality show I Didn’t Know I Was Pregnant, the fact remains – pregnant women don’t have periods. Therefore if you are pregnant and bleed (as much as a period), go visit your doctor immediately.

When to worry

When spotting turns into bleeding and you experience severe pelvic pain, a fever or feel extremely weak and anxious, this could be a sign of an ectopic pregnancy (baby growing outside the womb) and must be treated as an emergency.

Bleeding with period-like pain that becomes worse after having a warm bath can be symptomatic of an early miscarriage. Miscarriages are sometimes unavoidable, but if you have had repeated miscarriages, you should phone your doctor. Steps to prevent another miscarriage (like putting a stitch into the cervix), can be done early in the pregnancy and help prevent this problem. 

Women who are HIV positive or have an Rh blood incompatibility should take any vaginal bleeding seriously. Bleeding gives the virus an opportunity to be transmitted to the baby and a blood-group incompatibility can affect the health of the unborn baby.

Women who have conceived through in vitro fertilisation (IVF) should contact their specialist if they spot or bleed.

The cause may be insignificant, but you need to be monitored just the same.

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