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What Causes First Trimester Bleeding?

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Bleeding during pregnancy is often terrifying and may set off the panic attacks.

In case you experience bleeding during pregnancy, you should not panic, as it does not always indicate a problem with the pregnancy.

However, there is a difference you need to understand between normal pregnancy bleeding and bleeding that requires treatment from an obstetrician and gynaecologist.

Causes of Bleeding during Pregnancy

Bleeding during pregnancy or vaginal bleeding is common among pregnant women. It usually happens in the first trimester.

However, there have been cases of pregnancy bleeding indicating something serious.

For pregnant women, it is especially important to learn about the possibilities that could cause the bleeding. It is advised that you see your obstetrician and gynaecologist to make sure everything is fine. 

Bleeding Occurs in the First Trimester

About 20% of pregnant women experience vaginal bleeding in the first 12 weeks of pregnancy.

Read on to know more about the possible causes of first trimester bleeding.

Implantation Bleeding

You may experience blood spotting within the first 6 to 12 days of pregnancy. This occurs when the fertilised egg implants itself in the uterine wall.

At that point, some women often do not realize that they are pregnant. They would assume that they were on their menstrual period due to the very light bleeding that can last several hours to several days.


Miscarriage is the natural death of an embryo or fetus  which usually occurs before 20 weeks of gestation. Bleeding in the first trimester could be due to a possible miscarriage, as miscarriages occur most often in the first 12 weeks of pregnancy.

However, bleeding during the first trimester of pregnancy does not always mean a miscarriage.

Below are several symptoms of a miscarriage:

  • Contraction.
  • Weight loss.
  • Vaginal discharge 
  • Abdominal cramps and pain.
  • Severe headache 
  • Vaginal lumps and bumps.
  • Mild to severe back pains.

Ectopic Pregnancy 

Ectopic pregnancy is a phenomenon where a fertilised embryo implants outside the uterus, usually occurring in the fallopian tubes.

If the embryo continues to grow, this may result in the rupture of the fallopian tubes, which can be life-threatening for pregnant women. Though it is potentially dangerous, ectopic pregnancy only occurs in 2% of pregnant women.

It may be difficult to observe the difference between an ectopic pregnancy and a normal pregnancy.

There are several symptoms of an ectopic pregnancy that you should be aware of, such as:

  • Headache.
  • Weakness.
  • Shoulder pain.
  • Vaginal bleeding.
  • Severe lower abdominal pain, especially on one side.

Molar Pregnancy

Molar pregnancy is a very rare condition caused by abnormal tissue growing in the uterus. In this condition, there is no formation of fetal tissue. 

A molar pregnancy can lead to serious complications if the tissue is cancerous and spread to other parts of the body.

Here are some symptoms of molar pregnancy: 

  • Pain and tenderness in the hips.
  • Extreme nausea and vomiting.
  • Enlarged uterus 
  • Bleeding or spotting from the vagina in the first trimester – the blood is usually bright red to dark brown in color

Apart from what is mentioned above, sexual intercourse and a pap smear test can also cause bleeding. It is because the movement or the test is in contact with the cervix, which triggers a mild infection.

Bleeding Occurs in the Second or Third Trimester 

Compared to the first trimester, bleeding during the second and third trimesters often leads to more serious problems, especially if abnormal bleeding is experienced. This may indicate something is wrong with the mother or the baby. 

You should consult your obstetrician and gynaecologist immediately if you experience bleeding in the second or third trimester.

There are several possible reasons why bleeding occurs:

Placenta Previa

Placenta previa can occur when the placenta is in the lower part of the uterus and covers almost the entire surface of the birth canal. The frequency of this disorder is only about 1 in 200 cases. 

Bleeding with placenta previa is painless. You should immediately get yourself examined if you experience the condition.

Vasa Previa

The condition of vasa previa is extremely rare. This occurs when the baby’s blood vessels develop in the umbilical cord or placenta, then pass through the opening to the birth canal.

Vasa previa disorder is very dangerous for both the mother and the baby, as the blood vessels can tear at any time and put the baby at risk of heavy bleeding and loss of oxygen.

Placental Abruption

Placental abruption is a pregnancy complication, in which the placenta detaches from the inner wall of the uterus before birth. This complication occurs in about 1% of pregnant women.

Placental abruption can danger both the mother and baby. 

The following are signs of placental abruption:

  • Uterine tenderness or rigidity
  • Abdominal pain
  • Back pain
  • Vaginal bleeding 

Preterm labor

If you experience vaginal bleeding or any signs or symptoms of labor before 37 weeks of pregnancy, do not wait to call your obstetrician and gynaecologist as you may be having preterm labor.

Vaginal bleeding late in pregancy may indicate that your body is getting ready to give birth.

A few days or a few weeks before labor begins, amniotic fluid that surrounds the surface of the uterus will come out of your vagina.

Treatment by Obstetrician & Gynaecologist (OBGYN) 

To identify the cause of bleeding during pregnancy, you should undergo a pelvic exam or blood test to check the hormone levels in your body.

Your obstetrician will ask you about the symptoms experienced, such as cramps, pain, and dizziness.

If you only experience mild symptoms and your baby is doing fine, you would most likely be asked to undergo outpatient procedures.

However, in some severe cases, you may be admitted in order for the doctor to conduct additional tests. Inpatient care will make it easier for the medical personnel to act quickly in case further treatment is required. 

Things to Do When Bleeding Occurs During Pregnancy

If you experience bleeding during pregnancy, here is what you can do: 

Wear Menstrual Pads 

Wear a menstrual pad to observe and track how much you are bleeding and note the color of the blood – it can be bright red or dark brown. Try not to wear tampons or engage in sexual intercourse as long as you are still bleeding.

Check Yourself into The Hospital

If you experience heavy vaginal bleeding and abdominal pain, you should head to a hospital emergency room for immediate treatment, as this may be a sign of a miscarriage or other serious problems.

Get an Ultrasound

Your doctor may recommend an ultrasound to identify the actual cause of the vaginal bleeding. An ultrasound will make it easier for your doctor to observe the condition of your uterus.

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