Difference between spotting and bleeding

Spotting:

• Blood that is visible on your underwear or the toilet paper when you wipe after urinating.
• Appears as light brown or pink spots.
• Does not require a pad or panty liner.

Bleeding:

• Is bright red.
• Flows like in a period.
• Requires a sanitary pad to manage.

Bleeding in Pregnancy: Important First Steps to Take

If in the first trimester:

• Keep track of how heavy it is, if it gets heavier or lighter, and how many pads you are using.
• Lie down and rest for 24 hours.
• Check the colour of the blood like brown, dark or bright red.
• See a doctor after 24 hours.
• If cramping, dizziness, or in 2nd or 3rd trimester, see a doctor immediately.

Coping with Bleeding During the First Few Weeks of Pregnancy

Triggers:

• Sex:  Pregnancy hormones make the cervix drier causing blood vessels to rupture easily. It also has a higher blood supply now. Transvaginal ultrasound or PAP smear can cause it, too.
• Implantation bleeding:  Fertilization occurs in the fallopian tubes.  When the fertilized egg travels down the tube and attaches itself to the wall of the uterus, some bleeding might occur for some women.
• Old blood:  Previous period’s blood comes out as ‘brown discharge’. It looks like coffee sediment and generally resolves in a day or two.
• Infections: Chlamydia, gonorrhoea, or herpes.
• Miscarriage: Because miscarriage is most common in the first 12 weeks of pregnancy, first-trimester bleeding is a cause for worry. However, 90% of women who bleed don’t miscarry.

When to Worry About Bleeding in the 1st Trimester

If your bleeding has lasted for more than a day, the doctor will do an ultrasound to see if the pregnancy is safe.

Let’s look at the kinds of losses:

• Missed abortion: A miscarriage in which the foetus didn’t form or is no longer developing, but the placenta and embryonic tissues are still in your uterus.
• Ectopic pregnancy: Your fertilized egg has mistakenly attached somewhere outside the womb, possibly in the fallopian tubes-the connections between the ovaries and the womb. An ectopic pregnancy happens in up to 2.5 % of all pregnancies.
• Molar pregnancy: This happens when the placental tissue grows abnormally due to a genetic error during fertilization.

Signs of Miscarriage in 1st Trimester

Bleeding during a miscarriage can look like coffee sediment or it can be pink to bright red.

If you miscarry before you're 8 weeks pregnant, it might look the same as a heavy period.  The blood may appear brown or bright red and may be accompanied by clots or tissue with a gush of clear or pink fluid or discharge (amniotic fluid).

Look out for these signs of miscarriage:

• lower abdomen cramping and pain.
• vaginal discharge of fluid or tissue.
• disappearing symptoms of pregnancy (nausea, breast tenderness).

1st Trimester: Action needed

Ultrasound to check foetus and heartbeat. Blood test to measure HCG.

HCG test will be done twice 48-72 hours apart to see if it's doubling.

2nd or 3rd Trimesters

Causes:

• Placenta previa: Low placenta that partially or completely covers the opening of the birth canal. Occurs in only 1 in 200 pregnancies. Could be partial, low-lying, marginal, and major or complete placenta previa. ‍
• Placental abruption: In about 1% of pregnancies, the placenta detaches from the wall of the uterus before or during labour and blood pools between the placenta and uterus. It is dangerous. If your placental abruption is small, bed rest may help. For a moderate separation, hospitalization is needed.
• ‍Uterine rupture: In rare cases, a scar from a previous C-section can tear open during pregnancy. It can be life-threatening and requires an emergency C-section.  ‍
• Vasa previa: In this very rare condition, the developing baby's blood vessels in the umbilical cord or placenta cross the opening to the birth canal.  ‍
• Subchorionic Haematoma: The chorion membrane is a thin layer between your placenta and the uterine wall. Sometimes, blood collects in the folds of the chorion.

In all these cases, the doctor will admit you and take the right surgical and non-surgical options.

Miscarriage in 2nd / 3rd trimester

In uncommon cases, pregnancy can be lost in the later trimesters.

The signs are:

• No movement of the foetus
• Vaginal bleeding or spotting
• Back or abdominal cramping
• Unexplained fluid or tissue passing from the vagina

In case of loss, either delivery is induced or foetus is removed via dilation and evacuation, also known as D and E.

3rd Trimester: Sign of Labour

• As your cervix begins to open, the mucous plug will pop out, and you may experience stringy and mucousy spotting.
• Some women experience the loss of their mucous plug over several days and may notice it as pink-tinged bloody spots or streaks.
• Loss of the mucous plug signals labour is close by though some women don’t lose their mucous plug until they’re in active labour.
• If before the 37th week, you might be in preterm labour.
• If an incompetent cervix,  a cerclage (stitches) will be placed.
• Labour-stopping medications might be given.

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