Bleeding in Pregnancy

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MH speaks to the experts to find out what’s normal and when it’s time to worry.



Even when not pregnant, unexpected bleeding is almost always a cause for concern – except when you’re on your period of course. When expecting, vaginal bleeding can feel like a very scary experience. This can range from spotting (light bleeding) to a heavy discharge, and varies in colour and consistency.


The good news: not all bleeding is bad, and not all cases signify danger for the mother and baby. In fact, according to Dr Serene Lim, associate consultant in the Department of Obstetrics and Gynaecology at Singapore General Hospital, bleeding in the first trimester is fairly common, occurring in about 30 per cent of cases.


“The significance of bleeding depends on the gestational age of the pregnancy, amount and duration of bleeding and whether there are any associated symptoms such as abdominal pain and reduced foetal movements,” she says.


Bleeding During the First Trimester


There are several causes for bleeding during the first trimester of pregnancy, and a common cause of spotting in particular, is implantation bleeding. This occurs when the embryo implants itself on the uterine lining. Often, this happens even before the mother realises that she is pregnant and may last for a few days.


Another common cause is a cervical polyp, a painless growth in the cervix which can bleed as a result of increased oestrogen levels. Conversely, cervical ectropion – an erosion that causes the cervical canal to turn outward – is also caused by a hormonal change and can result in bleeding as well.



Other causes for bleeding during the first trimester

of pregnancy include miscarriage and ectopic pregnancy,

which occurs when the embryo attaches outside the uterus.



Molar pregnancy arising from a problem at fertilisation, which results in an abnormal embryo and placenta to develop, as well as cervical cancer, are also some rare causes for such bleeding.


Second and Third Trimesters


Beyond the first trimester, vaginal bleeding is a larger cause for concern in the later stages of pregnancy. If this happens during the second and third trimesters, it can be caused by placental abruption (when the placenta detaches from the uterine wall), placenta praevia (low-lying position of the placenta) or other serious complications related to the placenta or uterus.


“If it occurs when the baby is premature, it can be a symptom of a late miscarriage (if it occurs in the second trimester) or preterm labour. Sometimes infection and cervical problems such as a polyp or ectropion and rarely cervical cancer can also cause bleeding during the second and third trimesters,” says Dr Lim.


Bleeding can even happen late in pregnancy, and the most common form of this is called a bloody show, which is a blood-stained mucous discharge which is a sign of the onset of labour. Get ready, baby’s coming! If you’re already full-term and there are no other symptoms, this is completely normal.


Taking Action


However, if the bleeding is more than bloody mucus, the pregnancy is preterm, or there are other symptoms such as painful contractions, water bag breakage or reduced foetal movements, seek medical attention immediately.


Whatever the case and whichever stage you are in, Dr Lim advises that it is always best to report all cases of bleeding to your doctor, even if the bleeding eventually stops.


The amount of bloody discharge that appears does not necessarily signify the seriousness of the situation either. Spotting can be a result of harmless implantation as much as it can be a sign of a miscarriage or ectopic pregnancy.


So if you are seeing red down below, just keep calm and pay your doctor a visit.

Thanks for sharing!