Vaginal bleeding during pregnancy is never considered a normal occurrence and always warrants medical attention. Because the severity of bleeding ranges from a minor event to a serious obstetric emergency, determining the appropriate level of care is essential. This guide helps triage symptoms, providing direction on when to seek emergency services versus when to call your healthcare provider. This information is not a substitute for professional medical advice.
Symptoms That Demand an Immediate ER Visit
A rapid, heavy loss of blood requires immediate attention in an emergency setting. Heavy bleeding is defined as soaking through a standard sanitary pad in one hour, or less, for two consecutive hours, or passing blood clots larger than a golf ball. This volume of blood loss can quickly lead to shock.
Immediate emergency department evaluation is also necessary if severe symptoms accompany the bleeding. These signs include intense abdominal or pelvic pain, especially if the pain is one-sided or radiates to the shoulder. This type of pain, particularly in early pregnancy, could suggest a ruptured ectopic pregnancy.
Other symptoms requiring emergent care include signs of hypovolemic shock, such as dizziness, lightheadedness, or fainting. A fever of 100.4 degrees Fahrenheit or higher, chills, or a sudden decrease in fetal movement in the second or third trimester also warrant prompt assessment.
When to Contact Your Healthcare Provider
If bleeding is present but does not meet the criteria for a severe emergency, contact your obstetrician, midwife, or clinic first. This applies to light spotting, which may appear pink, brown, or light red and does not saturate a pad. This type of bleeding is often seen as a few drops or only when wiping.
Light bleeding that quickly stops, or is associated with a specific event, should also be reported. For instance, spotting after sexual intercourse or a pelvic examination is often due to the increased blood flow and sensitivity of the cervix during pregnancy.
Your medical team needs to be aware of all bleeding episodes to monitor the pregnancy and rule out complications. If the office is closed, utilize their after-hours advice line. They will determine if an urgent office visit, lab work, or an ultrasound is necessary for a complete evaluation.
Understanding Potential Causes of Bleeding
The potential causes of bleeding differ significantly depending on the stage of pregnancy. In the first trimester, a common, self-limiting cause is implantation bleeding, which occurs when the fertilized egg attaches to the uterine lining. Bleeding can also result from changes to the cervix, where hormonal shifts increase blood flow and sensitivity.
More serious first-trimester causes include a threatened miscarriage, where bleeding occurs but the pregnancy is still viable, or an ectopic pregnancy, where the fertilized egg implants outside the uterus. Early bleeding with a confirmed fetal heartbeat often results in a continuing pregnancy.
Bleeding in the second and third trimesters is less frequent and may signal more significant complications. Conditions such as placenta previa, where the placenta covers part or all of the cervix, or placental abruption, where the placenta prematurely separates from the uterine wall, are concerning later-term causes. Toward the end of pregnancy, a small amount of pink or bloody mucus, known as “bloody show,” can indicate the beginning of labor.