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The sight of any unusual vaginal discharge during pregnancy is alarming, especially if it looks like it might be blood. Bleeding during pregnancy is actually not that uncommon, and it doesn’t always mean there’s a problem.

Depending on the stage of your pregnancy and your other symptoms, there’s a long list of reasons you might see pinkish or brownish discharge.

If you’re not pregnant and your period or discharge is pinkish or brownish, it could be totally normal, or it could be a sign of hormonal imbalance, among other things. Check out this decoder key for the color of your period.

It might sound confusing that you can be pregnant and still have what looks kinda like a period at the same time. Spotting — light bleeding that’s pink, brown, or red — is common during early pregnancy, and it’s usually nothing to worry about.

Here are the likely explanations:

Implantation bleeding

When a fertilized egg attaches to your uterine wall (1 to 2 weeks after fertilization), you may have spotting that lasts a few hours to a few days. This is called implantation bleeding.

You might even think it’s your period, since it’s too early to know you’re pregnant. Not every woman notices implantation bleeding, but it’s harmless.

Cervical irritation

Light bleeding after sex or a gynecological exam might be due to irritation of your cervix. Your cervix will be more sensitive and have more blood flow during pregnancy. Cervical irritation will not cause a miscarriage, but it’s best to have a doctor check it out.

Ectopic pregnancy

If a fertilized egg implants somewhere other than your uterus — usually in a fallopian tube — it’s an ectopic pregnancy. Ectopic pregnancies are not viable and can be dangerous if the fallopian tube ruptures. An estimated 1 to 2 percent of pregnancies are ectopic.

The symptoms include strong cramping or sharp pain in the abdomen, low levels of the pregnancy hormone human chorionic gonadotropin (hCG), and vaginal bleeding.

Miscarriage

Miscarriage is a heartbreakingly common experience, occurring in 10 to 15 percent of known pregnancies. While bleeding in early pregnancy can be a sign of miscarriage, it might also be what’s called a threatened miscarriage.

With a threatened miscarriage, there’s cramping and bleeding, but the pregnancy continues. Research has shown that 17 percent of women who experience threatened miscarriage have further complications later in pregnancy.

Other causes of spotting in early pregnancy

While it’s not usually dangerous, spotting can happen after sex, gyno exams, and heavy lifting or exercise. Some pelvic infections or a urinary tract infection may also cause bleeding during pregnancy.

Just as in the first trimester, your cervix may bleed when irritated in the second trimester. Here are other possible causes of spotting during the middle of your pregnancy:

Cervical polyp

Increased blood vessel growth around your cervix can cause harmless growths called cervical polyps. Like an irritated cervix, polyps may bleed after sex or medical exams.

Placenta previa

Bleeding is possible when the placenta is located low in your uterus, near your cervix. Placenta previa happens in about 0.5 percent of pregnancies (about 1 in 200) and must be monitored by a doctor.

The risk of placenta previa is higher for women who have previously had a cesarean delivery or other uterine surgery.

Preterm labor

Another cause of second trimester spotting is preterm labor, which is when regular contractions and cervical changes happen before 37 weeks of pregnancy.

Signs include:

  • regular or frequent contractions
  • low, dull backache
  • pelvic pressure
  • mild abdominal cramps
  • vaginal spotting or light bleeding
  • your water breaking
  • changes in vaginal discharge

Late miscarriage

While it’s less common than in the first trimester, miscarriage can occur during the second trimester. Some causes include womb structural issues, infections, certain medications, and untreated health conditions such as diabetes and high blood pressure.

Mucus plug

During pregnancy, your cervix becomes blocked by a mucus plug, which will come out as you near delivery. Discharge increases and may be sticky and pink. This can happen a few weeks or a few days before labor.

Heavy bleeding concerns

Placenta previa, described above, may cause heavy bleeding and should be monitored by your healthcare provider. Heavy bleeding is a dangerous complication at any time during pregnancy.

Placental abruption (when the placenta detaches from the uterine wall) may also cause heavy bleeding. It occurs in 1 percent of pregnancies, usually in the last 12 weeks. Signs include bleeding and abdominal pain.

In some cases, the placenta may grow deeply into the uterine wall, a condition called placenta accreta. This may cause life threatening blood loss during delivery, but it can often be detected by ultrasound in advance. Delivery requires careful planning to protect mother and baby. A hysterectomy is often inevitable.

In vasa previa, membranes between the umbilical cord and placenta lie near the cervix and may rupture right before labor. There is a risk of massive blood loss for both mother and baby.

If vasa previa is detected by ultrasound, a cesarean delivery will be planned at 35 to 37 weeks. While dangerous, the condition occurs in only about 1 in 2,500 pregnancies.

These are all scary but unlikely scenarios. They can be life threatening but, if properly monitored and treated, can still result in a healthy baby and mom after delivery. The best steps are to be informed and follow up with your healthcare providers for evaluation and delivery planning.

Most miscarriages happen in the first trimester, and in most cases, they can’t be prevented. But having one doesn’t mean future pregnancies will also end in miscarriage.

The main symptoms of miscarriage are vaginal bleeding, cramping, and tissue passing through the vagina. Other signs include back pain, weight loss, pink discharge, painful contractions, and a sudden decrease in pregnancy symptoms.

The term “miscarriage” applies to a pregnancy loss up to 20 weeks. Later losses are considered stillbirth.

Support

Miscarriage affects many people, and we don’t talk about it enough. If you’ve experienced a miscarriage, it’s important to remember that you didn’t cause it and couldn’t have prevented it.

Speak to your healthcare provider and family about emotional support and physical healing after a miscarriage.

Thin, white discharge (aka leukorrhea) is totally normal during pregnancy. Notify your healthcare provider any time discharge varies, smells bad, or is colored.

You should also mention any spotting or bleeding, especially if it’s enough to fill a pad or tampon, lasts longer than a day, or is accompanied by pain.

Here are some general guidelines for treating bleeding during pregnancy:

During weeks 1 to 12

  • If you have spotting or light bleeding that goes away in a day, tell your healthcare provider at your next appointment.
  • If bleeding lasts longer than a day, tell your provider within 24 hours.
  • If you have moderate to heavy bleeding, pass tissue from your vagina, or have abdominal pain, cramping, fever, or chills, call your doctor immediately.

During weeks 13 to 24

  • Contact your healthcare provider the same day if you have light bleeding that lasts a few hours.
  • Call your provider immediately if you have any bleeding that lasts longer than a few hours or is accompanied by abdominal pain, cramping, fever, chills, or contractions.

During weeks 25 to 40

  • Call your doctor immediately if you have any vaginal bleeding or abdominal pain.

While spotting is common in the first trimester, it may signal problems later in pregnancy. No matter how far along you are, tell your healthcare provider if you have spotting, bleeding, or changes in discharge.

Some complications can be treated and still result in a healthy baby.