Discharge And Spotting During Pregnancy: Should You Be Worried?

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Pregnancy is a joyful time – you’re anticipating your bundle of joy, after all. However, it can also be a really awkward phase. The changes your body goes through are a mix of magical, surprising and, let’s face it, downright gross. One of the things many women experience is discharge and spotting during pregnancy. It can be scary when it happens as you’re undoubtedly wondering if it’s normal or if it’s a sign that something is wrong with your pregnancy

Dr Freda Khoo, consultant gynaecologist and obstetrician at Freda Khoo Clinic for Women, says that discharge and spotting during pregnancy is not uncommon – it can happen in up to 20 to 30 per cent of pregnancies. It is usually harmless and does not lead to any adverse complications. However, there are some conditions which we need to be on the lookout for. 

First, understand the terms

“Spotting during pregnancy would refer to any form of blood from the vagina – pink streaks, fresh red blood or altered blood, which would be brown in colour,” exlains Dr Khoo, who adds that spotting and bleeding are two different things.

Spotting during pregnancy refers to light vaginal bleeding and she cites examples such as small streaks of pinkish stains on the underwear or upon wiping, or small spots of bleeding of about 1-2 cm in diameter. Bleeding, on the other hand, would mean a relatively larger amount of blood extruded. It would look like a proper menstrual flow. 

On the other hand, discharge refers to fluid which might be clear, or at times yellowish or greenish. Dr Khoo says it’s normal to experience an increased amount of vaginal discharge in pregnancy. This is because changes in hormone levels and an increased amount of blood flow to the pelvic area leads to the cervix producing more mucus, which results in an increased amount of vaginal discharge. For example, white discharge during pregnancy is normal.

“Normal, or ‘physiological’ vaginal discharge in pregnancy is typically clear or milky white in colour. It is thin and fluid, sometimes slightly white and mild-smelling,” she adds. “When vaginal discharge in pregnancy becomes thick and curd-like, or greenish with an offensive smell, then it is a sign that there is a vaginal infection. Infections could be yeast infections or bacterial infections. When this happens, one should see a doctor for treatment.”

spotting during pregnancy
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Why do I have discharge and spotting during pregnancy?

There are several reasons you could have spotting during pregnancy. Spotting in the first trimester is most commonly due to implantation bleeding and cervical changes. Implantation bleeding – slight bleeding during pregnancy – is harmless. It is often light and occurs during the time when the fertilised egg is attaching itself to the uterus. 

However, Dr Khoo notes it is important to rule out more serious causes like a threatened miscarriage, an ongoing miscarriage or an ectopic pregnancy.

“In pregnancy, changes in hormone levels and increased blood flow to the pelvis make the cervix more prone to bleeding, especially after increased physical activity or at times, after sexual intercourse. This bleeding is coming from the cervix and is also harmless,” she explains.

There are times, though, when spotting in the first trimester might mean that the pregnancy is not stable and is a sign of a threatened miscarriage. This might be accompanied by lower abdominal cramps. In such cases, your doctor might prescribe you some medications to help stabilise your pregnancy. 

“An ectopic pregnancy refers to a pregnancy that is occurring outside of the uterus; it most commonly occurs in the fallopian tubes,” Dr Khoo reveals. “An ectopic pregnancy might also present with spotting and abdominal pain. An ectopic pregnancy cannot be kept and must be removed, or it will be a threat to the mother’s life.”

If you’re spotting during pregnancy beyond the first trimester, it might be due to other causes like placenta praevia, vaginal infections or even placental abruption. 

Dr Khoo shares that placenta praevia occurs when the placenta attaches itself in the lower portion of the uterus, resulting in the placenta partially or fully covering the cervical opening. This could cause vaginal bleeding. Vaginal infections might cause spotting too, accompanied by vaginal discharge with itch or smell. Dr Khoo says these infections need to be treated, or it may lead to adverse pregnancy outcomes like preterm labour. 

As for placental abruption, it is a medical emergency and usually presents with voluminous bleeding and intense abdominal pain. When such symptoms occur, one needs to rush to the hospital for immediate attention, says Dr Khoo.

spotting during pregnancy
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Should I be worried?

So how can you tell if your discharge or spotting during pregnancy is harmless or if you need to see a doctor? Dr Khoo acknowledges that “it is difficult to differentiate between the various causes of spotting on your own”.

“However, as a general guide, if the spotting is very little, then the cause for concern would be less,: she says. “On the other hand, if the amount of spotting is considerable and increasing, then you should be more concerned.

“Having said that, it is generally a good idea to consult your doctor if you do experience any spotting during pregnancy. Only a detailed history, a bedside examination together with an ultrasound scan would allow your doctor to differentiate between the various causes and advise you accordingly,” she adds.  

There are also other symptoms you should pay attention to. For example, if the spotting during pregnancy is relentless, increasing in amount or is accompanied by lower abdominal cramps, Dr Khoo advises to consult a doctor. Other symptoms to watch out for are pain at the shoulder tip, lightheadedness or feeling faint. These are symptoms of internal bleeding from an ectopic pregnancy, says Dr Khoo. 

If you’re worried about discharge or spotting during pregnancy, there are ways you could prevent or minimise it. Dr Khoo tells us that, at times, spotting might be precipitated by sexual activity or increased physical activity, so cutting down on sexual activity or physical activity might help to decrease the occurrence of spotting. And, if spotting is due to a threatened miscarriage, medication might help to support the pregnancy. She advises to speak to your doctor about it. 

“There are a myriad of causes of spotting during pregnancy and it is generally a good idea to consult your doctor to differentiate between the various causes before any advice should be given or followed,” she adds.

spotting during pregnancy
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Common scenarios for discharge and spotting during pregnancy

Dr Khoo takes us through some scenarios that could happen during pregnancy and whether or not you should worry about them:

1. Light bleeding in the first trimester

At most times this could be due to implantation bleeding or cervical changes in pregnancy. This is most likely harmless. However, sometimes miscarriage could also present with a light bleeding initially.

2. Heavy bleeding without pain

This would be alarming and medical advice should be sought immediately. Different causes would be miscarriage, placenta praevia or placenta abruption. 

3. Pinkish brown discharge

Brown discharge just represents altered blood; it likely means that the bleeding has been slow and of small volume, and has had time to oxidise before it is extruded from the vaginal canal. There could be a variety of causes for this, ranging from miscarriage to cervical polyps to placenta praevia.

4. Discharge with unpleasant smell

If the discharge accompanies with it an unpleasant smell, this could mean that there is a vaginal infection. It can be treated with either oral tablets or vaginal pessaries. 

5. Discharge with itching and burning

Likewise, symptoms of itching and burning also signifies an element of infection. You should consult your doctor for advice and medication.