Spotting (Light Vaginal Bleeding) in Early Pregnancy: What Does It Mean and What to Do About It

Spotting or light bleeding during early pregnancy can cause a great deal of alarm to the unsuspecting woman. However, as long as the bleeding does not progressively increase in amount and is not associated with abdominal cramping it is usually innocent and does not lead to miscarriage. Such innocuous bleeding is often due to local trauma to that part of the cervix that protrudes into the upper vagina. It often results from the hormonal changes in early pregnancy, that causes the fragile, delicate glandular lining of the inner cervical canal to roll outward (evert), exposing the delicate surface of the inner lining of the cervical canal to abrasive vaginal secretions. In some cases, trauma at the time of sexual vaginal penetration or mechanical irritation caused by vaginal suppositories will traumatize the “everted” inner cervical lining, causing local bleeding

This having been said, any bleeding in pregnancy warrants prompt investigation to make certain that the conceptus is viable, exclude an inevitable miscarriage and sometiumes an ectopic pregnancy. A speculum examination must be done to examine the cervix for signs of an eversion and local bleeding. In pregnancies beyond 5 weeks, this should always be followed by a vaginal ultrasound examination, to confirm the existence of a viable intrauterine gestation that is appropriately developed for the stage of pregnancy, exclude intrauterine bleeding and in the event that no intrauterine pregnancy is observed, and to try and exclude a tubal (ectopic) pregnancy.

Women who present with such vaginal “spotting” should be advised to avoid sexual vaginal penetration until the bleeding has stopped for at least 1 week. Orgasm should not be discouraged as it poses no threat to the pregnancy.