Images of spotting during pregnancy: How Much Is Normal? What Causes It?
Imaging of vaginal bleeding in early pregnancy
Bleeding during the first trimester of pregnancy is common. Although
usually of no permanent consequence, it can be a sign of complication,
such as a threatened abortion or a failed intrauterine pregnancy, or
other serious pathology, such as ectopic pregnancy or gestational
trophoblastic disease. Familiarity with the imaging patterns of these
entities is important, as misdiagnosis can lead to harm to the mother,
fetus, or both. This review will focus on the most common causes of
bleeding in the first trimester, their imaging appearances, and
Imaging in pregnancy
Radiology plays an essential role in identifying and diagnosing early
pregnancy complications, with ultrasound (US) being the primary imaging
modality. Nearly all instances of first trimester bleeding can be
adequately evaluated with a combination of clinical evaluation, serum
β-hCG assay and US, preferably via endovaginal technique. Magnetic
resonance imaging has a limited role, particularly if the US is
technically inadequate, or in the setting of an indeterminate adnexal
mass. There is essentially no role for CT in evaluating first trimester
bleeding. These recommendations and further discussion are outlined in
the most recent revision of the ACR Appropriateness Criteria for First
Trimester Bleeding (Table 1).1
Ultrasound images can be obtained via transabdominal or endovaginal
approaches; usually both are utilized in tandem. Transabdominal scanning
is usually obtained first, with a lower-frequency curved or vector
transducer, typically 4-6 MHz. This provides a large field of view,
optimal to demonstrate large or widespread processes such as large
adnexal masses or hemoperitoneum. Endovaginal US is usually required for
a more detailed evaluation of the uterus and ovaries. Endovaginal
probes utilize a higher frequency, typically 8-10 MHz, yielding
increased resolution at the expense of less tissue penetration. Because
accurate measurements of early gestational processes are crucial,
endovaginal imaging should be utilized whenever possible. For this
review, all size references are based on endovaginal measurements unless
Normal early development
Decidual reaction appears first
Although the first trimester begins at the first day of the last
menstrual period, fertilization occurs approximately two weeks later,
marking the beginning of the conceptus period of the first trimester
(3-5 weeks menstrual age). Implantation of the blastocyst into the
endometrium occurs during the fourth menstrual week, at which point the
endometrium is referred to as the decidua.2 During this time
the very early chorionic sac may be visible as a small fluid-filled sac
with an echogenic rim located eccentrically within the endometrium,
known as the “intradecidual sign” (Figure 1).3 This can be
seen as early as 4.5 weeks, and is nearly 100% specific for an
intrauterine pregnancy (IUP), although it is only 60-68% sensitive.4
This precedes the “double decidual sign,” which consists of two
concentric echogenic rings: the decidua capsularis surrounding the
gestational sac, and the decidua parietalis representing the opposite
wall of the endometrium, often separated by a thin collection of fluid
within the endometrial cavity (Figure 2).5 As with the
intradecidual sign, the double decidual sign is highly specific but
insensitive; furthermore, a yolk sac may be visible before this sign is
apparent, making it less useful in confirming an early IUP. Importantly,
one should differentiate these two early signs of an IUP from a fluid
collection within the endometrial canal, the “pseudo-gestational sac”
Yolk sac appearance
The yolk sac is the first structure able to be visualized within the
early gestational sac (chorionic sac), usually by the time the mean
gestational sac diameter (MSD) is 8-10 mm (Figure 4).6 A
normal yolk sac is always less than 6 mm in diameter; a yolk sac greater
than 6 mm is nearly 100% specific for an abnormal pregnancy.7 Shortly
following appearance of the yolk sac, the embryo is usually apparent at
approximately 6 weeks, when the MSD is greater than 16 mm, as a small
echogenic structure along one side of the yolk sac. Cardiac activity can
usually be identified by the time the embryo is visible.
Amnion and embryo formation
Formation of the amniotic sac coincides with formation of the yolk
sac, but is usually not visible at this early stage secondary to its
very thin membrane. By 7 weeks’ gestational age, the amniotic sac
becomes visible as it fills with fluid and separates from the embryo
(Figure 5). By the time the amniotic sac is visible, the embryo can be
readily identified; the absence of an embryo, or “empty amnion sign,” is
highly specific for a failed pregnancy (Figure 6).8 As the amniotic sac enlarges, it gradually obliterates the chorionic sac, with complete fusion by 12 weeks gestational age.9
In the absence of visualization of any of the above in the setting of
a positive urine or serum β-hCG, the pregnancy should be considered a
pregnancy of unknown location, or PUL.
Failed intrauterine pregnancy
Familiarity with the specific US criteria for diagnosing a failed or
anembryonic pregnancy (“blighted ovum”) (Figure 6) is essential. The
traditionally taught size discriminatory thresholds for declaring an
abnormal pregnancy have been called into question,10 and the
Society of Radiologists in Ultrasound has subsequently adopted revised
criteria; the results of their consensus conference statement have
recently been published.11 In brief, a major reason for the
updated criteria was to increase the specificity of the imaging
diagnosis of a failed IUP to prevent the unwanted termination of very
early but potentially viable pregnancies.
The traditional radiologic teaching has been a “multiple of 5’s”
rule: 1) a yolk sac should be visible when the mean gestational sac
diameter (GSD) is >10 mm; 2) an embryo should be visible when the
mean GSD is >15; and 3) a heartbeat should be present when the crown
rump length (CRL) of the embryo is >5 mm. While likely indicating an
abnormal pregnancy, they are not specific. Strict adherence to these
criteria will uncommonly result in the false diagnosis of a failed
pregnancy when in fact there is a potentially viable pregnancy that
could be harmed by intervention. The revised criteria for diagnosing
pregnancy failure are as follows (Table 2).11 Note the increase in CRL and mean GSD size thresholds, below which a failed pregnancy should not be diagnosed.
One of the most important new concepts is that the diagnosis of a
failed pregnancy should not be made based on a single elevated β-hCG
measurement in the setting of a PUL. Normal pregnancies can develop
subsequent to an ultrasound without an IUP and β-hCG greater than the
traditional discriminatory threshold of 2000 or even 3000 mIU/mL.12,13
Therefore, the diagnosis of a failed or ectopic pregnancy should never
be based on a single β-hCG measurement in the absence of definitive US
The term “threatened abortion” applies to any pregnancy of less than
20 weeks with abnormal bleeding, pain or contractions, with a closed
cervix. Bleeding occurs in up to 27% of pregnancies, with the subsequent
risk of miscarriage approximately 12%.14
Subchorionic, or perigestational, hemorrhage is present in approximately 20% of women presenting with a threatened abortion,15
and is the most common cause of bleeding in normal IUPs, usually
presenting in the late first trimester. On US, these appear as either
hyperechoic or hypoechoic, depending upon the age of the blood products
(Figure 7). Most often these are not associated with any significant
clinical sequelae, particularly if fetal cardiac activity is present.
Large bleeds, defined as involving more than 2/3 the circumference of
the gestational sac, are more likely to result in pregnancy failure
(Figure 8).16 For smaller hematomas, no size thresholds have been confirmed to be prognostic,17 although this finding is a risk factor for subsequent pregnancy complications.18,19
Ectopic pregnancy accounts for 2% of all pregnancies, as last
reported by the U.S. Centers for Disease Control and Prevention in 1992.20
The incidence is higher in patients with a history of prior ectopic
pregnancy, tubal disease, presence of an intrauterine device, and in
those undergoing in vitro fertilization.21 The classic
clinical triad is pain, bleeding, and adnexal mass; however these are
present only in a minority of cases. The vast majority of ectopic
pregnancies occur within the fallopian tube (tubal ectopic). Less common
locations include interstitial (cornual), cervical, within a cesarean
section scar, or ovarian. Occasionally, the only US finding will be free
Visualization of a live embryo outside of the uterine cavity is 100%
specific for ectopic pregnancy, but is rarely encountered in practice.
More often, an adnexal tubal ring is identified. On US this consists of
an echogenic ring with central fluid, separate from the ovary. The ring
may or may not contain a yolk sac or embryo. The ring is typically more
echogenic than the ring of a corpus luteum, with which it can
potentially be confused (Figure 9).22,23 Distinguishing
between the two is vital, as the misdiagnosis of a corpus luteum as an
ectopic pregnancy in the setting of PUL can have tragic consequences.
Endovaginal transducer pressure on the ovary can help determine if the
lesion is within or separate from the ovary. As ovarian ectopic
pregnancies are exceedingly rare, demonstrating an intra-ovarian
location confirms a corpus luteum and essentially excludes an ectopic
Often, the ectopic may be identified only as an extra-ovarian adnexal
mass, without the classic ring-like appearance, because of hemorrhage.
While the presence of color flow helps to confirm an ectopic pregnancy
mass, the converse is not always true. Not all ectopics are vascular,
and the absence of color Doppler flow does not exclude an ectopic
pregnancy. While large amounts of hemorrhage typically indicate a
ruptured ectopic, occasionally a ruptured hemorrhagic cyst can present
with a similar clinical and US picture.
When an ectopic pregnancy implants within the interstitial segment of
the fallopian tube, it is termed an interstitial (or cornual) ectopic.
These can be mistaken for IUP if not fully investigated, as they can
have a normal interface with the endometrium along their inner margin.
Additionally, the distinction from tubal ectopics is important, as
cornual pregnancies have an increased risk of severe hemorrhage and
The interstitial location can be identified by the eccentric location
high within the uterus, as well as by the presence of only a thin
mantle of myometrium along the outer margin, usually less than 5 mm
thick.24,25 An additional feature that can be helpful is the
“interstitial line sign,” representing a thin echogenic line extending
from the endometrial canal directly to the gestational sac, representing
the cornual segment of the endometrial canal or interstitial portion of
the fallopian tube (Figure 10).26
As with interstitial ectopic pregnancies, the risk of significant
bleeding and mortality is increased with cervical ectopics relative to
tubal ectopics. The gestational sac in a cervical ectopic pregnancy must
be distinguished from a gestational sac passing through the cervix
during an abortion in progress. In the case of a cervical ectopic, the
gestational sac usually maintains its normal round or slightly ovoid
shape. Additionally, the presence of perigestational blood flow on color
Doppler can aid in the distinction (Figure 11).27,28 A passing gestational sac has a crenated or elongated appearance with no embryonic cardiac activity (Figure 12).29
Cesarean section scar pregnancy
Pregnancies implanted at the cesarean section scar site frequently
result in spontaneous miscarriage (44%), but are at increased risk of
developing placenta previa and placenta accreta if they develop later
into pregnancy, and are associated with increased risk of severe
hemorrhage at delivery.30 Diagnosis is easier to establish in
the first trimester, when there is an empty uterine cavity, a
gestational sac implanted anteriorly at the level of the cervical os or
at the visible or presumed cesarean section scar site, and
perigestational Doppler flow (Figure 13).
Management of ectopic pregnancies
Ectopic pregnancy can be managed medically or surgically. Imaging
features that influence management include the size of the ectopic;
presence of embryonic cardiac activity, pelvic hemorrhage or tubal
rupture; and the location of the ectopic. Nonsurgical techniques include
systemic methotrexate or ultrasound-guided local injection of
methotrexate or KCl. For tubal ectopics, salpingostomy or salpingectomy
may be performed. Interstitial ectopics may require cornual resection or
hysterectomy. Cesarean section or cervical ectopics may require a
combination of medical and surgical therapy.
Vascular causes of bleeding
Retained products of conception
Retained products of conception (RPOC) can be found following
therapeutic or spontaneous abortion, as well as post-partum. Following
first-trimester abortion, there is typically normal or mildly elevated
β-hCG. The presence of a retained gestational sac is not a diagnostic
dilemma but is rarely encountered. The presence of blood flow within a
thickened endometrium, particularly when associated with a visible mass,
is highly suggestive of RPOC (Figure 14). However, the absence of
Doppler flow does not necessarily exclude RPOC. Unfortunately there is
no definitive endometrial thickness threshold that is entirely specific;
however a thickness <10mm likely excludes the possibility of
clinically significant RPOC.31
Arteriovenous malformations (AVMs) of the uterus can be either
congenital or acquired; and can be encountered in the setting of prior
therapeutic abortion, dilatation and curettage, cesarean section or
invasive tumor such as endometrial carcinoma or gestational
trophoblastic disease.17 AVMs can be comprised of a single
arteriovenous fistula (AVF) or a complex structure of multiple vessels.
US usually demonstrates a complex mass, with color Doppler revealing
internal flow (Figure 15). Spectral Doppler demonstrates low-resistance
arterial waveforms and pulsatile venous waveforms consistent with
There is frequently overlap in the ultrasound appearance of AVMs and
RPOC, and the distinction is not always possible. RPOC tend to be
located within the endometrium, with AVMs in the myometrium; however,
the presence of heterogeneous blood within the endometrial cavity can
obscure the myometrial margins or mimic RPOC. Clinical history and serum
β-hCG are helpful in differentiating these two entities.
Gestational trophoblastic disease
Bleeding is one of the most common clinical presentations of this
spectrum of disorders that includes hydatidiform mole, invasive mole,
and choriocarcinoma. The hallmark is excessive production of β-hCG.
Other classic signs of a rapidly enlarging uterus, hyperemesis
gravidarum, and pre-eclampsia are more common in the second trimester.33
Complete hydatidiform mole is the most common of these entities. On
US, the classic “cluster of grapes” appearance is often not present in
the first trimester and appearance is variable. Findings may include a
small echogenic mass without cystic spaces or a mixed solid and cystic
mass within the endometrium.34 Theca lutein cysts in the
ovaries result from increased β-hCG production, but are usually not
present until the second trimester. Being avascular, color flow is
typically not helpful in diagnosing a complete hydatidiform mole (Figure
The distinction between non-invasive mole and invasive
mole/choriocarcinoma is not always possible with US. In contrast to
hydatidiform moles, invasive moles and choriocarcinomas demonstrate
color flow on Doppler, with low-impedance waveforms (Figure 17).35
Invasive moles grow deep into the myometrium, sometimes with
penetration into parametrial tissues and peritoneum, but rarely
metastasize. In contrast, choriocarcinoma readily metastasizes to the
lungs and less frequently the pelvis,17 for which CT is useful (Figure 18). Magnetic resonance imaging may aid in evaluating persistent residual disease in the pelvis.
Ultrasound can readily distinguish the most common causes of vaginal
bleeding in early pregnancy, and plays an essential role in patient
management. Familiarity with the US appearance as well as new guidelines
is essential to avoid causing potential harm to the mother or
- Lane BF, Wong-You-Cheong JJ, Javitt MC, et al. ACR Appropriateness Criteria®
First Trimester Bleeding. Available at
American College of Radiology. Accessed April 28, 2014.
- Gupta N, Angtuaco TL. Embryosonology in the first trimester of pregnancy. Ultrasound Clinics. 2007; 2:175-185.
- Yeh HC. Sonographic signs of early pregnancy. Crit Rev Diagn Imaging. 1988; 28:181-211.
- Chiang G, Levine D, Swire M, et al. The intradecidual sign: Is it reliable for diagnosis of early intrauterine pregnancy? AJR Am J Roentgenol. 2004;183:725-731.
- Bradley WG, Fiske CE, Filly RA. The double sac sign of early intrauterine pregnancy: use in exclusion of ectopic pregnancy. Radiology.1982;143:223-226.
- Nyberg DA, Mack LA, Laing FC, Patten RM. Distinguishing normal from abnormal gestational sac growth in early pregnancy. J Ultrasound Med. 1987;6:23-27.
- Stampone C, Nicotra M, Muttinelli C, Cosmi EV. Transvaginal sonography of the yolk sac in normal and abnormal pregnancy. J Clin Ultrasound.1996;24:3-9.
- McKenna KM, Feldstein VA, Goldstein RB, Filly RA. The empty amnion: A sign of early pregnancy failure. J Ultrasound Med. 1995; 14:117-121.
- Coady AM. The first trimester, gynaecological aspects. In: Allan PL,
Baxter GM, Weston MJ, eds. Clinical Ultrasound. 3rd ed. Edinburgh:
Churchill Livingstone; 2011:740-769.
- Abdallah Y, Daemen A, Kirk E, et al. Limitations of current
definitions of miscarriage using mean gestational sac diameter and
crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol. 2011;38:497-502.
- Doubilet PM, Benson CB, Bourne T, Blaivas M, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013; 369:1443-1451.
- Doubilet PM, Benson CB. Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med. 2011; 30:1637-1642.
- Mehta TS, Levine D, Beckwith B. Treatment of ectopic pregnancy: is a
human chorionic gonadotropin level of 2,000 mIU/ml a reasonable
- Hasan R, Baird DD, Herring AH, et al. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Ann Epidemiol. 2010; 20:524-531.
- Nyberg DA, Laing FC. Threatened abortion and abnormal first
trimester intrauterine pregnancy. In: Patterson AS, ed. Transvaginal
ultrasound. St. Louis: Mosby-Year Book, 1992: 85-103.
- Bennett GL, Bromley B, Lieberman E, Benacerraf BR. Subchorionic
hemorrhage in first-trimester pregnancies: prediction of pregnancy
outcome with sonography. Radiology. 1996; 200:803-806.
- Dighe M, Cuevas C, Moshiri M, et al. Sonography in first trimester bleeding. J Clin Ultrasound. 2008; 36:352-366.
- Nagy S, Bush M, Stone J, et al. Clinical significance of
subchorionic and retroplacental hematomas detected in the first
trimester of pregnancy. Obstet Gynecol. 2003; 102:94-100.
- Borlum KG, Thomsen A, Clausen I, Eriksen G. Long-term prognosis of pregnancies in women with intrauterine hematomas. Obstet Gynecol. 1989; 74:231-233.
- Centers for Disease Control and Prevention (CDC). Ectopic pregnancy–United States, 1990–1992. MMWR Morb Mortal Wkly Rep. 1995; 44:46-48.
- Levine D. Ectopic pregnancy. Radiology. 2007; 245:385-397.
- Frates MC, Visweswaran A, Laing FC. Comparison of tubal ring and
corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med. 2001; 20:27-31.
- Stein MW, Ricci ZJ, Novak L, et al. Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med. 2004; 23:57-62.
- Chen GD, Lin MT, Lee MS. Diagnosis of interstitial pregnancy with sonography. J Clin Ultrasound. 1994; 22:439-442.
- Graham M, Cooperberg PL. Ultrasound diagnosis of interstitial pregnancy: Findings and pitfalls. J Clin Ultrasound. 1979; 7:433-437.
- Ackerman TE, Levi CS, Dashefsky SM, et al. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189:83-87.
- Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early
cervical pregnancy: a review and a report of two cases treated
conservatively. Ultrasound Obstet Gynecol. 1996; 8:373-380.
- Vas W, Suresh PL, Tang-Barton P, et al. Ultrasonographic differentiation of cervical abortion from cervical pregnancy. J Clin Ultrasound. 1984; 12:553-557.
- Kakaji Y, Nghiem HV, Nodell C, Winter TC. Sonography of obstetric and gynecologic emergencies: part I, obstetric emergencies. AJR Am J Roentgenol. 2000; 174:641-649.
- Jurkovic D, Hillaby K, Woelfer B, et al. First-trimester diagnosis
and management of pregnancies implanted into the lower uterine segment
Cesarean section scar. Ultrasound Obstet Gynecol. 2003; 21:220-227.
- Brown DL. Pelvic ultrasound in the postabortion and postpartum patient. Ultrasound Q. 2005; 21:27-37.
- Polat P, Suma S, Kantarcy M, et al. Color Doppler US in the evaluation of uterine vascular abnormalities. Radiographics. 2002;22:47-53.
- Hou JL, Wan XR, Xiang Y, et al. Changes of clinical features in hydatidiform mole: analysis of 113 cases. J Reprod Med. 2008;53:629-633.
- Green CL, Angtuaco TL, Shah HR, Parmley TH. Gestational trophoblastic disease: a spectrum of radiologic diagnosis. Radiographics. 1996; 16:1371-1384.
- Zhou Q, Lei XY, Xie Q, Cardoza JD. Sonographic and Doppler imaging
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Bleeding and spotting from the vagina during pregnancy
Bleeding and spotting from the vagina during pregnancy are common. Up to 1 out of 4 (up to 25%) of all pregnant women have some bleeding or spotting during their pregnancy.
Bleeding and spotting in pregnancy don’t always mean there’s a problem, but they can be a sign of miscarriage or other serious complications. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.
Call your health care provider if you have any bleeding or spotting, even if it stops. It may not be caused by anything serious, but your provider needs to find out what’s causing it.
What’s the difference between bleeding and spotting?
Bleeding or spotting can happen anytime, from the time you get pregnant to right before you give birth. Spotting is light bleeding. It happens when you have a few drops of blood on your underwear. Spotting is so light that the blood wouldn’t cover a panty liner. Bleeding is when the blood flow is heavier, enough that you need a panty liner or pad to keep the blood from soaking your underwear and clothes.
What should you do if you have bleeding or spotting during pregnancy?
Call your health care provider if you have any kind of bleeding during pregnancy and do these things:
- Keep track of how heavy your bleeding is, if it gets heavier or lighter, and how many pads you are using.
- Check the color of the blood. Your provider may want to know. It can be different colors, like brown, dark or bright red.
- Don’t use a tampon, douche or have sex when you’re bleeding.
Call your health care provider right away at any time during pregnancy or go to the emergency room if you have:
- Heavy bleeding
- Bleeding with pain or cramping
- Dizziness and bleeding
- Pain in your belly or pelvis
What causes bleeding or spotting early in pregnancy?
It’s normal to have some spotting or bleeding early in pregnancy. Bleeding or spotting in the first trimester may not be a problem. It can be caused by:
- Having sex
- An infection
- Implantation. When a fertilized egg (embryo) attaches to the lining of the uterus (womb) and begins to grow.
- Hormone changes. Hormones are chemicals made by the body.
- Changes in your cervix. The cervix is opening to the uterus that sits at the top of the vagina.
- Certain types of testing during pregnancy like an amniocentesis or Chorionic villus sampling (CVS). These are tests that are done to check for genetic abnormalities in your baby. Genetic abnormalities are changes in the genes that are passed down to a baby from mom or dad. These genetic changes can cause health problems for a baby.
- Problems related to smoking. If you smoke, it’s best to stop before pregnancy or as soon as you know you’re pregnant.
Sometimes bleeding or spotting in the first trimester is a sign of a serious problem, like:
- Miscarriage. Almost all women who miscarry have bleeding or spotting before the miscarriage.
- Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
- Molar pregnancy. This is when a mass of tissue forms inside the womb, instead of a baby. Molar pregnancy is rare.
What causes bleeding or spotting later in pregnancy?
Bleeding or spotting later in pregnancy may be caused by:
- Having sex
- An internal exam by your health care provider
- Problems with the cervix, like an infection, growths, inflammation or cervical insufficiency. This is when a woman’s cervix opens too early. Inflammation of the cervix is when it may be painful, swollen, red or irritated.
Bleeding or spotting later in pregnancy may be a sign of a serious problem, like:
- Preterm labor. This is labor that happens too early, before 37 weeks of pregnancy.
- Placenta previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix.
- Placenta accreta. This is when the placenta grows into the wall of the uterus too deeply.
- Placental abruption. This is when the placenta separates from the wall of the uterus before birth.
- Uterine rupture. This is when the uterus tears during labor. This happens very rarely. It can happen if you have a scar in the uterus from a prior cesarean birth (also called c-section) or another kind of surgery on the uterus. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.
How are bleeding and spotting treated?
Your treatment depends on what caused your bleeding. You may need a medical exam and tests.
Most of the time, treatment for bleeding or spotting is rest. Your provider may also suggest treatments like:
- Take time off from work and stay off your feet for a little while
- You may need medicine to help protect your baby from Rh disease. Rh disease is when your blood and baby’s blood are incompatible (can’t be together). This disease can cause serious problems — even death — for your baby.
- Don’t have sex, douche or use tampons
- If you have heavy bleeding, you may need a hospital stay or surgery
Last reviewed: April 2020
7 Things Spotting During Pregnancy Could Mean
When you’re pregnant, any sign that you’ve been bleeding can be incredibly scary. But don’t panic: Spotting during pregnancy is actually a lot more common than you think, and most of the time it’s nothing to worry about.
“Even though spotting in early pregnancy is common and can be perfectly normal, it can drive fear into the heart of the expectant mother,” says Dr. Prudence Hall, founder and medical director of The Hall Center and author of Radiant Again & Forever. “Bleeding in pregnancy is expected in many instances and can be completely normal. At other times, it can indicate a failing pregnancy, miscarriage, problem with the placenta, or premature labor.”
All in all, it’s a good idea to see your doctor anytime you’re experiencing spotting to make sure both you and your baby are safe. But before you assume the worst, here are some common causes for light bleeding during pregnancy.
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The Embryo Is Implanting
One of the earliest symptoms of pregnancy is light bleeding. So if you’re hoping to conceive but find that you’re bleeding just a little bit around the time of your expected period, it’s possible you were successful after all. “This bleeding is usually due to the embryo implanting into the wall of the uterus around 10-12 days after fertilization,” Hall says. “Because fertilization of the embryo occurs right in the middle of a woman’s 28 day cycle, and implantation happens 10-12 days later, this bleeding can easily be mistaken for a period. The difference is that it’s usually lighter and lasts only a day or two rather than 5 to 7 days.”
RELATED: 15 Signs of Pregnancy You’ll Experience Almost Immediately
You’re Having a Light Period
Even though it might seem crazy, you can still have your period when you’re pregnant — and that means some spotting will occur. “Bleeding can take place at around 6 to 8 weeks of gestation, at the time when a woman’s period would normally occur in the second month,” Hall says, noting that even some women a few years into menopause continue to have periods. “The same can be true in pregnancy, with bleeding occurring around 8 weeks because the body is so used to bleeding each month. But unlike regular period blood, this bleeding is typically really light and limited to spotting or dark brown blood.”
You Had Sex
Having sex during pregnancy can be lots of fun — and is totally encouraged! But if you experience some spotting after, it’s probably no big deal. “As pregnancy progresses, many women will experience spotting after intercourse. This is normal and occurs because the cervix becomes vascular. Bumping it due to sex can cause minor spotting,” Hall says. “Many women experience this and as long as it is occurs after intercourse and is only slight streaking or a spot or two, it’s usually nothing to be worried about.”
You Just Had an Exam
If you’re freaking out about some spotting after a doctor’s visit, don’t fret: “Spotting can happen after a sonogram or pelvic exam by your doctor or medical practitioner. This happens due to a normal increase in blood flow to the uterus and cervix,” Hall says.
RELATED: 9 Things Your Gyno Wants You To Stop Doing Now
You Have an Infection
Unfortunately, pregnancy doesn’t give you a pass from all the normal, super-fun vagina stuff ladies deal with. That means you’re still susceptible to infections, which can cause a little blood to appear. “If a woman contracts a vaginal infection such as yeast, she could experience some cervical bleeding,” Hall explains.
You Had a Miscarriage
While some spotting is harmless, it can also mean something more serious. According to Hall, bleeding due to a miscarriage begins right around 6 to 8 weeks of pregnancy. “It starts with spotting, progressing to heavy cramping, and then a heavier than normal period,” she says. “In these instances, women may have felt symptoms of their pregnancy subside before the actual miscarriage bleeding begins, causing real fear about losing the pregnancy.”
RELATED: 5 Signs of Miscarriage You Should Never Ignore
You’re Going Into Premature Labor
No one wants to have their baby early — and spotting could be a sign your little one is ready to come out before you are. “If spotting occurs as pregnancy progresses and is accompanied by cramping, there is concern about premature labor,” Hall says. “As the cervix softens and slightly opens, spotting can happen.” Talk to your doctor about the best way to proceed. The good news is, labor can be stopped by hydration, bed rest, and medication.
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Spotting During Pregnancy: When It’s Normal and When It Could Signal a Problem
Spotting during pregnancy can be a perplexing issue. Isn’t one of the boons of pregnancy not ruining more underwear with period blood? Sorry to break it to you, but this is a thing. According to the American College of Obstetricians and Gynecologists (ACOG), spotting during pregnancy happens in 15 to 25 percent of pregnant people. Though it’s probably easier said than done, there’s no need to automatically panic because you have some pregnancy spotting—it can actually be a completely standard part of the experience of growing a tiny human.
But when is spotting during pregnancy a sign of a possible problem and when is it normal? Here’s what experts want you to understand about this.
What Is It
Spotting is another word for light bleeding, according to ACOG. Maybe you see a little bit of blood in your underwear or on the toilet paper after you wipe. Spotting during pregnancy essentially means any light bleeding from your vagina when you’re most definitely not on your period—because, hello, you’re pregnant.
What Causes It
There is not just one definitive cause for spotting during pregnancy. In some cases, spotting can be a sign of miscarriage or ectopic pregnancy, which happens when a fertilized egg implants in a fallopian tube instead of the uterus, Jamil Abdur-Rahman, M.D., board-certified ob-gyn and chairman of obstetrics and gynecology at Vista East Medical Center in Waukegan, Illinois, tells SELF. It can also sometimes signal preterm labor or infection, he explains.
But there are also plenty of other less serious reasons for spotting during pregnancy.
Difference Between Spotting and Bleeding
Spotting is another word for light bleeding, ACOG says, and that’s definitely different from having a heavy flow. But spotting is technically still bleeding. Your cervix may bleed more easily during pregnancy because more blood vessels are developing in this area. ACOG specifically says that it’s “not uncommon” to have spotting or light bleeding after sex, a Pap test, or pelvic exam when you’re pregnant. If you’re soaking through less than one pad or tampon in three hours, that’s generally considered mild bleeding or spotting and is likely no big deal, Sherry Ross, M.D., an ob-gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. Still, if you’re concerned or it continues, that’s certainly worth bringing up with your doctor, midwife, or care provider.
When It’s Normal
In general, there are several circumstances that are thought of as typical, common reasons for spotting during pregnancy.
First and foremost, spotting can occur because of implantation bleeding, which happens when a fertilized egg implants into your uterine lining, the experts explain. This typically happens within one to two weeks after conception, according to ACOG.
Pregnancy also creates more blood flow than usual to the uterus, vagina, and cervix, says Dr. Abdur-Rahman. That blood can seep out after sex or any other physical activity, or even for seemingly no reason, he explains.
How to Tell If It’s a Problem
To reiterate, pregnancy spotting is usually nothing to freak out about. But it’s good to know what’s normal and what’s not. Below are the signs that something might be up with your pregnancy and when you should call your care provider.
1. The bleeding is pretty heavy.
If you’re going through more than one pad or tampon in three hours, that’s considered moderate bleeding, Dr. Ross says. Anything more than that is heavy bleeding. During pregnancy, both moderate and heavy bleeding can be worrisome, she explains. If you think you’re experiencing either of those, get in touch with your doctor ASAP. This is especially important if you see a lot of tissue or clots in the blood, the Mayo Clinic notes.
2. It’s accompanied by intense pain, fever, or chills.
Cramps often accompany spotting, so you might feel some twinges of discomfort here or there. But anything that morphs into more significant pain is worth noting and potentially calling your doctor about. “Mild cramping can be considered normal, but if you have to sit down or put a hot water bottle on your lower back or it’s anything more than a little cramping, it’s more of a cause for concern,” says Dr. Ross.
Spotting during pregnancy: When should you worry about it
Whether you are a first-time mother or have been pregnant before, spotting or light bleeding can certainly freak you out. But frequent bleeding or spotting during pregnancy is completely normal sometimes and almost one-third of all pregnant women experience it. Bleeding can happen due to several reasons, sometimes it is not even related to pregnancy. Most of the time it is harmless but at times it can be a sign of some complication like miscarriage, ectopic pregnancy, and placenta previa, and thus should never be ignored.
Here are some of the reasons why you may experience bleeding:
Spotting in the first trimester
About 20-30 per cent of women experience some level of vaginal bleeding in the first 12 weeks of pregnancy. As per a study carried out in 2010, spotting is commonly seen in the sixth and seventh week of pregnancy and it is not always a sign of miscarriage. As per the American Pregnancy Association, here are some common reasons of bleeding in the first trimester.
Implantation bleeding: The implantation of the egg in the lining of the uterus occurs about 4 weeks into your pregnancy. If your experience bleeding about a week to 10 days after conception, then it is due to implantation of the embryo into the wall of the uterus. There is nothing to worry about it.
Sexual intercourse: During the second and third trimester, your cervix becomes swollen due to increased blood supply in the area. Getting intimate during this period can lead to light spotting.
Infections: Sometimes bleeding also happens due to infection, which is mostly sexually transmitted. In this case, you need to get yourself diagnosed as it may lead to further complications.
Early pregnancy loss or miscarriage : Early miscarriage occurs during the first 13 weeks of pregnancy. If you experience brown or bright red bleeding, consult your doctor immediately. You may also experience mild to severe back pain, cramping or contractions and sudden decrease in pregnancy symptoms.
Ectopic pregnancy: Ectopic pregnancy is a medical emergency that happens in the first trimester of your pregnancy. This happens when the fertilized egg attaches itself outside of the uterus. Along with bleeding and light spotting, if you experience sharp or dull abdominal or pelvic pain, weakness, dizziness, or fainting, then contact your doctor immediately.
Spotting during the second trimester
Irritation in the cervix: During the second trimester, light bleeding or spotting generally happen due to irritation in the cervix, usually caused after sex or a cervical exam. This is quite common and is not worrisome.
Cervical polyp: This is another common reason for bleeding or spotting in the second trimester. A cervical polyp is the growth of small, elongated tumors on the surface of the cervical canal. This can lead to spotting due to an increased number of blood vessels in the tissue around the area. This is harmless and you do not need to worry about it.
Other reasons: Light bleeding and spotting are quite common, but if you experience any vaginal bleeding that’s heavy as a menstrual period, consult your doctor straight away. Heavy bleeding can be due to some complications like placenta previa, premature labor, late miscarriage.
Spotting during the third trimester
In the third trimester, light bleeding or spotting mostly occurs after sex or a cervical exam. It can also happen due to a “bloody show,” or it can be a sign of labour pain. If you experience heavy vaginal bleeding during your third trimester, then seek immediate emergency medical care. It could also be caused due to placental abruption.
What You Need to Know
When you’re pregnant, the last thing you want to see is blood in your underwear. That flash of red or brown can instantly conjure up fears of miscarriage—but bleeding and spotting during pregnancy is more common than you’d think, and it’s not always a signal something is wrong. Read on to help you navigate the ins and outs of pregnancy spotting, including why you might be bleeding and what to do about it.
Is Bleeding or Spotting During Pregnancy Normal?
“Vaginal bleeding is actually quite common in pregnancy,” says Michael Cackovic, MD, an ob-gyn and maternal fetal medicine specialist at the Ohio State University Wexner Medical Center. In fact, about 20 percent or more of women experience some form of bleeding during the first trimester, and the majority go on to have perfectly healthy pregnancies. “The bleeding may be any combination of light or heavy, intermittent or constant, painless or painful,” Cackovic says. But while many women experience bleeding during pregnancy, it’s not considered normal and should always be evaluated by a doctor.
Causes of Spotting During Pregnancy
If you experience spotting while pregnant, it’s easy to imagine worst-case scenarios, but in reality, it could be due to something much more innocent—while it still merits a call to your doctor, light spotting during pregnancy isn’t usually cause for alarm.
It’s important to be able to distinguish pregnancy spotting from full-on bleeding, since they can indicate different things. The key difference between the two is the amount of blood you see and the source of the bleeding: Spotting is lighter (some drops here and there) and can last for a few days, says Jennifer Wider, MD, a women’s health expert. Bleeding, on the other hand, is a heavier flow, similar to a menstrual period, and can be more worrisome, especially if accompanied by cramps.
Here, the common causes of spotting during pregnancy:
• Implantation spotting. After your egg is fertilized, it embeds itself in your uterine wall, which can cause spotting about a week after conception, says G. Thomas Ruiz, MD, an ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “It’s usually fairly light but can be heavy enough that some people think it’s a light period.” Implantation spotting can be disappointing (if you assume it’s your period) or alarming, but it’s actually a happy sign you’re pregnant.
• Sex. During pregnancy, your cervix is especially sensitive, and “the friction of the penis hitting the area can make it bleed,” Cackovic says.
• Cervical abrasion. “Spotting sometimes just comes from an abrasion on the cervix or in the vagina,” Cackovic says. This could be caused from intercourse or even a gynecological exam, such as a vaginal ultrasound. Typically, the abrasion will heal within a few days.
• Cervical polyps. While harmless, polyps on the cervix are more prone to light bleeding during pregnancy thanks to your higher estrogen levels and increased number of blood vessels in the cervical tissue. Contact with the polyps—such as during sex or a vaginal exam—can prompt spotting.
• A weak cervix. Your cervix is supposed to stay tightly closed during pregnancy to protect your growing baby, but it doesn’t always work out that way. Sometimes the cervix will shorten or weaken in the second trimester, leading to spotting, Ruiz says. “If we catch it in time, we can put a stitch around the cervix to save the pregnancy,” he says.
Causes of Bleeding in Early Pregnancy
A study revealed that one in four women experienced spotting in the first trimester, usually occurring around week 6 or 7 of pregnancy. The good news? This pregnancy spotting wasn’t always an indication that anything was wrong.
Are you noticing some spotting in your first trimester? There are a few reasons you might experience bleeding in early pregnancy, and they range in severity.
• Hormonal changes. Sometimes pregnancy spotting is something as harmless as your body simply going through changes. In this case, light spotting can occur in early pregnancy and isn’t cause for concern. Stil, it’s important to rule out all possible dangers before attributing spotting to hormonal changes.
• Uterine wall bleeding. In some cases, women may experience bleeding from their uterine wall as the placenta and amniotic sac fill the space in a woman’s uterus, Ruiz says. “It can cause heavy bleeding but isn’t dangerous,” he says.
• Miscarriage. The majority of miscarriages occur within the first 13 weeks of pregnancy. If you have heavy bleeding accompanied by cramps, back pain, brown vaginal discharge or a sudden loss of pregnancy symptoms, it could be a sign of a miscarriage, Cackovic says. The risk of miscarriage in healthy women is anywhere from 10 to 25 percent.
• Infection. Spotting could be a sign of an infection, which could be dangerous—another reason to speak with your doctor if you notice spotting while pregnant.
• Ectopic pregnancy. This is when the fertilized egg implants outside of the uterus, usually the fallopian tube. In this case, the embryo isn’t viable; if left untreated, ectopic pregnancy can be dangerous for the mother’s health and is considered a medical emergency. Thankfully, the complication is rare, occurring in 20 out of every 1,000 pregnancies. If you’re experiencing any spotting along with stomach or pelvic pain, dizziness, weakness, rectal pressure or fainting, contact your doctor right away.
• Molar pregnancy. A rare cause of bleeding, molar pregnancy results from an aberrant chromosome count in the fertilized egg and leads to the growth of abnormal tissue instead of healthy fetal tissue. Only 1 in every 1,000 pregnancies is molar.
Causes of Bleeding in Late Pregnancy
Bleeding in late pregnancy, either in the second or third trimester, can be a sign that you’re experiencing an emergency situation—or that you’re simply about to have a baby. Common causes include:
• Placenta previa. This condition, which happens when the placenta partially or totally covers the cervix, can cause bleeding in late pregnancy as the cervix dilates, Ruiz says. If the placenta previa prompts heavy bleeding, you may need a planned c-section; unstoppable bleeding may require an emergency c-section.
• Placental abruption. In this rare but serious complication, the placenta separates from the uterus, causing bleeding. Only 1 percent of expectant women experience a placental abruption, usually in the last 12 weeks of pregnancy.
• The bloody show. If you notice bleeding as you approach your due date, it could be the bloody show, especially if the blood is mixed with mucus. The bloody show is simply a sign that your cervix is beginning to dilate and your mucus plug has been released, Ruiz says, meaning baby is probably on the way.
• Late miscarriage. While the majority of miscarriages happen in the first trimester, a small percentage of them do occur after 13 weeks and before 20 weeks, known as a late miscarriage. If you experience pregnancy spotting or bleeding, cramping or pain in your back or abdomen, tissue in your discharge or a loss of pregnancy symptoms, contact your doctor immediately.
• Premature labor. Spotting accompanied by symptoms such as cramps, contractions, abdominal pressure or back pain could mean you’re going into premature labor. Call your doctor if you’re experiencing these symptoms.
What to Do for Bleeding or Spotting During Pregnancy
Experiencing bleeding or spotting while pregnant isn’t always an indicator of danger, but you should still call your doctor right away. They’ll likely do a speculum exam to evaluate the source of the bleeding, along with blood work, an ultrasound and fetal monitoring to check on baby’s status, Cackovic says.
If the bleeding is heavy, place a maxi pad in your underwear; it’ll help gauge how much you’re bleeding. Never insert a tampon or anything else into the vagina, and steer clear of sex until the bleeding has cleared and your doctor has given you the go-ahead.
During pregnancy, it’s important to stay in tune with your body and make note of any changes in your symptoms. While pregnancy spotting or bleeding can be alarming, the sooner you contact your doctor, the sooner you can rule out any dangers and address any issues.
Michael Cackovic, MD, is an ob-gyn specializing in maternal fetal medicine at the Ohio State University Wexner Medical Center in Columbus. He earned his medical degree from Hahnemann University College of Medicine in 1997.
Jennifer Wider, MD, is a New York City-based women’s health expert and author. She received her medical degree from the Mount Sinai School of Medicine.
G. Thomas Ruiz, MD, is the lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California. He earned his medical degree from UC Irvine School of Medicine and has been practicing medicine in Orange County since 1993.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump:
14 Early Signs of Pregnancy
Miscarriage Symptoms: Signs and Causes
How to Recognize Implantation Bleeding
When you’re trying to conceive, it’s only natural to obsessively monitor what’s happening with your vagina. But don’t panic and assume you’re not pregnant if you notice a little spotting. Light, brief bleeding that lasts just a day or two can actually be a sign of early pregnancy. It’s known as implantation bleeding, and it can be a tip-off that an egg has successfully nestled into your womb.
It can be unnerving when you see a streak of blood on your underwear or after wiping. Of course, if you’re actively looking for signs of pregnancy, you may feel optimistic or even excited about this sudden symptom. Suffice to say, you probably have a lot of questions—and we’re here to help. Want to learn how to recognize implantation bleeding, when it occurs, what it looks like and how you can tell the difference between this kind of bleeding and menstruation? Read on to get the full lowdown on implantation bleeding and what it may (or may not) mean.
What Is Implantation Bleeding?
Implantation bleeding is a small amount of spotting or bleeding that happens after a newly fertilized egg burrows into the lining of your uterus. Since the uterine lining is rich with blood, some women spot a little at this point. This is totally normal and no cause for concern, but a pregnancy test and doctor’s visit may be order to make sure implantation bleeding is truly the culprit.
So how much do you bleed during implantation? “It’s typically a small amount of spotting or bleeding,” says Laurie MacLeod, APRN, CNM, a certified nurse midwife at ProMedica in Oregon, Ohio. Implantation bleeding is usually much lighter than a regular period; it’s not enough to warrant a feminine pad, but you might consider wearing a pantyliner just in case.
How common is implantation bleeding?
According to the American Pregnancy Association, approximately one third of women experience implantation bleeding in early pregnancy. All in all, there’s no real way to know whether spotting (or lack thereof) indicates pregnancy—only a test can tell. “Bleeding in the first trimester is common, although I would never say ‘normal,’” says Michael Cackovic, MD, a maternal fetal medicine physician at the Ohio State University Wexner Medical Center in Columbus, Ohio. According to him, about 25 to 30 percent of women will experience some bleeding—including implantation bleeding—in the first trimester.
If you have no implantation bleeding, that’s perfectly normal too. “Don’t worry! It has no bearing on the success of your pregnancy,” says Julie Lamppa, APRN, CNM, a certified nurse midwife at Mayo Clinic.
When does implantation bleeding occur?
If you’re compulsively checking your underwear every few hours in hopeful anticipation, you may be wondering: How soon after conception would you notice spotting? So, when does implantation bleeding occur? “Implantation bleeding may occur right around the time you think you may be getting your period,” Lamppa explains—which is why it can be confusing for women who experience it. “Some women will notice a small amount of spotting or bleeding about 10 to 14 days after fertilization of the egg,” she adds.
If you suspect you’re experiencing implantation bleeding, you may be eager to take a home pregnancy test—and stat. Not so fast, though. While there’s no harm in taking a test at this point, you’re better off waiting a few more days.
According to the Cleveland Clinic, your body starts producing human chorionic gonadotropin (hCG) about 10 days after conception, which is around the same time implantation bleeding may occur. At this early stage in a healthy pregnancy, hCG levels double every two days. Still, it takes time for the hormone to build up in your system and reach a volume that can be detected by an over-the-counter urine test. Some tests may be able to detect hCG about 10 days after conception, but waiting until after a missed period can lower the chance of a false negative. Blood tests are more sensitive to hCG and can detect the hormone 9 to 12 days after conception.
How long does implantation bleeding last?
It depends on the woman, but some claim it lasts for one day, while others say three or four. Implantation bleeding can seem like a period, but it doesn’t last as long. “You don’t continue to bleed like a normal period,” Lamppa says.
Implantation Bleeding Vs. Period: How to Tell the Difference
How can you tell if it’s implantation bleeding or your period? Depending on how you typically experience menstruation, this could be a bit of a waiting game. Implantation bleeding is usually lighter than a normal period. “If you experience bleeding that’s considered to be heavy spotting or bleeding, that would be more than implantation bleeding,” Lamppa says. But if you tend to have light periods anyway, you might not notice a huge difference.
Your period will typically last longer than implantation bleeding, Macleod adds. If you bleed for a day or two, it’s more likely to be implantation bleeding. If it stretches beyond that time frame, you may have gotten your period. Still not sure? Wait a few more days and take a pregnancy test.
What Does Implantation Bleeding Look Like?
Now that you understand what it is and when it occurs, you might be left wondering: What does implantation bleeding look like? The truth is, implantation bleeding can resemble a lighter version of your period. The color is usually pink or slightly red when it starts, MacLeod says, although it can be brownish as the bleeding resolves. The texture can vary, but it shouldn’t be overly thick. “It should not contain clots,” Lamppa says. Clots typically form with heavy bleeding, so if you’re truly experiencing implantation bleeding, you shouldn’t have them.
Implantation Bleeding Symptoms
Women can experience implantation bleeding differently. Some may have no additional symptoms besides the light bleeding, while others may start to encounter a few early signs of pregnancy, MacLeod says. According to her, these can include:
• Nausea • Headache • Lower back pain • Light cramping • Breast tenderness • Fatigue
But again, don’t worry if you don’t experience these things. “You may not have any associated pregnancy symptoms at this time because it’s still so early,” Lamppa says.
There are a lot of things that can cause bleeding during the first few weeks and months of pregnancy. “Causes of bleeding during early pregnancy can range from irritation to the cervix and vagina as blood flow is increased to the area, to threatened miscarriage or even ectopic pregnancy,” Cackovic says. If you experienced bleeding and you’ve gotten a positive pregnancy test, it’s important to see your doctor sooner rather than later to determine what’s going on.
“Your provider will assess how far you are into the pregnancy, the amount of bleeding you’re experiencing, if you’re feeling pain and other possible risk factors,” Lamppa says. “All of this information will help your provider figure out the next best steps for your care.”
When you’re actively trying to get pregnant, it’s natural to scrutinize the inner workings of your reproductive system and even compare your symptoms to those of other women. But remember, you may have implantation bleeding, or you may not, and your experience may be different than others’. The tricky part is determining if the spotting is actually the result of implantation or something else entirely (like your period). If you’re on pins and needles waiting for an answer, take a deep breath, monitor for additional bleeding and consider taking a test in a few days. Of course, never hesitate to reach out to your doctor with any concerns.
Michael Cackovic, MD, is a maternal fetal medicine physician at the Ohio State University Wexner Medical Center in Columbus, Ohio. He is also an associate professor of medicine at Ohio State University. He received his medical degree from Drexel University College of Medicine in Philadelphia, Pennsylvania.
Julie Lamppa, APRN, CNM, is a certified nurse midwife at Mayo Clinic. She is a graduate of the University of Minnesota Medical School in Minneapolis, Minnesota.
Laurie MacLeod, APRN, CNM, is a certified nurse midwife at ProMedica, an integrated healthcare organization in Oregon, Ohio. She received her Master’s of Science in nursing, specializing in midwifery, from The University of New Mexico in Albuquerque, New Mexico.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.
Plus, more from The Bump:
14 Early Signs of Pregnancy
How to Recognize Implantation Cramps
[What to Know About Ovulation Pain When You’re Trying to Conceive]](https://www.thebump.com/a/ovulation-pain)
90,000 Discharge during pregnancy: types of discharge
Discharge is one of the intimate topics that worries many expectant mothers. What is going on “there”? What is causing all this discharge? In the early stages of pregnancy, vaginal discharge may increase, and at the end of pregnancy, mucus with traces of blood may be one of the signs of an impending birth – this is how the mucous plug that protects the entrance to the uterus during pregnancy comes off. Some secretions that have a specific odor and color may be a sign of infection.In this article, you will learn about the types of discharge you may encounter during pregnancy, which ones are harmless, and which ones require medical attention.
Which discharge during pregnancy is normal?
Normally, discharge during pregnancy is transparent or white, usually sticky, without a pronounced odor. If the discharge leaves a yellowish mark on your linen or pad, don’t worry. During pregnancy, levels of the hormones estrogen and progesterone rise and blood flow to the vagina increases, so there may be more discharge, especially in the second trimester.In fact, the discharge protects the fetus from infection, because this is how the vagina naturally cleans and removes dead cells. After the full period of gestation (at the 39th week), the discharge may become mucous. This is a mucous plug, which we will discuss in more detail below.
Is the discharge a sign of pregnancy?
As a rule, discharge is not a sign of pregnancy, but at the very beginning, spotting is sometimes noted. This is implantation bleeding that occurs when a fertilized egg is attached to the lining of the uterus.In early pregnancy, such discharge is usually pink in color, slightly paler than menstrual bleeding.
By the way, if you recently found out that you will become a mother, we recommend calculating the approximate date of birth using our calculator.
What is leucorrhea?
Leucorrhea (leucorrhoea) is the medical term for all types of vaginal discharge, not just those that are characteristic of pregnancy. Typically, it is a clear or whitish mucus-like substance that begins to be produced during puberty.The color, consistency and amount of discharge depends on the day of the menstrual cycle. During pregnancy, there may be more discharge than usual, but this is completely natural.
What discharge during pregnancy is a sign of infection?
Unfortunately, during pregnancy, the body is more prone to vaginal infections. The reason is that due to pregnancy hormones, the composition of the vaginal flora changes, so the body is more susceptible to diseases such as thrush and bacterial vaginosis.
Any change in the color, odor, or consistency of vaginal discharge can indicate an infection, so be alert during pregnancy. Changes also occur with bacterial vaginosis – because of it, the discharge, as a rule, acquires a pungent fishy odor and a gray, white or green color. With thrush, the discharge can be viscous, lumpy, white. If you notice these symptoms or something else is causing you anxiety, discuss it with your doctor, who will find treatment.Untreated vaginal infection can spread to the uterus, and this is already dangerous for the health of the fetus.
When should I see a doctor?
If the color or consistency of the discharge changes, or if an unpleasant odor develops, consult a doctor. Also, you should consult a doctor if you experience itching or pain when urinating. Wateriness or traces of blood in your discharge may mean that you are leaking water or a mucus plug. If your due date is less than 37 weeks, this may indicate the onset of premature labor.In this case, you need to see a doctor at the first symptoms. If at any stage of pregnancy you experience vaginal bleeding (more severe than minor bleeding), see your doctor right away or call an ambulance.
How to avoid vaginal infection during pregnancy?
In order not to bring bacteria from the intestines into the vagina, wipe should be done from front to back. Wash yourself regularly with water and neutral soap. It is recommended to wear underwear made of cotton or other natural breathable fabric and not wear tight clothes (save your favorite leggings for later).
If an unpleasant odor appears, do not use syringes. Treatment for such symptoms is prescribed by a doctor.
What other changes in the nature of the discharge are worth paying attention to?
Immediately before the onset of pregnancy, during it and immediately after, women sometimes experience the following changes in the nature of discharge:
Discharge during ovulation. The volume of discharge (leukorrhea) depends on the day of the menstrual cycle. The amount of secretions increases immediately before ovulation (the most favorable time for conception), while they usually have a liquid consistency.Immediately after ovulation, the discharge becomes thicker and less noticeable, and its volume decreases. These fluctuations are usually noticed by women who purposefully plan pregnancy and monitor the periods of ovulation.
Mucous plug. Mucous plug, as the name suggests, consists of mucus that accumulates in the cervix, blocking the entrance to the uterine cavity. Its purpose is to protect the fetus from infection. Just before the onset of labor, the cervix dilates and the plug comes out of the vagina.The color of this mucus is usually clear or slightly pinkish with traces of blood, and its consistency is usually thicker than that of normal pregnancy discharge.
Amniotic fluid. A few hours before the start of the labor, the fetal bladder breaks through and water leaves. This does not always happen on the same scale as in the movies: some have a small trickle of water, others may have a greater volume of water, and still others do not notice anything at all.
Lochia. Immediately after natural childbirth or cesarean section and separation of the placenta, new discharge appears – lochia. It is a bloody mucus that is secreted for several days after giving birth. At first, it is a thick red discharge, which gradually turns pale and becomes yellowish or white. After cesarean section, the volume of lochia is slightly less than after natural childbirth. Lochia usually lasts four to six weeks after delivery.
During pregnancy, many amazing changes take place in the body.To find out what’s next for you and your baby, download our special pregnancy guide.
Questions of pregnant women • pregnancy • answers of the gynecologist
If stretch marks are still formed and there is a desire to reduce them, it is advisable to do this as soon as possible, while the stretch marks are relatively fresh and easier to correct. If you are a nursing mother, you should consult your doctor before undergoing any cosmetic procedure.
One of the most common procedures for reducing stretch marks is a body massage.Depending on the type of massage, it will help restore skin elasticity after childbirth, strengthen muscles, stimulate skin circulation, which in turn contributes to the formation of collagen. To improve skin tone, wraps, vacuum massage, lymphatic drainage massage, body peeling (AHA, chemical and abrasive peeling) are recommended to help reduce the resulting stretch marks. It should be noted that these procedures are carried out in a course, one or two times will not be enough. Also, body treatments should be combined with regular physical activity (walks, swimming in the pool, therapeutic exercises) and a balanced, healthy diet.
Mesotherapy of the body is often used to reduce stretch marks. These are subcutaneous injections of natural, biologically active substances that stimulate self-healing of the skin, contribute to its elasticity and tone. The procedure uses microneedles, with the help of which extracts of plant and animal origin, vitamins, amino acids and minerals are injected under the skin, which in the form of injections work much more effectively than traditional cosmetics. Getting under the skin, the active substances affect certain places – mesotherapeutic drugs are injected in small doses into the problem areas.Depending on the desired effect, you can choose different mesotherapy cocktails. This procedure is carried out as a course, and then prophylaxis is desirable – repeating the procedure every 3-6 months.
One of the most modern procedures for effectively reducing stretch marks is plasmolifting, or I-PRF. This is a progressive treatment that helps to restore and improve the skin condition. The main advantage of this method is the absence of side effects, because the patient’s own blood is used, to which no other chemicals are added.Thus, there is no risk of allergic reactions and infections. It is a reliable and natural method to improve the condition and appearance of the skin, using the resources of the patient himself. In addition, during the procedure, the patient feels only slight discomfort, because thin needles are used, which practically do not cause pain. During the procedure, after checking the patient’s state of health, blood is taken from the vein (approximately 15-30 ml), with the help of a centrifuge, valuable platelet-rich plasma is separated from it.The separated plasma is injected into problem areas by injection. In a small amount of blood, the concentration of platelet and stem cell growth factors is significantly higher, and they affect the problem area. Plasma I-PRF in cosmetology is used to restore and revitalize dry, tired skin, improve the condition of problem skin in case of scars and stretch marks.
Everything about female secretions. Capital Health Clinic
Normally, the discharge does not belong to pathologies, it is one of the elements of the natural work of the reproductive organs.The mucus produced by the secretory glands is needed for the formation of healthy microflora inside the vagina. Normal discharge does not have a characteristic odor, it is creamy, white or transparent. Before ovulation begins, their volume may be greater. All this refers to the natural phenomena of the body.
Any changes in smell, color, consistency or volume of secretions should alert the woman. Sometimes this is a reason to see a specialist. Such changes indicate the development of the pathological process.
Let’s consider the main types of vaginal discharge:
- by volume, there are abundant, scarce and moderate;
- by consistency distinguish between watery, curdled, foamy and slimy;
- can be transparent, white, greenish, yellow, brown or bloody in color;
- sourish in smell, sweetish, odorless and with a strongly pronounced unpleasant odor.
If the discharge is scanty, this may indicate a drying out of the vaginal mucosa.In this case, a woman may feel discomfort during intercourse. Most often, this condition occurs in the premenopausal period, during the onset of menopause. This is due to age-related changes, a decrease in estrogen levels, endocrine pathologies, or the intake of hormonal drugs.
Profuse discharge is often visually visible on underwear. This problem is most relevant in the middle of the menstrual cycle or during pregnancy just before childbirth. Odorless and colorless, this is a normal variation.If there are other changes, it is better to consult a doctor.
Thick discharge of a curdled consistency most often indicates the development of a fungal infection and requires treatment. Often accompanied by a sweet scent.
If the discharge is foamy, especially with an unpleasant odor, this indicates a bacterial infection of the vaginal microflora.
Thick, whitish discharge sometimes indicates the presence of thrush, more research is needed.
Bloody discharge between periods are alarming indicators; immediate consultation with a gynecologist is required.
Discharge of yellow or green color indicates the development of the inflammatory process.
If any changes are found, it is best for a woman to consult a specialist. For the diagnosis of the vaginal mucosa, studies are assigned:
- swab for flora;
- PCR diagnostics;
- bacteriological cultures;
- blood test.
After establishing the exact cause, the gynecologist prescribes the necessary treatment depending on the situation.
90,000 fetal ultrasound – IntraMed
Pregnancy is one of the most exciting, memorable and important periods in the life of every woman. Modern medicine is actively developing, and there are new requirements for research while waiting for a baby. This is primarily an ultrasound scan during pregnancy – at its different stages.This diagnostic method allows today to identify pathologies and inconsistencies in the fetus, which until the moment of the birth of the child was not possible until recently – for example, Down’s syndrome and other chromosomal abnormalities, having been born with which, a person had to live with them all his life. The safety of ultrasound during pregnancy, the price of which in our medical center is more than affordable, is evidenced by studies of the American Institute of Ultrasound in Medicine, as well as the absence of any fetal disorders when using this method for 20 years.Consider the question of when an ultrasound is done during pregnancy.
First ultrasound during pregnancy (up to 11 weeks)
Ultrasound of the fetus in early pregnancy is usually performed using a transvaginal probe. A study at 6-10 weeks of pregnancy helps determine that she is developing. It is possible to listen to the fetal heartbeat on an ultrasound scan, and also to establish that pregnancy develops inside the uterus (thereby excluding the diagnosis of “ectopic pregnancy”), and to determine the number of fetuses.The first ultrasound scan during pregnancy up to 11 weeks is recommended in case of bloody discharge, as well as if the previous pregnancy ended in miscarriage, was a frozen or ectopic pregnancy.
Ultrasound of the fetus in St. Petersburg at 11-13 weeks of pregnancy
By the 11th week of pregnancy, the fetus reaches a size at which it becomes possible to conduct a detailed study of its anatomical structures. This is the best time to diagnose congenital malformations that are incompatible with life or leading to disability.In the course of this study, signs of chromosomal diseases in the fetus are determined – an increase in the thickness of the collar space, the absence of a nasal bone. After the 14th week of pregnancy, the collar space disappears in all fetuses, so it is extremely important to undergo an ultrasound scan in our clinic in St. Petersburg during pregnancy at a period of 11-13 weeks in order to have time to measure this indicator.
The specialists of our clinic have international certificates of the Fetal Medicine Foundation (FMF) for ultrasound examination at 11-13 weeks of pregnancy and annually confirm the quality of their measurements.
Combined (ultrasound and biochemical) first screening of the risk of developing chromosomal abnormalities and congenital malformations of the 1st trimester of pregnancy
The current level of development of medical technologies allows examining pregnant women and identifying among them the risk group for the presence of Down’s disease and other chromosomal diseases in the fetus as early as 11 weeks of pregnancy. The most effective is the combination of ultrasound and biochemical studies in the period from 11 weeks to 13 weeks and 6 days.A biochemical study of the blood of a pregnant woman allows you to determine the concentration of various proteins produced in the placenta: PAPP-A and beta-hCG. For each week of pregnancy, there are own norms for the content of these proteins in the blood; with the chromosomal pathology of the fetus, the ratio of proteins will change. It has been shown that the most significant differences in protein concentrations in the norm and in the case of Down’s disease in the fetus are observed at 10-12 weeks of gestation. A biochemical study of the blood of a pregnant woman during these periods reveals about 70% of fetuses with Down’s disease.The combination of fetal ultrasound data and biochemical studies can increase the efficiency of detecting fetuses with Down’s disease by up to 85%. Currently, this method of examination is the most effective way to prevent the birth of a child with Down’s disease or other chromosomal diseases.
Ultrasound at 18-22 weeks of gestation
By 18-22 weeks of pregnancy, the fetus reaches a weight of 400-500 grams. and a length of 22-27 cm. Ultrasound of the fetus in St. Petersburg during these periods of pregnancy allows you to examine in detail all anatomical structures and identify most malformations.During the study, a search for signs of Down’s disease and other chromosomal abnormalities is carried out. After the second screening, the main tasks associated with prenatal diagnosis are considered solved. During this study, the volume of amniotic fluid, the structure and position of the placenta are assessed. If necessary, a transvaginal probe measures the length of the cervix and determines the risk of developing premature birth.
Ultrasound at 32-34 weeks of gestation
The main task of ultrasound during pregnancy at 32-34 weeks is to measure the circumference of the head and abdomen, measure the length of the bones of the arms and legs, and calculate the estimated weight of the fetus.Such a study assesses the possibility of spontaneous childbirth, developmental delay or disproportionate development of the fetus. Also, ultrasound at 32-34 weeks of pregnancy allows you to: measure the volume of amniotic fluid, excluding high or low water, determine the location of the fetus: head, pelvic, transverse, using Doppler examination to assess the blood flow in the vessels of the fetus and the blood flow of the umbilical cord and make sure that the fetus gets enough nutrients and oxygen.
Volumetric (3D / 4D ) Ultrasound
Standard ultrasound during pregnancy, the price of which is indicated in the corresponding section of our website, is a series of flat two-dimensional images of the fetus or its individual organs.
Three-dimensional, or 3D-ultrasound during pregnancy is a method of obtaining an image by complex transformation of two-dimensional information into a three-dimensional three-dimensional model. The transformation is carried out using a three-dimensional sensor and a special computer program with which the ultrasound machine is equipped. The resulting pictures can be rotated and viewed from different angles.
Four-dimensional ultrasound (4D) is a three-dimensional image of the fetus plus its movement in real time. As a result, the three-dimensional static image is complemented by the fourth dimension – time, and the activity of the fetus, its facial expressions in motion, becomes visible.
3D ultrasound during pregnancy and 4D can be done at various stages of pregnancy. But the result and image quality depend on the position of the fetus in the uterus, on the volume of amniotic fluid in front of his face, on such obstacles in the path of the ultrasound wave as a scar on the uterus, uterine fibroids, and subcutaneous tissue. It is almost impossible to get a three-dimensional image of a face if the fetus is pressed against the wall of the uterus. In this case, you have to wait 15-20 minutes until he changes his position.
The most suitable time frame for obtaining a face image is 20-26 weeks.During this period, the fetus often changes its position, and there is enough amniotic fluid in the uterus so that the face and body can be seen. After 30 weeks of gestation, the fetus reaches such a size that, in order to fit in the uterus, it needs to be well grouped. In this case, obtaining a high-quality image may be difficult or even impossible. Everything will depend on the position of the fetus.
It should be borne in mind that 3D and 4D studies are an addition to the usual fetal ultrasound and do not replace it.Measurement of the size of the fetus and the exclusion of malformations is carried out using a standard two-dimensional ultrasound.
In our clinic, you can record the study on any storage medium and print color photos of 3D images.
Ultrasound during pregnancy | GUZ City Maternity Hospital, Chita
Ultrasound is the safest and most effective way to assess fetal development and pregnancy.
According to the recommendations of the Ministry of Health and Social Development of the Russian Federation, in order to ensure timely prenatal diagnosis of congenital and hereditary diseases during pregnancy, it is necessary to conduct three ultrasound examinations at 11-13, 18-21 and 30-34 weeks.This ultrasound screening is mandatory (Order of the Ministry of Health and Social Development of Russia No. 457).
Ultrasound studies include many methods that allow in different directions and at a certain time to reliably assess the condition of the mother and the fetus.
Ultrasound allows the doctor to identify existing and potential problems, get rid of suspicions, and also allows parents to see their unborn child. Ultrasound diagnostics allows a pregnant woman and a doctor to approach childbirth with the least uncertainty.
Carrying out ultrasound:
- At transabdominal examination , the doctor manipulates the ultrasound probe along the woman’s anterior abdominal wall, the gel applied to the skin improves the conductivity and thereby improves the image quality. With the help of a transabdominal sensor, it is also possible to conduct a Doppler study, thanks to which the blood supply to the fetus is assessed, and, equally importantly, it provides an opportunity for the expectant mother to hear the heartbeat of her child for the first time.
- At transvaginal examination , a special probe is painlessly inserted into the woman’s vagina. The advantage of this research method is obtaining a more detailed image, due to the closer location of the sensor to the uterus.
As pregnancy progresses, ultrasound provides an opportunity to evaluate the fetoplacental system of the fetus. To determine the features of the functional state of the fetus, a cardiotocographic study is performed.
Ultrasound fetometry allows early detection of fetal growth retardation. In this case, dopplerometry provides an opportunity to ascertain the deviations that have arisen in the placental circulatory system.
If it is necessary to evaluate the fetoplacental system, it is possible to carry out echography, in determining the features of the functional state of the fetus – cardiotocography.
If fetal growth retardation is suspected, ultrasound fetometry is performed. Dopplerometry makes it possible to identify abnormalities in the placenta circulatory system, i.e.e. to exclude the development of placental insufficiency.
Ultrasound diagnostics of pregnancy
Ultrasound diagnostics is possible from the earliest stages of embryo development.
Received information allows:
- Confirm pregnancy
- Determine the number of embryos
- to evaluate the “quality” of pregnancy, to specify the gestational age by the size of the ovum and embryo
- to identify at early stages in order to prevent complications and “neglected” cases (ectopic pregnancy, cystic drift, etc.)
- to determine the causes of bleeding from the genital tract during pregnancy
It is especially important to conduct an ultrasound scan to confirm pregnancy in cases where test results or other signs raise doubts about its existence.In addition, thanks to this non-invasive diagnostic method, which, in turn, is safe and painless, it is also possible to assess the condition of the pelvic organs and identify concomitant gynecological pathology affecting the fetus.
In some cases, an ultrasound scan allows you to determine abnormalities in the structure of the uterus, which is especially important in women who have had miscarriages or complications during previous pregnancies in the past.
First screening ultrasound at 11-13 weeks of gestation.
The first ultrasound examination is extremely important. This study will make it possible to objectively assess the formation of many anatomical structures and organs of the fetus, as a result of which it is possible to exclude gross malformations of their development.
At this time, the ultrasound examination will reveal:
- Number of fruits (one or more). In the case of diagnosing multiple pregnancies (more than one fetus), placentation and amniotic membranes are studied in detail.If each of the fetuses has its own placenta, then parents can prepare for the birth of twins, if the placenta is common – twins.
- The exact term of pregnancy, which allows you to establish the expected date of delivery, as well as to schedule the necessary additional studies in a timely manner.
- Features of the formation of the placenta and umbilical cord.
- Ultrasound signs indicating chromosomal abnormalities (thickness of the collar space, image of the nasal bones, blood flow in the ductus venosus and through the tricuspid valve, etc.)) An integrated approach to the assessment of these echographic markers allows you to most accurately identify a high-risk group for the birth of children with chromosomal abnormalities, for example, such as Down’s syndrome and others.
- Fetal malformations. At 11 – 13 weeks, a number of fetal malformations can be identified. At this time, doctors have a huge advantage – the time to conduct genetic research and, as a result of unfavorable results, the ability to terminate the pregnancy without further serious complications for the woman.
- Pathological conditions that are possible during pregnancy.
Despite a thorough study at this stage of pregnancy, it is impossible to say with confidence about the absence of fetal malformations – this is due to the small size of its anatomical structures. The optimal time to assess fetal anatomy is 18 to 21 weeks.
Second screening ultrasound for 18-21 weeks of pregnancy.
18 – 21 weeks is the optimal time for visualization of fetal structures.During this screening, a detailed study of the anatomy of the fetus is possible, a more accurate determination of the duration of pregnancy and the identification of developmental delays.
Carrying out an ultrasound examination at this stage of pregnancy allows:
- Pregnancy period based on fetal organ size and maturity
- Determination of the position of the fetus
- Determination of the presenting part of the fetus
- Determining the sex of the fetus (considering good visualization)
- Assessment of the state of the placenta (localization, its thickness, structure)
- Determination of the amount of amniotic fluid
Assessment of the state of the cervix is important at this time.This is necessary for the timely correction of its inconsistency (a frequent complication in multiple pregnancies).
Also, at a period of 18-21 weeks, it becomes possible to reliably assess the blood flow (Doppler study) in the uterine arteries and umbilical cord arteries, in order to predict the development of various complications in the later stages of pregnancy.
But, unfortunately, the laws of prenatal formation of the fetus are such that not all developmental anomalies can be detected by ultrasound examination in the prenatal period, even in the interval of 18-21 weeks.
The third screening ultrasound scan during pregnancy 30-34 weeks .
The third study is necessary to identify those malformations that manifest themselves only in the later stages of pregnancy. In addition, in the interval of 30-34 weeks, additional studies (Doppler ultrasonography, cardiotocography) are carried out to assess the intrauterine state of the fetus, the nature of developmental delay, the presence of hypoxic changes and intrauterine infection, determine the degree of entanglement of the baby with the umbilical cord and predict some complications in the prenatal period and during childbirth. …Thanks to the ultrasound scan at this gestational age, it is possible to determine the tactics of delivery that is optimal for the birth of a healthy baby.
With the help of an ultrasound examination, at this time it becomes possible:
- Estimate the parameters of prenatal development
- Exclude fetal defects
- Determination of the position and presentation of the fetus, which in turn may affect the method of delivery
- Calculation of the estimated weight and height of the fetus
- Identify fetal developmental delays
- Assess the condition of the placenta (thickness, structure, density and stage of maturity)
- Amniotic fluid volume measurement
- Measurement of the thickness of the uterine scar (after previous cesarean sections)
Cardiotocography (CTG) – a method of functional assessment of the state of the fetus based on recording the fetal heart rate and their changes depending on uterine contractions, the activity of the fetus itself or the action of external stimuli.
This study is carried out only in the third trimester of pregnancy, as well as during childbirth .
The fetal heart activity is recorded by a special ultrasound sensor, which is fixed on the anterior abdominal wall of a pregnant woman in the area of the best audibility of the fetal heart sounds. The ultrasound signal reflected from the fetal heart is generated by the transducer and again perceived by the transducer. An electronic system converts the recorded changes in the intervals between individual fetal heart beats into an instantaneous heart rate, calculating the number of beats per minute at the time of the study.
Currently, cardiotocography has become an integral part of a comprehensive assessment of the condition of the fetus. Thanks to CTG, the possibilities of diagnostics both during pregnancy and in childbirth are significantly expanded, which makes it possible to effectively solve the issues of rational tactics of their management.
CTG should be carried out no earlier than 32 weeks of gestation , due to the fact that it is by this time that the relationship between cardiac activity and the motor activity of the fetus is formed, which reliably reflects the functional capabilities of its central nervous, muscular and cardiovascular systems.
By the 32nd week of pregnancy, the average duration of an active state is 50-60 minutes, and a quiet one – 20-30 minutes. Earlier use of CTG does not ensure the reliability of the diagnosis, since it is accompanied by a large number of false results.
Doppler / Doppler
Doppler ultrasound / Doppler, including color Doppler mapping – study of blood flow in the vessels of the fetus , vessels of the umbilical cord and uterus .
The results of Doppler ultrasound allow us to judge the state of the uterine-placental-fetal blood flow and indirectly indicate the intrauterine state of the child.
Reliable information about the state of uterine blood flow can be obtained from 20 to 21 weeks. In late pregnancy (after 30 weeks), Doppler ultrasound is a desirable component of every ultrasound scan.
Normal blood flow indices serve as a fairly reliable sign of the normal intrauterine state of the fetus, but do not exclude the development of certain complications in the later stages of pregnancy.
The presence of blood flow disturbances in different parts of the uteroplacental-fetal system requires strict dynamic control, including in a hospital setting.
Doppler ultrasonography is required at:
- discrepancy between the size of the fetus and the gestational age;
- abnormal amount of amniotic fluid;
- Premature maturation and other pathological conditions of the placenta.
Erosion of the cervix is a common pathology that occurs in more than a third of women.Modern medicine recognizes that surgical treatment is appropriate only in extreme cases. In IMMA clinics, the necessary research is carried out, monitoring and treatment of pathological conditions associated with changes in the epithelium of the cervix are carried out. The patient can count on highly qualified assistance in solving the problem.
In our clinics you can:
For more details and for any questions, please contact the number indicated on the website.
In modern medicine, the term “cervical erosion” refers to two different pathologies that imply a violation of the epithelium.For the diagnosis, a visual examination by a gynecologist is enough, so a regular visit to a doctor will guarantee protection against possible complications.
Features of the structure of the cervix
The cervix is the lower part of the uterus that protrudes into the vagina. In its center there is a canal that connects the uterine cavity and vagina. In the normal state, the surface of the organ is pink and smooth. The outer epithelium consists of several layers of cells:
- Basal tissue, in this layer of the mucous membrane there is a continuous division of cells, which ensure the change of the upper layers of the mucous membrane;
- intermediate layer, consisting of maturing cells formed in the basal tissue;
- Superficial or functional tissue, consists of flat cells that provide mechanical and biological protection against adverse factors.
The inner surface of the uterus is lined with another type of tissue – a single-layer epithelium, consisting of cylindrical cells. The appearance of the surface differs from the surface of the neck in a brighter, usually red color. In a normal state, the tissue of cylindrical cells is not accessible during a gynecological examination. The junction point of the squamous and cylindrical types of epithelium is located inside the cervical canal, normally it cannot be seen.
By the term “cervical erosion” experts understand two different pathological conditions of the epithelium, which are related.
True erosion is damage to the upper layer of the epidermis, in essence it is a wound. Such a violation looks like a bright red round ulcer with irregular edges. It is characterized by edema, inflammation, purulent and bloody discharge.
Such erosion does not always require special treatment, the healthy layer of the epithelium is restored by itself within two to three weeks. If the damage is shallow, the infection does not join them and the body has a strong immune system, then the epithelium is quickly restored.However, the healing process should be under the supervision of a specialist to exclude the development of complications.
The causes of true erosion of the cervix can be different:
- mechanical damage as a result of childbirth, abortion, rough intercourse;
- inflammatory processes in the vagina and cervical canal. Acrid secretions can eat away at the top layer of cells;
- the influence of infections, pathogens injure the delicate epithelium.
In some cases, complications in the form of scarring may occur.They deprive the upper layer of the cervix of the necessary elasticity, which threatens damage and tears during natural childbirth.
Symptoms of true erosion of the cervix are erased. This is due to the peculiarity of the structure of this organ: there are no nerve endings, therefore, injuries, ulcers and wounds do not bother the woman much and heal independently and imperceptibly.
When complications arise, for example, the addition of an infection or the development of an inflammatory process, the signs of true erosion of the cervix become more obvious.Unpleasant sensations appear during intercourse, pain in the lumbar spine, discharge with blood elements is observed.
Another common consequence of improper epidermal repair is the replacement of a multilayer, cylindrical type of tissue with flat cells lining the inner surface of the uterus. This condition is called ectopia or false erosion.
Ectopia of the cervix
More than a third of the fair sex has this phenomenon.Ectopia was excluded from the list of gynecological diseases. In modern medicine, it is considered a feature of the structure of the epidermis and requires urgent treatment only in certain cases.
There are the following reasons for the appearance of false erosion of the cervix:
- hormonal disruptions caused by disruption of the adrenal glands, ovaries, thyroid gland;
- prolonged inflammatory processes in the vagina and cervical canal with a large amount of secretions that damage the delicate layer of the epithelium;
- vaginal dysbiosis, violation of microflora as a result of non-observance of hygiene rules, unprotected intercourse, frequent change of sexual partners;
- decreased immunity;
- complications in the healing of true erosion and other damage to the cervix.
90,039 sexually transmitted infections;
Recent studies have shown that already at the stage of intrauterine development in girls, the development of false erosion is observed. The true causes of the phenomenon are poorly understood. Such a pathology does not require treatment, it usually disappears on its own until the age of 25, when the process of maturation of the cells of the vaginal and cervical epithelium ends.
Varieties of ectopia
The spread of squamous epithelium can affect the deep layers of the surface of the cervix and cause various neoplasms and changes in tissue structure.There are three forms:
- clean view. The altered surface is smooth and has a brighter red color. Usually found in congenital pathology.
- glandular, suggests deep tissue changes, its appearance resembles a sponge.
- cystic, accompanied by the appearance of tubercles with signs of an inflammatory process.
- mixed, combining both types.
Complicated recurrent false ulcer requires close monitoring by a doctor, as it can cause a malignant tumor.In this case, it may be necessary to remove the erosion of the cervix.
Signs of ectopia
Symptoms and signs of false erosion of the cervix are as follows:
- copious odorless discharge;
- burning sensation.
90,039 pain during intercourse;
90,039 spotting after intercourse or medical procedures;
If complications arise, for example, an infection or an inflammatory process, the symptoms intensify, the discharge becomes purulent with a pungent odor, and itching in the vagina may appear.
Erased symptoms and irregular visits to the doctor lead to the fact that the pathology develops for many years. Under the influence of complications, there may be a threat of malignant degeneration of tissues.
Causes of ectopia
In modern medicine, there are several theories that reveal the causes and mechanisms of the appearance of false erosion. The most common opinion about the inflammatory nature of the disease. Inflammation in the vagina and cervical canal leads to the formation of a large amount of secretions that irritate the epithelium of the cervix.True erosion occurs, but due to the unfavorable environment and lack of treatment, healing is accompanied by the replacement of cylindrical cells with flat ones.
It is believed that hormonal imbalance can cause ectopia. Decreased steroid production leads to tissue replacement. This phenomenon can be observed in girls during puberty, in pregnant women and women going through menopause.
Ectopia occurs with mechanical damage during childbirth, eversion and prolapse of the pelvic organs.
Erosion during pregnancy
The appearance of ectopia during pregnancy is a consequence of a change in the hormonal background of a woman, a decrease in immune defense, and does not require special treatment. The danger lies in possible complications. The affected areas of the cervix do not perform a protective function, therefore, the threat of infection and the occurrence of an inflammatory process increases. The doctor chooses the most gentle medicines allowed during pregnancy.
Prevention of complications is the observance of the rules of personal hygiene, the use of condoms during intercourse.
Injuries during childbirth can cause true erosion. Against the background of recovery processes, elimination of lochia, the disease passes unnoticed for a young mother.
Pathological changes in the epithelium of the cervix are clearly visible during a gynecological examination. To make an accurate diagnosis, determine the treatment strategy, the following studies are carried out:
- bacteriological culture;
90,039 tests for infections, including AIDS;
Colposcopy. This examination method involves a careful study of pathology using special equipment. The colposcope magnifies the image thirty times, allowing you to accurately determine the nature of the changes. To determine the type of tissue, solutions of iodine (Lugol) or vinegar are used. They do not harm the mucous membrane, however, due to the reaction of the tissue, they stain it in different colors, which makes it possible to highlight problem areas. The specialist carefully examines the changes, notes the places that require the use of additional research methods, including cytological analysis and biopsy.
Cytological examination. Cytological analyzes show changes in the structure of cells, the presence or absence of signs of malignant changes. For the study, the doctor makes a scraping.
Biopsy. This study involves examining the tissue for signs of malignant changes. In the process of carrying out a colposcopy, the doctor marks out the places that require checking. Tissue plucking procedures are painless and may be accompanied by slight discomfort.This study is mandatory before determining treatments for cervical erosion.
Tests for the presence of infections, determination of the state of microflora. One of the first steps in erosion treatment is to identify infections and inflammation. They can be the cause of the disease, after the elimination of which the normal outer cover will be restored.
The results of the examination will enable the doctor to determine how to treat the erosion of the cervix.First of all, it is necessary to eliminate infections and inflammation.
Treatment of cervical erosion is not always required. For example, with congenital ectopia and minor changes in the epithelium that do not cause discomfort, one observation is sufficient.
If ectopia does not go away after 25 years, occupies a large area, is accompanied by complications, then various techniques are used, based on one mechanism. The pathological layer of cells is destroyed so that a normal epithelium is restored in its place.There are several methods. Differing in availability, possible consequences:
- radio wave exposure;
- laser therapy.
Radiowave exposure is the most gentle method of treatment. After it, a scab does not form, since the pathological layers of cells not only die off, but evaporate, a film appears instead. Healing is fast and there are no scars.
The answer to the question of whether to cauterize cervical erosion depends on each specific case.
Prevention and surveillance is the guarantee of health
A frivolous attitude towards ectopia can lead to serious complications: infertility, cancer. The affected epithelium does not perform protective functions, therefore, the risks of inflammation and infection with infectious diseases increase. Unjustified aggressive methods of exposure can lead to scars and relapses.
High-quality monitoring and treatment of cervical erosion in Moscow is carried out in IMMA clinics. The availability of the latest equipment, the ability to conduct high-precision laboratory tests, and the professionalism of the staff guarantee success in the prevention of gynecological diseases.
Regular gynecological examinations are necessary to maintain women’s health!
90,000 ultrasound during pregnancy fetal ultrasound on Ladoga
During pregnancy, each woman, as a rule, is sent for an ultrasound examination several times.In obstetric practice, this diagnostic method is the most indicative and does not have harmful consequences either for the baby or for the expectant mother.
What will ultrasound show during pregnancy.
Ultrasound as a diagnostic method has significantly expanded the capabilities of obstetricians and gynecologists. The study is as informative as it is visual. Everything that happens “inside” is visible on the screen, while the image can be not only flat, but also three-dimensional. Ultrasound scanners of the latest generation are supplemented with the 3D / 4D function, which allows you to see even the facial expressions of an unborn child.By the way, it is possible to identify fetal malformations only with the help of ultrasound.
In the normal course of pregnancy, each expectant mother is routinely examined three times:
- Ultrasound at 10-14 weeks : it is necessary to assess the state of the placenta, as well as the basic anatomical structures of the fetus; already at this time, it is possible to identify severe malformations of the child, as well as a number of chromosomal abnormalities – Down’s, Edwards’ syndromes and others; the doctor also specifies the gestational age.
- Ultrasound scan at 20-24 weeks : its main task is to diagnose possible pathologies of fetal development; at this time, the weight of the child is already up to 500 g, so you can reliably determine his gender; in addition, the doctor studies the state of the placenta – its structure, degree of maturity, the intensity of blood flow in its vessels, in order to prevent the consequences of ill health in time; if the condition of the cervix indicates the danger of premature birth, there is time to take countermeasures.
- Ultrasound at 32 – 34 weeks : at this time, the state and dynamics of development of the internal organs of the fetus, as well as its growth and development in general, are assessed in order to make adjustments in time for deviations from the norm; examine the placenta, measure the amount of amniotic fluid; the doctor assesses the level of motor activity of the fetus and assesses its position in the uterus in order to outline a strategy for adequate obstetrics.
In addition to the planned ultrasound, the doctor may prescribe additional examinations for the woman, if he considers it necessary. For example, in the early stages of pregnancy, ultrasound will help establish the very fact of its onset. In addition, early ultrasound is indicated for bleeding, as well as if the woman has a history of miscarriage or missed pregnancy.
In the later stages of an ultrasound scan, it is necessary to clarify the diagnosis of the expectant mother or notice abnormalities in the development of pregnancy in time, and then take measures to eliminate the fatal consequences.
For ultrasound, you do not need preparation. The study takes place in a comfortable environment for the expectant mother without any pain or discomfort.
Ultrasound and your baby’s safety.
In fact, the only thing that worries expectant mothers is how the ultrasound will affect the baby. Everyone wants to provide protection for their baby, so the questions are: “Is it safe? What are the immediate and long-term consequences of the procedure? ” – doctors hear often.
Numerous studies of mammals indicate that no pathological changes occur in tissues and cells when exposed to ultrasound.Embryos of laboratory animals and chromosomes of living cells do not undergo any noticeable negative consequences.
That is why WHO doctors recommend that every woman undergo an ultrasound scan during pregnancy. It will not harm either mom or baby. And the higher your chance of giving birth to a healthy baby will be!
In our center, ultrasound of pregnant women is performed using the most modern equipment. You will be able not only to see with your own eyes that your child is developing as it should, but also to receive documentary confirmation of this in the form of a color photo from a scanner screen or video recording as a souvenir.
Why do pregnant women need ultrasound?
Undoubtedly, the most important moment in the life of every woman is the birth of a child. And, of course, I want this event to go like clockwork. Ultrasound during pregnancy allows you to determine the state of the placenta and the fetus in the early stages, as well as prevent or eliminate abnormalities if such are detected.
Ultrasound data during pregnancy provide additional information that is very important for the diagnosis of fetal malformations – limbs, spine, face.The last word in ultrasound technology is a universal ultrasound scanner.
With the help of an ultrasound examination, the expectant mother can see an image of her baby. This is an ideal way to identify fetal abnormalities.
Is ultrasound scan harmful to the fetus during pregnancy?
Over time, there was a widespread belief that an ultrasound of the abdominal cavity, carried out during pregnancy, can cause any harm to the baby in the womb.However, this belief has no scientific justification and, most likely, is caused by the desire to protect the baby from all sorts of adversities traditionally inherent in parents. Research from which it follows that ultrasound is harmful to the fetus does not exist.
Ultrasound is considered a safe, accurate and inexpensive method for examining the fetus. Ultrasound during pregnancy has become the standard diagnostic method and plays an important role in monitoring every pregnant woman around the world.
Ultrasound for pregnant women is recommended in the following cases:
- Diagnosis and confirmation of early pregnancy;
- For bloody vaginal discharge in early pregnancy;
- Determining the timing of pregnancy and the size of the fetus;
- Diagnosis of fetal malformation (congenital structural disorders);
- To determine the localization of the placenta;
- For multiple pregnancies;
- In the presence of bloody vaginal discharge (to determine the viability of the fetus).
When doing ultrasound for pregnant women.
In Russia, during the entire period of pregnancy, ultrasound is usually done several times. This is explained by the fact that at each stage of fetal development, control of strictly defined indicators is required. So, the sex of the child can be easily determined at the twelfth week. That is why it is recommended for expectant mothers to carry out ultrasound at least three times:
- For a period of 12 – 14 weeks;
- For a period of 20 – 24 weeks;
- For a period of 32 – 34 weeks.
We remind you that this procedure is useful not only for pregnant women, but also for regular pain in the lower abdomen, irregularities in the cycle and suspected infertility.
The main task of fetal ultrasound is to prevent hereditary and congenital diseases in children.
During pregnancy, the obstetrician-gynecologist must refer the pregnant woman to ultrasound (ultrasound). Ultrasound during pregnancy must be done three times, at the end of each.At each stage, doctors will receive their own invaluable information about the state of the fetus.
The most important question that arises in pregnant women is whether ultrasound for pregnant women does harm to the fetus. There have been many clinical trials that have proven that ultrasound during pregnancy is completely safe. Ultrasound is carried out exclusively to study the development of the fetus and does not cause any harm to it.
Video: Fetal ultrasound
In recent decades, ultrasound has helped to look into the process of pregnancy.The device allows doctors to detect anomalies even before childbirth, allows parents to see their unborn child: During the day, the child swallows half a glass of amniotic fluid. Even in the uterus, the baby sucks on the finger, developing a sucking reflex, which will be useful to him later. The fruit is constantly growing and we see how cramped it is there. With the help of ultrasound, you can even see how the baby blinks.
When to do ultrasound for pregnant women?
All expectant mothers are prescribed an ultrasound at the end of the first trimester of pregnancy for a period of 10-14 weeks.Already at this moment it is possible to determine if there are any serious deviations in the development of the fetus. At this time, the doctor measures the distance from the tailbone to the crown of the embryo (this indicator is called CTE), studying the anatomical structure of the fetus. By this indicator, one can judge how the fetus is fully developing, and whether its size corresponds to the norm.
The thickness of the collar space (TVP) is also estimated. Thanks to this indicator, it is possible to understand whether the fetus has chromosomal abnormalities. With TVP more than 2.7 mm, chromosomal abnormalities may be suspected.First of all, the likelihood of developing Down syndrome in the fetus. If the doctor suspects a threat, he will also have to take a blood test to clarify the well-being of the future baby.
By 12-14 weeks of pregnancy, almost all organs of the fetus have time to develop. Therefore, you can see the most obvious congenital pathologies of the brain, heart, the presence of unwanted formations. In the case of severe pathologies, it is not too late to terminate the pregnancy for medical reasons.
The second ultrasound is performed, this is the gestational age from 20 to 24 weeks.And it is this study that will answer such an exciting question for a boy or girl. Theoretically, the sex of the fetus can be determined already from the 12th week of pregnancy. But it is best seen at 16-20 weeks. By this time, the genitals of the fetus noticeably increase in size and are easier to see. So it is worth asking the question of determining the sex of the child during the second ultrasound. However, you will not be given a 100% guarantee. The child’s posture may simply prevent the doctor from seeing his gender.
At the second ultrasound, the doctor measures the abdominal circumference, the length of the femur, the inter-parietal size of the fetal head.Based on these indicators, one can judge whether there is a lag in the development of the future baby. In addition, an ultrasound specialist evaluates indicators such as blood flow in the vessels of the placenta, its location, degree of maturity, structure. This is very important because premature placental abruption is very dangerous and can be a reason for hospitalization. A thickening of the placenta is often a sign of infection, diabetes and other diseases that can harm the fetus.
Examination of amniotic fluid can provide additional information on fetal kidney development.Polyhydramnios may indicate Rh-conflict or some kind of infection. In both cases, special therapy and medical supervision will be required. Examining the umbilical cord, the doctor looks to see if it is entwined. However, at this stage, this is not as important as during the subsequent examination.
Examination of the cervix allows you to clarify whether there is no isthmic-cervical insufficiency. This is a pathology in which the cervix begins to open before 37 weeks, which can lead to the threat of premature birth.
The third ultrasound
The third ultrasound is performed for a period of 32-34 weeks.By this time, the fetus usually has time to take its final position inside the uterus and position its head or pelvic end “towards the exit.” Therefore, the obstetrician-gynecologist will be able to decide in advance how to carry out childbirth. With the help of an ultrasound machine, you can determine the approximate weight of the fetus, its size, and calculate the approximate delivery time.
The position of the placenta is also assessed, since by 32-34 weeks its migration is already over. Normally, the placenta is attached at the very top of the uterus, away from the cervix.