Spotting during late pregnancy with no identified cause
December 29, 2024 10:08 AM Subscribe
YANMD but my doctor doesn’t have an answer, and I’m really nervous. I have had three instances of spotting in my second trimester, and looking for ideas on what I should get checked out.
I spotted for the first time after an orgasm (but no intercourse) at 25 weeks. It was just once and I explained it away as uterine contractions, and put myself on pelvic rest but continued to move around normally.
At 26 weeks, about 5 days after the first time, I traveled on a domestic flight on too little sleep, with the beginnings of a cold (which I didn’t know about), and this time, spotted for about 24 hours. This scared me so I went to get checked out with an ultrasound. Everything looked fine with the heart rate, movement, cord, blood flow, placenta, amniotic fluid, cervix, etc. The only issue is that the baby dropped in size percentiles since my 20 week ultrasound, but the doctor was not concerned, especially since I had a small baby in my previous pregnancy. She said bleeding just happens sometimes.
No spotting for a stretch of 10 days. In the meantime, my cold got quite bad and I’ve been coughing incessantly (to the extent my abdomen hurts on one side) and unable to sleep well.
Today at 27 weeks, the spotting has started again, and it’s been going on for a few hours. I’ve been on strict pelvic rest and also taken it easy with movement for two weeks, but since it was 10 days since the last event, and I was feeling less anxious, I did take an outing with my older child where I walked (at a normal pace) for about an hour.
It’s brown blood with something that looks like leukorrhea mixed in, not like the mucus from a bloody show, but not dry.
What could be going on?? Is it an effect of my cold? My doctor doesn’t think so, but my body shakes and hurts every time I cough — could that be irritating my cervix or uterus?
Is this happening when I’m dehydrated and moving more than usual, even though I’m not actually exercising?
And then there’s the issue that I’m of advanced maternal age. Again, the doctor didn’t think that was a factor.
If you had repeated spotting and figured out a cause other than issues that were checked during the ultrasound and Doppler, please do chime in so I can get them checked out.
I spotted for the first time after an orgasm (but no intercourse) at 25 weeks. It was just once and I explained it away as uterine contractions, and put myself on pelvic rest but continued to move around normally.
At 26 weeks, about 5 days after the first time, I traveled on a domestic flight on too little sleep, with the beginnings of a cold (which I didn’t know about), and this time, spotted for about 24 hours. This scared me so I went to get checked out with an ultrasound. Everything looked fine with the heart rate, movement, cord, blood flow, placenta, amniotic fluid, cervix, etc. The only issue is that the baby dropped in size percentiles since my 20 week ultrasound, but the doctor was not concerned, especially since I had a small baby in my previous pregnancy. She said bleeding just happens sometimes.
No spotting for a stretch of 10 days. In the meantime, my cold got quite bad and I’ve been coughing incessantly (to the extent my abdomen hurts on one side) and unable to sleep well.
Today at 27 weeks, the spotting has started again, and it’s been going on for a few hours. I’ve been on strict pelvic rest and also taken it easy with movement for two weeks, but since it was 10 days since the last event, and I was feeling less anxious, I did take an outing with my older child where I walked (at a normal pace) for about an hour.
It’s brown blood with something that looks like leukorrhea mixed in, not like the mucus from a bloody show, but not dry.
What could be going on?? Is it an effect of my cold? My doctor doesn’t think so, but my body shakes and hurts every time I cough — could that be irritating my cervix or uterus?
Is this happening when I’m dehydrated and moving more than usual, even though I’m not actually exercising?
And then there’s the issue that I’m of advanced maternal age. Again, the doctor didn’t think that was a factor.
If you had repeated spotting and figured out a cause other than issues that were checked during the ultrasound and Doppler, please do chime in so I can get them checked out.
I checked some Dutch sources for you (reasoning below, if you're curious).
Here's what I learned:
- This could be an indication that there's something wrong with the placenta, which would be bad. It does seem to be recommended to get things checked out every time the spotting happens.
- A benign cause that could fit your situation: your uterus has more blood flow due to hormones and everything, and the veins are closer to the surface. Sex (and/or orgasm) can damage some of these veins and cause blood loss that can last for 24 to 36 hours (without further damage). It makes sense to me that coughing strong enough to shake your body could have a similar effect. (I'm no doctor, though.)
- I saw a recommendation to wear pads or something similar, so you can easily describe and quantify the blood loss.
I hope it's the 'benign cause' one and that you recover soon! (Colds can be such a pain.)
(I didn't find any new things to check, sadly. Looks like you'll need to keep calling if this happens, just in case.)
My reasoning for checking Dutch sources: it's common in the Netherlands for people to get prenatal care as well as home births under the guidance of (well-trained) midwives, if and while the pregnancy is low-risk. Part of the midwife training is judging whether the pregnancy is still low-risk, and a lot of that information is shared with the parents-to-be. I find it to be a healthy attitude.
In summary: it could be fine, but do get it checked out, even when it's the Nth time.
posted by demi-octopus at 10:50 AM on December 29, 2024 [3 favorites]
Here's what I learned:
- This could be an indication that there's something wrong with the placenta, which would be bad. It does seem to be recommended to get things checked out every time the spotting happens.
- A benign cause that could fit your situation: your uterus has more blood flow due to hormones and everything, and the veins are closer to the surface. Sex (and/or orgasm) can damage some of these veins and cause blood loss that can last for 24 to 36 hours (without further damage). It makes sense to me that coughing strong enough to shake your body could have a similar effect. (I'm no doctor, though.)
- I saw a recommendation to wear pads or something similar, so you can easily describe and quantify the blood loss.
I hope it's the 'benign cause' one and that you recover soon! (Colds can be such a pain.)
(I didn't find any new things to check, sadly. Looks like you'll need to keep calling if this happens, just in case.)
My reasoning for checking Dutch sources: it's common in the Netherlands for people to get prenatal care as well as home births under the guidance of (well-trained) midwives, if and while the pregnancy is low-risk. Part of the midwife training is judging whether the pregnancy is still low-risk, and a lot of that information is shared with the parents-to-be. I find it to be a healthy attitude.
In summary: it could be fine, but do get it checked out, even when it's the Nth time.
posted by demi-octopus at 10:50 AM on December 29, 2024 [3 favorites]
Not an OB but in my experience, brown blood can be "old blood," that is blood from a previous bleed is finally working its way out, but it could be something else. Is your OB with a team that you could use more broadly viewed contact method? Or call their after-hours service for whoever is on call? Regardless, I'd keep trying today and call tomorrow morning as soon as they open if you don't hear back.
And I'd personally would do bedrest and plenty of water today. Agree with using pads to try to quantify the amount.
And for me, any bleeding with uterine/abdominal pain/fever or decreased fetal movement would merit an ER visit at a center with a good OB service, being very clear upfront about the issue and asking for a sonogram.
posted by beaning at 1:20 PM on December 29, 2024
And I'd personally would do bedrest and plenty of water today. Agree with using pads to try to quantify the amount.
And for me, any bleeding with uterine/abdominal pain/fever or decreased fetal movement would merit an ER visit at a center with a good OB service, being very clear upfront about the issue and asking for a sonogram.
posted by beaning at 1:20 PM on December 29, 2024
I’m a CNM (TINMA, etc.). If you don’t know what’s going on, you should be eventuated in person by a clinician who is qualified to assess you and your baby. If you have been told on the phone “I don’t know what it is,” that is not appropriate and you should speak with someone else and be seen face-to-face.
I know how frightening and confusing it can be to have bleeding during pregnancy. It can be caused by many things, some more benign than others, but no one here can tell you what is causing *your* bleeding and any reassurance you find from internet strangers, no matter how well-meaning, is of very little value to you and your baby right now.
I’m sorry you’re experiencing this and I wish you well.
posted by stillmoving at 1:36 PM on December 29, 2024 [6 favorites]
I know how frightening and confusing it can be to have bleeding during pregnancy. It can be caused by many things, some more benign than others, but no one here can tell you what is causing *your* bleeding and any reassurance you find from internet strangers, no matter how well-meaning, is of very little value to you and your baby right now.
I’m sorry you’re experiencing this and I wish you well.
posted by stillmoving at 1:36 PM on December 29, 2024 [6 favorites]
At this point in pregnancy, I think going to the ER every time there’s bleeding is a good idea. I know it can be very expensive, but while common, bleeding is not normal and could be serious. Worst case is if you go into labor at home at 27w, which obviously needs to be avoided at all costs. The hospital will be able to do a stress test, and if early labor is a serious risk, they can do things to stave it off or at least give the first of the lung shots.
posted by night traveler at 5:15 PM on December 29, 2024 [1 favorite]
posted by night traveler at 5:15 PM on December 29, 2024 [1 favorite]
Best answer: I want to encourage you to seek medical advice, but it also sounds like you have sought medical advice and the advice is that the level of spotting is not concerning. You should re-discuss with your care team to get comfortable, but:
I am currently pregnant. This is number two. I have had brown spotting multiple times in both pregnancies. For me, it has never once been related to an actual medical issue that required treatment.
My care teams have been primarily concerned with volume of brown blood. My volume has been low — it has not required a pad, let alone soaked one. At times, it has been mixed with leukorrhea and has been characterized as cervical irritation and/or possibly the remnants of a small SCH. Because my care team took my concerns seriously, I felt confident accepting their answer that it was not concerning.
You deserve to feel confident in the answers your care team is giving you, and it sounds like you don’t yet. That is absolutely worth pursuing as a conversation, especially because you should have a clear sense of when they would be worried so you can watch out of those signs. (For example, I know my care team would’ve been concerned if it was foul smelling or if I had a fever). But yeah, the answer for smallish amounts of brown blood really can just be “uteruses/cervixes shed small clots sometimes and it does not affect the fetus or the woman,” and if that is what your care team believes is going on, that may be correct.
So: have another conversation. Seriously, you deserve to understand the advice you’re receiving and to understand why they’re ruling out anything more serious. But go into it open to the possibility that your doctor is correct that this is nothing to worry about.
posted by moosetracks at 6:57 PM on December 29, 2024 [5 favorites]
I am currently pregnant. This is number two. I have had brown spotting multiple times in both pregnancies. For me, it has never once been related to an actual medical issue that required treatment.
My care teams have been primarily concerned with volume of brown blood. My volume has been low — it has not required a pad, let alone soaked one. At times, it has been mixed with leukorrhea and has been characterized as cervical irritation and/or possibly the remnants of a small SCH. Because my care team took my concerns seriously, I felt confident accepting their answer that it was not concerning.
You deserve to feel confident in the answers your care team is giving you, and it sounds like you don’t yet. That is absolutely worth pursuing as a conversation, especially because you should have a clear sense of when they would be worried so you can watch out of those signs. (For example, I know my care team would’ve been concerned if it was foul smelling or if I had a fever). But yeah, the answer for smallish amounts of brown blood really can just be “uteruses/cervixes shed small clots sometimes and it does not affect the fetus or the woman,” and if that is what your care team believes is going on, that may be correct.
So: have another conversation. Seriously, you deserve to understand the advice you’re receiving and to understand why they’re ruling out anything more serious. But go into it open to the possibility that your doctor is correct that this is nothing to worry about.
posted by moosetracks at 6:57 PM on December 29, 2024 [5 favorites]
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posted by mumimor at 10:39 AM on December 29, 2024 [3 favorites]