Obviously miscarriage is what everyone worries about whenever they see spotting.
One in three women experience spotting or bleeding in pregnancy. Only 50% of these go on to have miscarriages, the majority in the first trimester. While 40% of pregnancies end up in miscarriage, most of these are before 4 weeks of pregnancy (i.e. 2 weeks post conception, when you would miss your period). After 4 weeks, the miscarriage rate goes down to 15%. In addition, once your baby’s heartbeat has been heard, the chance of miscarriage goes down to 5%. Part of the reason that so many pregnant women experience spotting is that there is a tremendous increase in blood volume, which means that capillaries in the cervix are easily disturbed causing bleeding. This is the equivalent of having your gums bleed after brushing or starting a nosebleed by blowing your nose – both things that many pregnant women also experience for the same reason. An average non-pregnant woman has about 4 litres of blood. The same woman when pregnant will increase her blood volume to over 6 litres! With this large increase, some of it may “leak” out sometimes.
Miscarriage cannot be predicted, only diagnosed. If you are having signs of a threatened miscarriage, your midwife may be able to send you for some testing:
In any case, by the time the bloodwork results are returned or an ultrasound appointment can be made, the situation will often have made itself obvious (i.e. either the bleeding stops, or becomes heavier and clearly a miscarriage).
What to expect depends on how far along you are, and how the miscarriage is diagnosed. Generally, the later your gestation, the more physically intense the experience. Typically, the first sign may be spotting that progresses from brown to red over a few hours or days, then has a few hours of very intense cramping and heavy bleeding, subsiding into regular bleeding like a normal period. You may pass some clots or tissue. Or the (impending) miscarriage may be diagnosed during an ultrasound. If this is the case, you have two options:
Once you are past the first trimester, it is unlikely you are losing the pregnancy. As in the first trimester, most causes of second and third trimester bleeding are benign, but at the same time should still be monitored.