First Trimester Spotting, BV and Preterm Contractions

03.23.11 The three most commonly asked questions


The most commonly asked questions I receive from readers are these three:

1. I had some spotting after sex and I’m still in my first trimester. Am I having a miscarriage?

2. My doctor says I have Bacterial Vaginosis? Will that make me infertile or miscarry?

3. I’m having contractions, but my due date is still weeks away. Am I having preterm labor?

I’ve written about all three of these subjects before, but let’s hit the highlights one more time.

1. First trimester spotting is really common and usually does not indicate a miscarriage. Instead, it usually means your cervix is receiving extra circulation, is easily irritated because of hormonal changes and when it got bumped (from sex, exercise, vigorous activity or for no good reason you can remember), a few tiny blood vessels leaked a little blood. Most of the time, this will be pink or brown and mixed with vaginal discharge. Sometimes, it will be bright red blood, but not so much as you’d have with a period.

2. Any time you have bleeding during pregnancy you should call your midwife or doctor, even if you’re in your first trimester. They might not be able to do anything about it, other than advise you to take it easy and avoid sex until the spotting goes away, but they can document it in your records and provide some reassurance that it’s normal. When the bleeding is heavier than spotting or doesn’t stop and when it’s accompanied by pelvic pain or cramping, then a miscarriage has to be considered.

Miscarriages happen in about 20% of all pregnancies. Most occur in the very earliest stages of pregnancy when Mom might not even know she’s expecting, but many happen later (usually in the first trimester), when Mom and Dad are already excited about their baby. While it’s absolutely sad, one miscarriage does not usually mean future pregnancies will also miscarry. Usually it means something was wrong with the fetus and Mother Nature decided to call him/her home.

One reader emailed that her discharge was pink after sex, then brown the next day. That’s reassuring though I’m it sure still caused her some worry. She wanted to know if she had to avoid sex throughout the rest of her pregnancy. She probably doesn’t have to avoid sex though she should get her midwife’s advice on that. Since many women say they have the best sex of their life during pregnancy, it would be a shame to miss out on that, wouldn’t it.

1. Bacterial Vaginosis (BV) is the #1 most commonly diagnosed vaginal infection – more common even than yeast infection. It happens when the normal bacteria that grows in the vagina gets out of control and tries to take over. While it can cause a funky-smelling discharge and vaginal irritation, a lot of the time it causes no symptoms at all. Women may not know they have it until they have a routine Pap smear and their doctor sees BV indicated on lab results.

BV is not a sexually transmitted disease though women who have several sex partners tend to get it more than monogamous women. Women who smoke get BV more often than non-smokers.

Some studies indicate a link between BV and preterm labor or miscarriage, and if the infection is really nasty and not treated, it can progress to become pelvic inflammatory disease, which can cause infertility. That’s not what usually happens though. Most of the time, BV is caught before it’s a really big deal and treated with antibiotics. Sometimes it takes more than one round or type of antibiotic to really knock it out, but for most women, that’s all it takes to get their vaginal bacteria back in proper running order.

A young reader said she didn’t fill her prescription for a month and was worried she’d be infertile for life. That’s not likely, especially since she had no symptoms. Pelvic Inflammatory Disease is painful and that’s what it takes to cause BV-related infertility. Just get the prescription filled, take all your medications as directed and you’ll most likely be just fine.

1. Preterm contractions versus preterm labor – It’s absolutely normal to have contractions during the second and third trimester. It’s your uterus way of working out and getting in shape for the marathon (labor and birth). You’ll also contract when your baby rolls over, puts pressure on certain muscle fibers, after sex, exercise, have a full bladder or when you’re a little dehydrated. Normal, normal, normal.

It’s not normal, however, for those contractions to be so strong, organized and frequent as to cause cervical change. If you have a few contractions and you’re nowhere near your due date, try drinking a glass of water and resting for a bit. They’ll probably space out and go away. If they keep on keeping on, however, and they’re getting more uncomfortable, call your midwife or doctor. They might have you go to the office or hospital for monitoring and a cervical exam. If your cervix isn’t dilating, thinning or the baby isn’t moving down in the birth canal, then you’re having preterm contractions, not preterm labor. But if your contractions are causing cervical change, then you might be in preterm labor. How your provider deals with those contractions depends entirely on how many weeks along your pregnancy is. More than 35 weeks and they probably won’t try to stop them. Less than that and they probably will.

One reader asked when she should start counting up her hours in labor because she’d been contracting since she was seven months pregnant. Well there are contractions and then there are contractions and she’ll know the difference when it’s really, truly labor. She shouldn’t start running a tally until her cervix is changing about a centimeter every couple of hours. That is, unless she’s going for a world record and then, by all means start counting at seven months.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

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