Written By: Dr. Ummay Kulsoom

Spotting is when you notice a few drops of blood (red, pink or dark brown) on your undergarments or tissue paper while bleeding refers to flowing blood and it requires you to wear a pad. About 15-25% of all pregnant mothers experience bleeding or spotting in first 12 weeks of pregnancy. Some causes include
  1. Implantation bleed: when fertilized egg implants into the uterine wall
  2. Hormonal changes: normal during pregnancy
  3. Changes in cervix: cervix becomes soft and congested and hence more sensitive to minor trauma leading to spotting
  4. Subchorionic hematoma: usually self resolving
These are benign causes and often do not require medical attention. While some more serious causes requiring medical care are-
  1. Ectopic pregnancy: pregnancy outside the uterus
  2. Molar pregnancy: instead of fetus, a tumor forms inside the uterus
  3. Cervical polyp: non cancerous growth , bleeds due to high estrogen levels in pregnancy
  4. Infection: chlamydia, gonorrhea, STI, UTI etc.
  5. Miscarriage: bleeding increases progressively and is usually associated with strong cramps.
So ladies, most of the time spotting is not concerning and you just need to relax and stay off your feet, drink lots of water because hydration is important, avoid sexual intercourse, avoid travel and take diet rich in nuts, olive oil, broccoli, kale, cabbage, cauliflower, pumpkin, beans and whole grains.
Keep in mind, there are some RED flags and you need to report to your doctor in case of heavy bleeding (fully soaking a pad every few hours), cramping or contractions, pelvic pain, dizziness or fainting, fever or chills.
Lately, progesterone supplements are being prescribed commonly in the subcontinent even to low risk healthy mothers as progesterone is known to be essential for implantation and maintenance of early pregnancy.
A large double blinded placebo controlled “PRISM” trial covering over 48 centers across England and Scotland in 2019 showed that progesterone therapy during the first trimester did not result in a significant higher incidence of live births than placebo.
Based on this study, NICE (2021) recommended progesterone therapy for pregnant women who have vaginal bleeding and at least one previous miscarriage.
It does not recommend progesterone for pregnant women with bleeding in current pregnancy without any history of previous miscarriage or those with history of miscarriage but no bleeding in present pregnancy.
Pregnancy is a gift of Allah, He is the creator, sustainer and the ultimate planner of all our affairs. Putting our trust in His plan and getting proper knowledge so that we can make informed choices is our responsibility. Whatever enters a pregnant mother’s body will definitely reach the developing fetus in one form or the other so be mindful, ask questions and decide before accepting any thing offered or suggested during this crucial and significant period of your life.