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Susan Warhus, MD

Your question:
I am 11? weeks pregnant and I have been having some light bleeding but no cramping at all, on and off for two weeks. My OB says that's normal. What's so normal about bleeding?

The expert answers:
Bleeding during the first trimester of pregnancy isn't necessarily normal, but it happens fairly often. It can certainly be frightening if it does occur, so I'm glad that you are being evaluated by your doctor.

A small amount of bleeding (a teaspoon or so) may not indicate anything worrisome at all. For example, implantation bleeding may occur as the embryo implants into your uterine wall, usually at about 7 to 9 weeks. In addition, many women experience spotting after sex or heavy lifting. That's because the cervix contains additional and engorged blood vessels during pregnancy.

When you experience bleeding during the first trimester, the two things to be concerned about are miscarriage or ectopic (tubal) pregnancy. You could be having a miscarriage if you experience significant bleeding (more than one-half cup), often accompanied by cramping. Sometimes you may pass large blood clots (gold-ball size) or fetal tissue. Symptoms for an ectopic pregnancy are vaginal bleeding and one-sided pelvic pain. If your doctor is concerned that you could have either a miscarriage or an ectopic pregnancy, he/she will probably want to perform a pelvic examination, and possibly order an ultrasound and special blood tests.

But keep this reassuring fact in mind: The majority of women who have vaginal bleeding during the first trimester continue their pregnancies and deliver healthy babies.

If your doctor is not concerned, perhaps it's because you have already had a reassuring ultrasound and/or heard the fetal heartbeat with a Doppler device. If you are still worried, it's important to express your thoughts and concerns to your doctor. Having a baby is one of the most precious and magical times of your life. I hope you will develop a comfortable rapport with your doctor, so that you can have a healthy and happy pregnancy and delivery.

Tags: spotting

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