Second Trimester Spotting: Color Guide, Causes, and When to Call Your Provider
Spotting (light bleeding) in the second trimester (weeks 14–27) is not normal but is relatively common and often benign. However, it always warrants evaluation to rule out serious causes.
Color Significance
| Color | Typical Implication | Urgency |
|---|
| Light brown / pink | Old blood (oxidized); often cervical irritation, post-coital, post-exam. | Contact provider same day. |
| Bright red | Fresh, active bleeding; more concerning. | Call immediately / go to L&D. |
| Heavy / clots | Significant bleeding. | Emergency (911 / nearest ER). |
Common Benign Causes
- Cervical ectropion / friability: Hormonal changes make cervix vascular; bleeds easily after sex, transvaginal US, bowel movement.
- Cervical polyp: Benign growth; often bleeds intermittently.
- Subchorionic hematoma: Blood between chorion and uterine wall; may resolve or persist.
- Vaginal infection: BV, yeast, trichomoniasis – can cause spotting.
Serious Causes
- Placenta previa: Placenta covers os; painless bright red bleeding (usually after 20w).
- Placental abruption: Premature separation; painful, dark/red bleeding, uterine tenderness, contractions – emergency.
- Preterm labor: Bleeding + regular contractions, pressure, backache.
- Vasa previa: Fetal vessels cross os; rupture → fetal exsanguination – emergency.
- Cervical insufficiency: Painless dilation + spotting.
Action Plan
- Call your OB/midwife immediately for any spotting.
- Describe: color, amount (pantyliner vs. pad), associated symptoms (pain, contractions, fetal movement).
- Avoid intercourse, tampons, douching until cleared.
- Follow provider instructions (office visit, ultrasound, monitoring, hospitalization).
Most spotting resolves without harming the pregnancy, but timely assessment is critical.
Gynecological Disorders - Related Articles
