How Does Implantation Bleeding Look Like?

The first tell-tale sign of pregnancy is absence of periods on the due date, or in medical terms, amenorrhea. But some pregnancy cases prefer to follow a by lane.

In the initial months following fertilisation of the embryo, an expecting mother can observe spotting during her regular expected date of menses. This symptom is what we call implantation bleeding or placental sign or Hartman's sign.

Why does it occur?

As the fertilised egg attaches itself to its mother’s uterus, the uterus undergoes several changes in order to be a accommodating home for the developing embryo. Under the influence of hormones, especially progesterone, the inner lining of the uterus differentiates into three parts. The one underlying the placenta is called decidua basalis, the one covering the growing fetus called decidua capsularis and the unattached part of the lining called decidua parietalis.

This decidua parietalis undergoes cyclic shedding just like in a normal menstrual cycle and results in implantation bleeding. The amount and duration are, however, lesser than a normal period because the hormones in maternal system prevent the inner lining of uterus to shed so that it can thicken and provide sufficient nourishment to the growing embryo. For this very reason, spotting is not common for all pregnant women.

When can it occur?

Placental sign can occur anytime up to 12th week of pregnancy, roughly corresponding to 2nd expected menstrual cycle. Such bleeding stops as the decidual space gets obliterated by fusion of deciduas capsularis and deciduas parietalis, leaving no endometrium to be shed during the beginning of the next expected cycle.

As a result, a pregnant woman misinterpreting implantation bleeding as normal periods will take a pregnancy test only to find herself to be 12-14 weeks pregnant.

How to differentiate from normal menstruation?

It is of utmost importance to know the distinguishing points between implantation bleeding and normal menstruation. A careful observation can help you to differentiate between the two. The few significant factors mentioned below are of note in this regard.

  • Amount – there will be scanty bleeding occasionally.

  • Duration – it lasts only for 1-2 days only. In contrast, a regular menstrual cycle usually has a duration ranging from 3 to 6 days.

  • Colour – blood is of brownish to blackish in colour as compared to vibrant red in regular periods.

Minute cramps may accompany these spotting.

Is it something to be worried about?

Implantation bleeding is a self limiting phenomenon. It stops by 12th week of pregnancy, i.e. the 2nd month following conception. No treatment guidelines have been set up for this. On the contrary it is believed to be a symptom of pregnancy in the first trimester. Many physicians, following proper assessment can ask the patient to go for a sonography to evaluate the age of pregnancy.

How to make sure it’s implantation bleeding?

If you cannot assess your condition and you are in a dilemma whether it’s too early to visit your gynaecologist, it’s wise to take a pregnancy test at home. By the time the mother reaches the second cycle following conception, a urine pregnancy test shows positive result.

Can there be any other reason for bleeding?

The initial 12-14 weeks of pregnancy are very crucial because there is a high chance of miscarriage. Spontaneous abortion of the fetus will present with bleeding, cramps and pain, but this bleeding will be much more in amount than a mere implantation bleeding.

When the mother-to-be takes up a lot of strenuous physical activities during the first three months, there looms a high chance of dislodgement of the embryo from its initial site of attachment in her uterus. This may lead to sudden bleeding and requires immediate medical attention.

Another condition where a woman can bleed in her pregnancy is when she has ectopic pregnancy. In this case the fertilised egg gets implanted at any place of the female reproductive tract other than the uterus, mostly in the fallopian tube. This new site of implantation is not suitable for harboring the growing embryo. As the embryo develops, the tube, not being able to grow with it, ruptures. Such a person experiences excruciating pain in her lower abdomen accompanied by bleeding. A case of ‘ruptured ectopic pregnancy’ needs to be dealt surgically with proper monitoring of blood loss as this can be fatal for the mother.

Sometimes women have complaints of bleeding following sexual intercourse. Any pressure on softened cervix during pregnancy can lead to spotting. If there is only minute bleeding, immediate medical examination will not be essential.