Q&A: I'm 32 weeks pregnant with twins and I noticed some spotting in my underwear. Is this vaginal bleeding? What should I do?

Spotting in the third trimester does count as bleeding. It can mean nothing, or be a sign of a serious condition. A small amount of bleeding (spotting) is less worrisome than heavy bleeding but still requires evaluation.

Sometimes light bleeding or spotting is just from the cervix being what we call "friable" (pronounced fry-able) meaning that the tissue is raw and can bleed from its surface. This can be normal but is sometimes a sign of infection. It usually doesn't mean much for the pregnancy. A friable cervix can be diagnosed with a speculum examination.

Sometimes spotting is from the cervix starting to open, or the placenta leaking some blood from inside the uterus (from placenta previa, placental abruption, or marginal separation). Ultrasound can help assess the position and condition of the placenta and whether the cervix is starting to shorten. If ultrasound shows that the placenta is located a safe distance away from the cervix, a pelvic examination can also help establish if the cervix is starting to open. If the placenta covers the inside of the cervix (placenta previa) internal examinations should be avoided.

As you can tell from the list of possibilities, the best approach is to see your doctor or midwife right away for evaluation. This isn't something that can be figured out on the phone or online. So call your doctor now. Good luck to you! I hope it turns out to be nothing.