Bleeding in pregnancy
What causes vaginal bleeding in early pregnancy?
Light bleeding or spotting can happen in the first trimester (first 12 weeks of pregnancy) for the following reasons:
- implantation bleeding
- subchorionic haematomas
- changes to your cervix
- vaginal infections
- ectopic or molar pregnancies.
Implantation is when the fertilised egg (developing embryo) plants itself in the wall of the womb. This usually happens around the time your period would normally have been due.
An implantation bleed is very light bleeding (spotting). It should be not heavy enough to soak through pads or underwear. Call your GP if you have heavy bleeding or any other concerns.
A subchorionic haematoma is the pooling of blood in the uterus (womb) around the sac that the embryo is developing in. It’s the most common cause of bleeding in the first 12 weeks of pregnancy (first trimester).
Symptoms include bleeding and abdominal pain. A subchorionic haematoma is usually nothing to worry about, but it can cause complications later in the pregnancy, such as:
- placental abruption
- early miscarriage
- late miscarriage
- preterm premature rupture of membranes (waters breaking early).
If you have subchorionic haematoma your healthcare professional will talk to you about what this means for your pregnancy and what care you will have.
Changes to your cervix
Pregnancy hormones can cause changes to the cervix, the channel between your vagina and your womb (uterus). This can sometimes cause bleeding. During early pregnancy, your cervix gets an increased blood supply and becomes softer. This can cause some bleeding after sex (also known as post-coital bleeding). This is usually nothing to worry about, but tell your midwife if this happens.
Occasionally, vaginal bleeding can also be caused by an infection. In most cases an infection can be cleared up with antibiotics, which are safe to take in pregnancy.
Vaginal bleeding and miscarriage
Vaginal bleeding can sometimes be a sign of something more serious, including a miscarriage. A miscarriage is when a pregnancy ends before 24 weeks.
Try to remember that many women who have bleeding in early pregnancy (before 12 weeks) go on to have a healthy pregnancy and baby.
Contact your GP, midwife or maternity unit if you have any vaginal bleeding or other possible miscarriage symptoms. It’s always best to get checked out.
An ectopic pregnancy is when a fertilised egg starts to grow somewhere other than the lining of the womb. It usually happens in the fallopian tube. Symptoms can include:
- tummy pain on one side
- pain in the tip of the shoulder
- discomfort when peeing or pooing.
An ectopic pregnancy can be dangerous for the mother or birthing parent.
Call your GP or call NHS 111 if you have any of these symptoms. An ectopic pregnancy can be serious – even life threatening – so it’s important to get advice straight away.
Unfortunately, it is not possible to save an ectopic pregnancy.
A molar pregnancy is when there's a problem with a fertilised egg, which means a baby and a placenta do not develop properly. Symptoms can include:
- severe morning sickness
- an unusually swollen tummy.
Unfortunately, it is not possible to save a molar pregnancy.
What should I do if I have vaginal bleeding in the first 12 weeks of pregnancy?
Vaginal bleeding does not always mean something is wrong. A lot of women have light bleeding or ‘spotting’ without pain in the first 12 weeks of pregnancy.
However, vaginal bleeding in pregnancy should always be investigated. If you notice any vaginal bleeding with or without stomach pain, contact your GP surgery or local GP walk-in service.
You can also contact your nearest Early Pregnancy Unit if they offer a self-referral or walk in service. You can also contact NHS 111 at any time of day.
If you are seen by your GP, they may refer you to an Early Pregnancy Unit if needed. Find out what happens at the early pregnancy unit.
Call NHS 111 if you are experiencing bleeding and:
- the bleeding is heavy
- the pain is severe
- you feel generally unwell.
When you go to the Early Pregnancy Unit you may wish to bring someone with you for support.
Firstly, you’ll be asked about:
- your symptoms
- your medical history
- any previous pregnancies
- the date that your last period started (so they can estimate how many weeks pregnant you may be).
Then, they may ask you to provide a urine sample to confirm that you are pregnant, or you may have an ultrasound scan.
They may also do an internal scan, where a small probe is inserted through your vagina to get a clearer picture. This is helpful if you are very early on in your pregnancy. It is not possible to do an abdominal scan as the pregnancy sac is tucked deep inside the uterus, in the pelvis, so a vaginal scan is the only option this early in the pregnancy.
Ultrasound scans are safe to have and do not carry any risk of causing a miscarriage.
It’s unlikely that they will be able to see a heartbeat if you’re not around 6-7 weeks pregnant yet. Instead, they will be checking the size of the pregnancy sac and that it is in the womb. This helps to rule out an ectopic pregnancy.
It’s usually possible to see the baby’s heartbeat from about 7 weeks. Sometimes they may need to invite you back for another scan about 1-2 weeks after your first one if:
- they want to check the baby’s growth
- they could not get a good enough picture during the first scan
- your bleeding or other symptom continue.
Other tests and examinations you may have
A speculum and/or vaginal examination
This involves a small instrument covered in gel being inserted into the vagina. This allows the doctor to check the neck of the womb to see if there is any obvious cause for the bleeding. It isn’t painful, but it can sometimes be a little uncomfortable.
This involves inserting a swab (which looks like a long cotton bud into the vaginal to collect some cells. This is to check for infections, such as chlamydia. The swab is safe to do and not painful.
A blood test
This is done to check your pregnancy hormone level (hCG). If this is under 5 IU/L then this indicates that you are not pregnant.
If it is above 5 IU/L they will expecting it to double about every 2-3 days, so they may ask you to come back to the unit for another blood test a few days later to see if the level is rising or falling.
Depending on the results of these tests, they will plan with you what will happen next. It can be a bit overwhelming when you get a lot of information at once, especially at stressful times, so feel free to ask as many questions as you need to make sure you understand what is happening and what to expect. They should also give you some written information to take away with you and a contact number to call in case you have further questions or need advice when you get home.
What cause bleeding in later pregnancy?
Some women may experience a light bleed later in pregnancy. This is may not be from inside the womb, but from the cervix, which can cause bleeding after sex. This may settle and doesn't necessarily mean there is a problem.
However, you should contact the hospital maternity unit immediately so you can be checked, just in case.
Here are some possible causes of bleeding in late pregnancy.
A late miscarriage is one that happens after the first 12 weeks of pregnancy, but before 24 weeks. It is also sometimes called a second-trimester or mid-trimester loss. Late miscarriages are not very common and happen in 1-2% of pregnancies.
Your midwife or doctor can discuss tests and treatment with you.
During pregnancy, there's a plug of mucus in your cervix. This mucus comes away before labour starts, or when in early labour, and it may pass out of your vagina. Find out more about the signs of labour.
Low-lying placenta (placenta praevia)
In some people, the placenta attaches low down in the uterus and may cover part of or all of the cervix (the neck of the womb). This may block the baby’s way out. In most cases, this would have been seen at one of your routine ultrasound scans and you will have an extra scan later in your pregnancy to see if the placenta has moved up. If the placenta does not move up, you may be offered a caesarean section.
You may also bleed heavily during your pregnancy and your baby’s birth. This can put you and your baby at risk. If you have a low-lying placenta and have heavy bleeding you may need emergency treatment – call 999.
Find out more about low-lying placenta.
This is a serious condition in which the placenta starts to come away from the womb wall. This causes vaginal bleeding and stomach pain.
Speak to your midwife, GP, or local maternity unit straight away if you think you have symptoms of a placental abruption.
This is a rare condition where the baby's blood vessels run through the membranes covering the cervix. These blood vessels are very delicate. If they tear when you are in labour or when your waters break, this can cause vaginal bleeding.
Contact your hospital maternity unit immediately if you are bleeding in late pregnancy. Find out more about vasa praevia.
What should I do if I have vaginal bleeding after 12 weeks of pregnancy?
Vaginal bleeding in pregnancy after 12 weeks is not common. If you have any kind of bleeding or spotting after 12 weeks, go to your local A&E or contact the hospital maternity unit immediately so you can be checked.
I’ve had a bump, fall or accident, what should I do?
If you’ve had a fall, bump or accident you should be checked by a doctor, GP, nurse or midwife – even if you are not bleeding.
If you have any vaginal bleeding or trauma to your bump (for example, if you fall over) contact your midwife or hospital maternity unit immediately. If you have rhesus negative blood, you may need an injection of anti-D. This will help protect any future pregnancies.
I’m having nosebleeds, what should I do?
Nosebleeds are quite common in pregnancy because of hormone changes.
These shouldn’t be anything to be worried about, but you should tell your midwife or doctor and they may check your blood pressure just to be safe.
I’m bleeding from my bottom (anus), what should I do?
A small amount of bleeding from the bottom may be due to a small tear or caused by piles (haemorrhoids). This is common in pregnancy.
These are swellings containing enlarged blood vessels inside or around your bottom. This causes itching, and pain or bleeding when having a bowel movement.
Speak to your GP, midwife if you are bleeding from the bottom. Don't use a cream or medicine to treat piles without checking it with a GP, midwife or pharmacist first.
Bleeding in pregnancy when you have had a previous miscarriage
Research has shown that taking progesterone may prevent a miscarriage if you:
- are bleeding in early pregnancy and
- you have had 1 or more miscarriages before.
Progesterone is not an effective treatment for people with an ectopic pregnancy or a pregnancy of unknown location (when there is a positive pregnancy test but the pregnancy cannot be detected (seen) either inside or outside the womb on a scan). Sadly, it is not possible to save these types of pregnancies.
Find out more about progesterone and how to access treatment.
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