Bleeding in pregnancy

Some light bleeding in early pregnancy isn’t uncommon but you should get checked immediately.

Is it normal to bleed in early pregnancy (before 24 weeks)? 

Spotting or light bleeding without pain is not uncommon before 12 weeks and is often not serious, but you should contact your doctor immediately to be checked.

If it is accompanied by a severe pain in one side of your stomach or pain in your shoulder tip, diarrhoea or bowel pain, it may be a sign of an ectopic pregnancy and needs to be checked urgently by your maternity unit.  

Bleeding combined with back or stomach pain may be a sign of miscarriage. Call your doctor immediately.

How common is bleeding in early pregnancy?

About 1 in 10 women experience some bleeding at some point during pregnancy. Light bleeding or spotting can occur in the first trimester for a few reasons.

What can cause bleeding in early pregnancy?

The usual cause for spotting in early pregnancy is when the fertilised egg (developing embryo) is embedding into the wall of the womb, normally referred to as an ‘implantation bleed’. This usually happens around the time of when your period would normally have been due following conception.

Bleeding can also be due to changes occurring to the cervix due to pregnancy hormones. Your cervix gets an increased blood supply and becomes softer so any slight trauma such as sexual intercourse can result in some bleeding.

Occasionally, vaginal bleeding can be caused by infection also.

A 'threatened miscarriage' is a warning sign for a miscarriage and is diagnosed where there is ongoing bleeding with or without pain but the pregnancy is continuing.

Bleeding can be a sign of miscarriage or ectopic pregnancy or molar pregnancy but it is important to remember that many women who experience bleeding early on do go on to have a successful pregnancy.

What is normal bleeding in early pregnancy?

An implantation bleed shows as spotting - very light bleeding usually pinkish or sometimes brown, often seen just by wiping after going to the toilet or in the underwear. It is not enough to soak through pads or underwear and normally only lasts for a day or so, though for some women it can last a little longer.

When should I see a health professional about bleeding?

Any bleeding in pregnancy should be investigated. If you experience any fresh red bleeding with or without pain, or accompanied by any other symptoms of miscarriage or ectopic pregnancy, then it is important to make contact with a health professional to be seen as soon as possible.

Where should I seek help?

If you feel generally well and the bleeding is not heavy, then you can call your GP or midwife for an appointment who can then assess if they need to refer to the local Early Pregnancy Unit. Sometimes, you can self-refer to a local Early Pregnancy Unit depending on your history and where you live. If you call your local GP surgery they should be able to advise you. You can find the details of your nearest unit at: www.earlypregnancy.org.uk

You can also call NHS 111 if you feel you need urgent medical help but it is not an emergency.

If it is during the night or at the weekend when a GP is unavailable and the bleeding is heavy or pain is severe and you feel unwell then you can access help through your local A&E department.

What to expect if you need to go to the Early Pregnancy Unit?

When you go to your appointment at your Early Pregnancy Unit you may wish to bring someone with you for support. At first, you will be asked about the symotoms that have brought you to the unit, as well as your medical history and previous pregnancies. You will also be asked for the date that your last period started so they can estimate how many weeks pregnant you may be.

The checks that they will carry out will depend on your symptoms, these include:

Providing a urine sample to confirm that you are pregnant

Having an ultrasound scan.

This maybe done abdominally so the scanner is rolled over your tummy, ideally you need a full bladder for this.

If necessary they may do an internal scan which means a small probe being inserted through your vagina to get a clearer picture, especially if you are earlier on in your pregnancy.

Both types of scan are safe to have and do not carry any risk of causing a miscarriage.

If you are before about 6-7 weeks’ pregnant then it is unlikely that they will be able to see a heartbeat, but they are checking the size of the pregnancy sac and that it is in womb to rule out an ectopic pregnancy.

From about 7 weeks’ gestation it is usually possible to see the baby’s heartbeat. Sometimes they may need to invite you back about 1-2 weeks after your first scan for another one, this usually is to check the growth of the baby or if they could not get a good enough picture during the first scan or if your bleeding or other symptom continues.

A speculum and/or vaginal examination

This involves a small instrument covered in gel being inserted into the vagina, and slowly opened up to allow the doctor to check the neck of the womb to see if there is any obvious cause for the bleeding. It is not painful but can sometimes be a little uncomfortable.

Vaginal swab maybe taken to check for infections such as chlamydia.

The swab looks like a long cotton bud which is inserted into the vaginal to collect some cells. It is safe to do and not painful.

A blood test to check your pregnancy hormone level (hCG).

If this is under 5 IU/L then this indicates that you are not pregnant. Above 5 IU/L they are looking at the pattern of the level, expecting it to double about every 2-3 days, therefore they may ask you to return to the unit for another blood test a few days later to be able to see if the level is rising or falling.

Depending on the results of the investigations, they will make a plan with you as to what will happen next. Sometimes it can be overwhelming when you get a lot of information at once, so 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.

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What are the causes of bleeding in late pregnancy (after 24 weeks)?

Some women may experience a light bleed later on in their pregnancy. This is may not be from inside the womb, but from the cervix, for example. Postcoital (after sexual intercourse) bleeding can occur due to this. This may settle and doesn't necessarily mean there is a problem, but you should always let your midwife or doctor know of any bleeding.

There are two more serious causes of bleeding in late pregnancy:

  • placenta praevia (a low-lying placenta). You may experience sudden, painless bleeding that can be light to heavy.  Most women who have placenta praevia will already know their placenta is low from their ultrasound scans, although most women with a low placenta do not go on to have placenta praevia.
  • placental abruption (abruptio placentae). Bleeding with discomfort or pain could mean you have had a placental abruption, which happens when the placenta starts to separate from the wall of your uterus. It is likely to be accompanied by cramps and tenderness when you press your stomach.  

Contact your midwife, doctor or maternity unit immediately if you are bleeding in late pregnancy.

When to call the midwife

More symptoms

Sources

  1. National Institute for Health and Care Excellence, Pain and bleeding in early pregnancy, quality standards briefing paper, London NICE, 2014. Also available at:http://www.nice.org.uk/nicemedia/live/14249/66831/66831.pdf (accesssed 29 April 2014)
  2. London Royal College of Obstetricians and Gynaecologists, Ectopic pregnancy - information for you, London RCOG, 2010. Also available at:http://www.rcog.org.uk/ectopic-pregnancy-information-for-you (accessed 29 April 2014)
  3. London Natonal Institute for Health and Care Excellence, Ectopic pregnancy and miscarriage, clinical guideline 154, London NICE, 2012
  4. Macdonald S, Magill-Cuerden J, Mayes’ midwifery, fourteenth edition, Edinburgh Bailliere Tindall Elsevier, 2012
  5. RCOG (2016) Bleeding and/or pain in early pregnancy. Information for you. Royal College of Obstetricians and Gynaecologists, London, UK
  6. NHS Choices (accessed Nov 2016, Next review due: 30/03/2017) Vaginal bleeding in pregnancy. http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vaginal-bleeding-p...
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Last reviewed on April 1st, 2014. Next review date April 1st, 2017.

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Comments

  • By Marisa (not verified) on 15 Jul 2018 - 19:28

    I m spotting when i wipe for 2 1/2 days now. 5 1/2 weeks pregnant and i go to work tomorrow. Im worried it can cause problems but my dr said not to worry. I miscarried 1 yr ago so im just scared

  • By Midwife @Tommys on 18 Jul 2018 - 12:13

    Hi Marisa
    If you have been reviewed by your doctor, then hopefully he/she has booked you in for another review soon?
    Spotting in early pregnancy can be normal- but being reviewed is sensible- as you have already done.
    If the type of work you is too much, then your doctor can advise you. So perhaps it might be best to be seen again as soon as you can to get his/her advice.
    All the best
    Sophie,Tommy's Midwife

  • By Beth (not verified) on 7 Jul 2018 - 01:46

    Im really hoping for an immediate or quick response. I’m 7.5 weeks pregnant (I think, from a due date calculator site) and went on vacation a few days after we took a pregnancy test. I started bleeding 6 days ago and it hasn’t stopped. I need to wear a pad and change it 2-3x a day. It’s like a very light period. I don’t think I’m actively miscarrying, as I’ve heard that’s much more intense and lots more blood. I have had 3-4 episodes of mild cramping and that’s it.

    I’m wondering if I should go see someone while I’m on vacation (not sure about insurance and costs on that). I was given the impression to wait it out and go see a midwife when I return home....which would be in 4 or 5 days. I guess that’s not hat far away, but as time has gone on I’m feeling guilty and questioning not getting checked out. Thank you! Bethany

  • By Midwife @Tommys on 9 Jul 2018 - 15:07

    Hi Beth,
    I would assume that you have made a decision as to whether to be checked out or not. We are not here at the weekend and are not able to respond urgently.
    It is possible that you have been having a miscarriage although I couldn't confirm that without tests. Pain/cramping and bleeding together is a symptom. Your decision depends on where you are and how heavily you are bleeding. Please don't hesitate to contact us if you need support when you are back from your holiday.

  • By Ellie (not verified) on 4 Jul 2018 - 18:22

    I had an early scan after having miscarrying my last pregnancy. I am currently 9week and 2days. The scan was a TV ultrasound at the time there was no pain. Woke up this morning with spotting and 2 small clots. Is this normal to spot after a TV scan?

  • By Midwife @Tommys on 5 Jul 2018 - 14:17

    Hi Ellie, Thank you for your comment.

    Some women can experience some spotting after a TV scan but as you have past 2 clots then it is advisable that you seek medical advice, you have had no red bleeding or abdominal pain and this is reassuring but just because of the clots please get checked over for your reassurance. You can call the GP or early pregnancy unit if this is available. Take Care, Tommy's Midwives x

  • By Sarah (not verified) on 3 Jul 2018 - 21:24

    Hi, I'm 42 and 20 weeks pregnant and since the beginning of my pregnancy once a month I've been getting brown discharge only for one day then it goes and I have really mold period pain, but only lasts a couple of hours. But this evening when I went to the loo I wiped and had brown blood, didn't look like the last times I had it, again with mild pains or more like an ache.
    I had my 20 week scan yesterday and all day and now I can feel the baby move.
    I'm quite worried as to what to do.

  • By Midwife @Tommys on 5 Jul 2018 - 13:38

    Hi Sarah, Thank you for your comment.

    It is reassuring that you have had your 20 week scan and that all was well, but if you are getting these pains and brown loss often, then we would advise that you call your local maternity unit to be seen. It could be that you may have erosions on the cervix that can bleed due to the increase blood supply but it is always better to get checked over and feel reassured. Hope this helps, Take Care, Tommy's Midwives x

  • By Virgie (not verified) on 15 Jun 2018 - 15:33

    Hi I'm 9 weeks and 4 days preggy and I've been bleeding for two weeks I used
    two pantyliners a day and every time I pee there is brown blood. At 8 weeks it was bright red but after 3 days it becomes brown and so on. I did and ultrasound and the baby has a strong heart beat and no complications but why am still bleeding today? I'm scared i might miscarried.

  • By Midwife @Tommys on 18 Jun 2018 - 14:45

    Hi Virgie, How long ago did you have the scan? If it was two weeks ago and you have continued to bleed it may be sensible to have another scan. However, we also know that women can have some bleeding as you describe and go on to have a normal pregnancy with a healthy baby.

  • By Clara Mkandawire (not verified) on 1 Jun 2018 - 10:07

    I Am 20 Weeks Pregnant But Am Still Bleeding Every Month. What Is The Problem Pls Help.

  • By Midwife @Tommys on 1 Jun 2018 - 12:14

    Hi Clara,
    Occasionally, for some women, some bleeding in their pregnancy when their period would have been due can happen. However as with any bleeding in pregnancy we would always advise you to call your maternity unit to be reviewed. At 20 weeks you should also have had a scan recently or have one booked soon, if not then do contact your midwife as soon as possible to arrange this.
    Best wishes
    Tommy's midwife

  • By Helen (not verified) on 28 May 2018 - 11:03

    I am 42 and I have two children and this is my third pregnancy. I haven't seen spot bleeding during my previous pregnancies. Today I am eight weeks pregnant and I have been seeing spot bleeding for the three days hitherto. I visited gynecologist two weeks ago and he told me by blood and urine test my pregnancy is ok and my pregnancy is not out of womb. Then what is the cause of the bleeding? please, I need your immediate advise. Thank you very much!!!

  • By Midwife @Tommys on 29 May 2018 - 15:15

    Hi Helen
    Sometimes bleeding in early pregnancy cannot be explained. Bleeding at any gestation of pregnancy should always be investigated as you have done, so you have done the right thing by getting checked.
    It would be sensible for you to be scanned if you have another episode of bleeding to ensure that all is ok with the pregnancy. Your local early pregnancy assessment unit can review you and do the scan if they think it is necessary. Here is a link to our page on bleeding in pregnancy, you might find it useful.
    https://www.tommys.org/pregnancy-information/symptom-checker/bleeding-pregnancy
    I wish you all the best for the future
    Sophie, Tommy's Midwife

  • By Naa1987 (not verified) on 9 May 2018 - 15:32

    Am 10weeks 4days pregnant on Saturday I spotted blood wen I wipe so on Sunday I went to hospital to check but they said everything is alright but bleeding in the first trimester is normal it's wenesday am still bleeding I haven't seen any clot yet but am feeling the cramps pls I need help could it's be am losing my baby or wat

  • By Midwife @Tommys on 11 May 2018 - 10:09

    Hi,
    I am sorry to hear that you are experiencing a worrying time at the moment. It is great to hear that you have been seen at the hospital and everything was ok however you say that the bleeding is on going and that you have a new symptom which is the cramps. It is great that you have not had any clots however it sounds like you should contact the hospital again to be reviewed. I know it is natural to think the worse, however it does not necessarily need that you are having a miscarriage.
    I hope this helps and wish you all the best.
    Tommy's midwives

  • By Rachel Worden (not verified) on 18 May 2018 - 09:34

    Bleeding in pregnancy is a worry but just to let you know I had heavy bleeding with large blood clots in my first pregnancy three times during the first trimester but after that it stopped. They never found out exactly why but each time I would go to A&E or early pregnancy unit and they would scan me to check everything ok. Advice would be to keep in contact with hospital, go in with any changes, and try to rest and keep on top of your iron either through food or Floridix and Spatone. I hope everything is ok x

  • By Claire (not verified) on 23 Apr 2018 - 15:23

    Hi

    I had some bleeding and stomach pains. I did call the MAU however they just said to keep an eye on it. How do I know there's no problems with the baby? I'm 14 weeks!

    Thanks

  • By Midwife @Tommys on 26 Apr 2018 - 12:23

    Hi Claire,
    We would advice that you call your local maternity unit again as you are bleeding and experiencing abdominal pain, they may want to scan you to see if there is any cause for the bleeding. You can also call your GP as well who will be able to refer you. Hope this helps, take care, Tommy's Midwives x

  • By Kelly (not verified) on 14 Apr 2018 - 09:26

    I'm 8 weeks and 4 days pregnant. Yesterday I had some spotting which then stopped. And then today whenever I wipe there is some blood and I've got some aching in my back. I have endometriosis and I had an ectopic pregnancy last year. Do you think this could be happening again

  • By Midwife @Tommys on 16 Apr 2018 - 10:35

    Hi Kelly, I am sorry that I was not able to reply on Saturday. At Tommy's we work Monday to Friday 9-5pm. I hope that you have been able to seek advice from the NHS over the weekend. With any bleeding at 9 weeks we would advise that you are seen and with a history of ectopic pregnancy you should be seen promptly. Please let us know if we can support you further and best wishes. Tommy's midwives

  • By sabrina schell (not verified) on 11 Apr 2018 - 18:50

    Okay so last month in march i started having brown spotting discharge as i get before my period so i thought oh im starting but the discharge only lasted for 2 days and went away i never started my period so i waited and took a test at the end of the month at first it came back negative but then turned positive the line was fague but you could clearly see it so i was like okay im pregnant and ive been having symptoms such as: my lower back is so stiff its uncomfortable, my body feels tired but im not, im having hot flashes, nausea sometimes, food cravings somtimes, gassy sometimes, and when i burp sometimes it burns but the beginning of this month bout the 4th probably the brown dischsrge came back mixed with blood and then it was just blood i took another test about the 4th or 5th of this month and it came back positive also the bleeding just stopped yesterday what do you think

  • By Midwife @Tommys on 12 Apr 2018 - 09:41

    Hi Sabrina, i have sent you an email reply, please check your inbox for full details.
    All the best
    Sophie,Tommy's Midwife

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