Bleeding in pregnancy

If you have any bleeding during your pregnancy, with or without pain, it’s very important to get it checked out.

Is it normal to bleed in early pregnancy (before 12 weeks)?

What can cause bleeding in early pregnancy?

Bleeding and miscarriage

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

Rhesus negative

Where should I seek help for bleeding in pregnancy?

Bleeding in pregnancy when you have had a previous miscarriage

Is it normal to bleed in early pregnancy (before 12 weeks)? 

It’s common to have light bleeding or ‘spotting’ without pain before 12 weeks. This isn’t often serious, but you should contact your doctor, midwife or Early Pregnancy Unit immediately to be checked, just in case.

Bleeding in pregnancy after 12 weeks is not common. Contact A&E or your hospital maternity unit immediately so you can be checked.

What can cause bleeding in early pregnancy?

Light bleeding or spotting can happen in the first trimester (first 12 weeks of pregnancy) for a few reasons.

Implantation bleeding

Implantation is when the fertilised egg (developing embryo) is embedding into the wall of the womb. This usually happens around the time your period would normally have been due. Some women have had implantation bleeding after 8 weeks of pregnancy.

An implantation bleed is very light bleeding (spotting) that is usually pinkish and sometimes brown. You may see it when you wipe after going to the toilet or in your underwear. It shouldn’t be enough to soak through pads or underwear. Usually it only lasts for a day or so, though for some women it can last a little longer.

Cervical changes 

Pregnancy hormones can cause changes to the cervix, which can sometimes cause bleeding. The cervix gets an increased blood supply and becomes softer. This can cause some bleeding after sex (known as post-coital bleeding).

Infection

Occasionally, vaginal bleeding can also be caused by an infection.

Bleeding and miscarriage

Bleeding can sometimes be a sign of something more serious. Try to remember that many women who have bleeding in early pregnancy (before 12 weeks) go on to have a successful pregnancy. Just make sure that your symptoms are checked. 

Miscarriage

A miscarriage is when a pregnancy ends before 24 weeks.

Symptoms can include:

  • bleeding, especially bleeding that is bright red and and needs a pad
  • back or stomach pain or cramping.

Some women may experience a 'threatened miscarriage'. This is diagnosed where there is ongoing bleeding with or without pain but the woman is still pregnant.

Ectopic pregnancy

An ectopic pregnancy is when a fertilised egg implants outside the womb, usually in the fallopian tube. Symptoms can include:

  • bleeding
  • tummy pain on one side
  • pain in the tip of the shoulder
  • discomfort when peeing or pooing.

Molar pregnancy

A molar pregnancy is when a foetus doesn't form properly in the womb and a baby doesn't develop. Symptoms can include:

  • bleeding
  • severe morning sickness
  • an unusually swollen tummy.

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, which can cause bleeding after sex. This may settle and doesn't necessarily mean there is a problem, but you should contact the hospital maternity unit immediately so you can be checked, just in case.

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

Low-lying placenta (placenta praevia) 

The area where the placenta is attached usually stretches upwards away from your cervix. A low lying placenta is when the placenta stays low in your womb, near to or covering your cervix. 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 is still low in your womb you may blead 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 you have bleeding you may need emergency treatment – call 999.  

You’re more likely to need a caesarean section if you have a low-lying placenta.

Placental abruption (abruptio placentea)

This is a serious condition in which the placenta starts to come away from the womb wall. It usually causes extreme stomach pain which does not come and go like contractions. It may occur even if there is no bleeding.

Contact your hospital maternity unit immediately if you are bleeding in late pregnancy.

Find out more about placental abruption.

Rhesus negative

During your antenatal care your midwife will find out your blood group and whether you have rhesus positive or negative blood. Knowing which group you are in is important. If you have rhesus negative blood, but your partner has rhesus positive blood, your baby has a chance of having rhesus positive blood too. If this happens, your body might see your baby’s blood as different to yours and develop antibodies. These antibodies can pass across the placenta and attack your baby’s blood cells.

This won’t normally affect your first pregnancy, but it can be very serious in later pregnancies. Because of this, if you have rhesus negative blood your midwife will offer you an injection called anti-D during your pregnancy to protect your baby.

If you have any bleeding or trauma to your bump (for example, if you fall over) contact your midwife or hospital maternity unit immediately. You may need to be checked and possibly have another injection of anti-D.

Talk to your midwife if you have any questions about your and your baby’s blood type.

Where should I seek help for bleeding in pregnancy?

Any bleeding in pregnancy should be investigated even if you are not experiencing any other symptoms. It is important to make contact with a health professional to be seen as soon as possible.

Before 12 weeks pregnant

If you feel generally well and the bleeding is not heavy, then you can call your GP or midwife (if you have one yet) 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 also call NHS 111 if you feel you need urgent medical help but it is not an emergency.

Go to your local A&E if you are experiencing bleeding and:

  • it is during the night or at the weekend when a GP is unavailable
  • the bleeding is heavy
  • the pain is severe
  • you feel generally unwell

After 12 weeks pregnant

Go to your local A&E or contact the hospital maternity unit immediately so you can be checked, just in case.

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

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.

Vaginal swab

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.

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Bleeding in pregnancy when you have had a previous miscarriage

If you have bleeding in your current pregnancy after one or more previous miscarriages, recent research has shown that progesterone can be beneficial. This research was published in 2019 and showed that the more previous miscarriages you had, the greater the benefit from progesterone treatment.

Progesterone is a hormone that helps thicken the lining of the womb and the mother’s body to accept the growing baby. It is given as pessaries (tablets) and taken twice daily in the vagina (like inserting a tampon).

The study that showed that progesterone can be an effective treatment was a large, multi-centre, randomised controlled trial, which is the gold standard of research trials.

4,153 women with early pregnancy bleeding from 48 hospitals across the UK participated in the study. Around half the women were given vaginal progesterone tablets and the other half were given placebo (dummy) tablets. The findings were:

  • For women with no previous miscarriages: the live birth rate was 74% (824/1111) in the progesterone group and 75% (840/1127) in the placebo group, i.e no benefit.
  • For women who have had 1 to 2 previous miscarriages: the live birth rate was 76% (591/777) in the progesterone group and 72% (534/738) in the placebo group, i.e some benefit.
  • For women who have had three or more previous miscarriages: the live birth rate was 72% (98/137) in the progesterone group and 57% (85/148) in the placebo group, ie substantial benefit.

The study did not find any safety concern from progesterone treatment.

Talk to your doctor

If you have early pregnancy bleeding and a history of a previous miscarriage, progesterone treatment can be of benefit. As this research is relatively recent, your doctor may not have heard of it, so please discuss this treatment with your GP or the doctors at your local Early Pregnancy Unit. If necessary, show them this information or or download this leaflet and take it with you.

Read more about the Prism trial. 

Information for clinicians

Live births

Progesterone

Placebo

Relative risk

95% confidence interval

P value

All women

75%

72%

1.03

1.00–1.07

0.08

Previous history of miscarriage

75%

70%

1.09

1.03–1.15

0.003

 

Read more

Sources

NHS Choices. Vaginal bleeding in pregnancy www.nhs.uk/conditions/pregnancy-and-baby/vaginal-bleeding-pregnant/ (Page last reviewed 26/01/2018. Next review due 26/01/2021)

Harville EW et al (2003) Vaginal bleeding in very early pregnancy. Human Reproduction. Volume 18, Issue 9, 1 September 2003, Pages 1944–1947

Sommerkamp S & Wittels K (2012) OB/GYN Emergencies, Elsevier, Philadelphia 

Sue Macdonald and Gail Johnson (2017) Mayes' Midwifery, Elsevier, Edinburgh

NHS Choices. Molar pregnancy www.nhs.uk/conditions/Molar-pregnancy/ (Page last reviewed 20/07/2017. Next review due 20/07/2020)

Royal College of Obstetricians & Gynaecologists (2011) A low-lying placenta (placenta praevia) after 20 weeks

NHS Blood and Transplant. Protecting women and babies with anti-D Immunoglobin http://hospital.blood.co.uk/media/28571/160915-27612-anti-d-blc7231p-final.pdf (Leaflet last reviewed 10/10/2016 Next review due 10/10/2019) 

Coomarasamy et al (2019). ‘A Randomized Trial of Progesterone in Women with Early Pregnancy Bleeding’. New England Journal of Medicine

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    Last reviewed on October 11th, 2018. Next review date October 11th, 2021.

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    Comments

    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
    • 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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