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.

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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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