Bleeding in pregnancy

What causes vaginal bleeding in early pregnancy?

Bleeding in pregnancy can be alarming but most women who have spotting or light bleeding in early pregnancy go on to have a healthy pregnancy and baby.

On this page we talk about bleeding and spotting. It is difficult to define exactly what these are like as each person is different. However, our midwives give the following definitions.

• Spotting is usually anything that is seen as a spot or smudge on wiping or possibly staining pants. It is not happening constantly and will come and go. It could be red, pink or brown.
• Light bleeding may stain a pad or pants and will be more constant. It would not soak through a pad. It could be red, pink or brown.
• Heavy bleeding would potentially soak through a pad. If you were soaking 2 pads an hour for 3 hours or more, you should seek urgent help. It is more likely to be red or dark red and possibly with some clots.

Always contact your GP, midwife or maternity unit if you have any vaginal bleeding or spotting. It’s always best to get it checked out.

Bleeding or spotting can happen in the first trimester (first 12 weeks of pregnancy) for the following reasons.

Implantation bleeding

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.

Subchorionic haematomas

A subchorionic haematoma is the pooling of blood in the womb (uterus) 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.

Infection

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.

Ectopic pregnancy

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:

• bleeding
• 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.

Molar 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:

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

Unfortunately, it is not possible to save a molar pregnancy.

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.

Contact your GP, midwife or maternity unit if you have any vaginal bleeding or other possible miscarriage symptoms such as cramps or backache. It’s always best to get checked out.

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.

Bleeding in early 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 already had 1 or more miscarriages.

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 early pregnancy bleeding.