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Key takeaways

• Some light bleeding or spotting in early pregnancy can be common.
• Always contact your doctor or midwife if you experience any vaginal bleeding.
• Track the amount and colour of bleeding, and use sanitary pads.
• Seek immediate medical help for heavy bleeding or severe pain.

Is bleeding during pregnancy normal?

Bleeding in pregnancy can be alarming. However, many women who have spotting or light bleeding in early pregnancy go on to have a healthy pregnancy and baby. Vaginal bleeding does not always mean something is wrong.

Spotting is usually seen as a spot or smudge when wiping. It may also be light staining on your underwear. It is not constant and can come and go. Light bleeding may stain a pad or your underwear. It will be more constant but will not soak through a pad. Both spotting and light bleeding can be red, pink, or brown. Heavy bleeding would potentially soak through a pad. This is more likely to be red or dark red, possibly with some clots.

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

Potential causes of bleeding in pregnancy

Bleeding or spotting can happen in the first 12 weeks of pregnancy (first trimester) for several reasons. It can also occur later in pregnancy.

First trimester causes

Implantation bleeding – This is very light bleeding or spotting that happens when the fertilised egg implants into the womb wall. This usually occurs around the time your period would have been due. Not all women experience this bleeding.

Cervical changes – Pregnancy hormones can cause changes to your cervix, increasing its blood supply and making it softer. This can sometimes cause bleeding, especially after sex.

Infection – An infection, such as a urine infection or a sexually transmitted infection, can cause bleeding. In most cases, antibiotics that are safe in pregnancy can treat an infection.

Subchorionic haematoma – A subchorionic haematoma is a collection of blood between the pregnancy sac and the womb wall. It is a most common cause of bleeding, with symptoms including bleeding and tummy pain.

Miscarriage – Bleeding in the first 12 weeks of pregnancy may be a sign of miscarriage.

Ectopic pregnancy – This occurs when a fertilised egg grows outside the womb, usually in the fallopian tube. It can cause bleeding, one-sided tummy pain, or shoulder tip pain and is a life-threatening emergency.

Molar pregnancy – A molar pregnancy is a problem with a fertilised egg where a baby and placenta do not develop properly, causing symptoms like bleeding and severe morning sickness. This type of pregnancy cannot develop into a healthy baby and will end.

Later pregnancy causes

Cervical changes or infection – These can also cause bleeding later in pregnancy.

Low-lying placenta – A low-lying placenta (placentra praevia) attaches low in the womb and can cause painless, bright red bleeding.

Placental separation – Placental separation (abruption) is a serious condition where the placenta starts to come away from the womb wall. It can cause vaginal bleeding, tummy pain, and frequent contractions, this is an obstetric emergency.

Blood vessels covering the cervix – Vasa praevia is a rare condition where delicate fetal blood vessels run through the membranes covering the cervix. If these vessels tear during labour or when waters break, it can cause vaginal bleeding.

A show – This happens when the plug of mucus that seals the opening of your cervix comes away. It sometimes comes with blood and can mean labour is starting.

How to manage bleeding at home

If you experience bleeding, use a clean sanitary pad or period pants. Do not use tampons, menstrual cups, or anything you put inside your vagina. This can increase the risk of infection.

Make a note of what the bleeding is like. This includes how much there is and if there are any large lumps or clots. You can consider taking pictures of any bleeding as well, as this can be useful. All this information will be helpful for your doctor or midwife.

When to call your doctor or midwife

Always contact your midwife or doctor urgently if you have any bleeding during pregnancy.

Urgent advice

1. Call your maternity unit if you have the phone number.
2. If you are less than 20 weeks pregnant, an early pregnancy unit (EPU) may be able to help. You can find how to contact one on your local NHS trust website or in your maternity notes.
3. If you do not have a maternity unit yet or cannot contact an early pregnancy unit, call NHS 111.

You should seek urgent advice for any light bleeding or spotting.

Immediate action required

Call 999 for an ambulance immediately if you have heavy bleeding with or without severe pain.

Call 999 if you are pregnant and bleeding and:

• You have severe pain in your tummy.
• You have pain in your shoulder.
• You feel sick, faint, dizzy, or lose consciousness.
• The bleeding is heavy, soaking through one or more sanitary pads in an hour.
• You have diarrhoea.
• You have pain or pressure when you pee or poo.

Contact your hospital or Early Pregnancy Unit (EPU) immediately if you are pregnant and bleeding and:

• You develop a high temperature (fever).

These can be signs you need immediate treatment.