Bleeding in pregnancy: what's common and when to worry

In short: Light spotting in early pregnancy is common and often settles, but bleeding at any stage of pregnancy should always be checked by a doctor. Early on it can come from implantation, a sensitive cervix or an infection, and sometimes it is a sign of miscarriage or an ectopic pregnancy. Later on it can point to a placenta problem or early labour. Call your gynaecologist the same day you notice any bleeding.

Seeing blood when you are pregnant is frightening. Your heart races and your mind jumps straight to the worst. Take a breath. Many women have some spotting, especially in the first few weeks, and go on to have healthy babies.

Still, bleeding is never something to keep to yourself or "wait and watch" at home. The only way to know what is going on is to let a doctor check you. This guide explains the common reasons, what is more worrying, and what to expect when you go in.

Is bleeding in pregnancy normal?

A few drops of pink or brown spotting can happen in a healthy pregnancy, most often in the first trimester. It is common enough that doctors see it every day.

But "common" does not mean you should ignore it. Even light bleeding needs a call to your gynaecologist, so they can decide whether you need a scan or a check-up. Heavier bleeding, bleeding with pain, or bleeding later in pregnancy needs to be seen quickly.

It helps to notice a few things before you call:

• How much blood: a few spots on underwear, or enough to need a pad
• The colour: pink, brown, or bright red
• Whether there are clots or tissue
• Any pain, cramps, back ache, fever or dizziness

Bleeding in the first trimester (up to 12 weeks)

This is when bleeding happens most often. Common reasons include:

• Implantation bleeding: light spotting around the time your period would have come, as the pregnancy settles into the womb lining. It is usually light and short.
• A sensitive cervix: in pregnancy the cervix (the neck of the womb) has more blood flow and can bleed a little after sex or an internal exam.
• Infection: a vaginal or cervical infection can cause spotting, sometimes with itching or unusual discharge.
• Miscarriage: bleeding with cramps or tummy pain can be a sign of a miscarriage. This is why every bleed in early pregnancy should be checked.
• Ectopic pregnancy: when the pregnancy grows outside the womb, usually in a tube. It can cause spotting with one-sided tummy pain, shoulder tip pain or feeling faint. This is an emergency.

If you are around 6 weeks pregnant and see spotting, it may be harmless, but only a doctor can confirm that, often with an ultrasound and sometimes blood tests. You can read more about spotting in brown discharge and spotting before your period.

Bleeding in the second and third trimester

Bleeding after 12 weeks, including in the 4th, 5th or 6th month, is less common and always needs prompt care. Possible reasons include:

• Cervix changes: inflammation, a polyp or an infection on the cervix can bleed. Learn more in cervical health and pregnancy.
• Low-lying placenta (placenta praevia): the placenta lies low and covers or sits near the cervix. It often causes painless, bright red bleeding.
• Placental abruption: the placenta starts to separate from the womb wall. It usually causes pain, a hard or tender tummy, and bleeding.
• Preterm labour: bleeding with regular tightenings, period-like cramps, back ache or a gush of fluid before 37 weeks.
• Late miscarriage: less common, but possible in the second trimester.

Near your due date, a little pinkish mucus (called a "show") can be a sign that labour is starting. Even then, let your hospital know.

Bleeding in pregnancy vs miscarriage

This is one of the most searched questions, and it is natural to want a clear answer. The honest truth is that you cannot tell from the bleeding alone.

Some signs make a miscarriage more likely:

• Bleeding that gets heavier, like a period or more
• Cramping or pain in the lower tummy or back
• Passing clots or tissue
• Pregnancy symptoms such as nausea or sore breasts suddenly fading

But many women with these signs have a pregnancy that continues, and some miscarriages happen with very little bleeding. An ultrasound, and sometimes repeat blood tests, is how a doctor finds out.

What to do at home while you get help

• Call your gynaecologist or hospital and tell them how many weeks pregnant you are
• Use a pad, not a tampon or menstrual cup, so you can see how much you are bleeding
• Avoid sex until a doctor has checked you
• Rest if you feel tired or crampy, and drink water
• Keep any tissue or clots you pass in a clean container if you can, to show the doctor
• Ask someone to come with you if you need to go in

Do not take anything for the pain without asking your doctor first.

When to see a gynaecologist

Tell your gynaecologist about any bleeding in pregnancy, even light spotting, and even if it has stopped.

Go to a doctor the same day if:

• You have spotting or bleeding at any stage of pregnancy
• You have bleeding with cramps or tummy pain
• You have a positive pregnancy test with pain or bleeding
• You have had a fall or a blow to your tummy, even if there is no bleeding

Go to the hospital emergency straight away if:

• Bleeding is heavy, soaking a pad every hour, or comes after a fall or injury
• You pass large clots or tissue
• You have severe or one-sided tummy pain, or pain in the shoulder tip
• You feel faint, dizzy, very weak, or you collapse
• You have a fever or chills with bleeding
• You are in later pregnancy (after about 24 weeks) and have any bleeding, or you have pain, a hard tummy, or fewer baby movements
• Fluid gushes or leaks from the vagina before 37 weeks

How a doctor finds the cause

Your doctor will ask how many weeks pregnant you are, how much you have bled and what other symptoms you have. They may:

• Check your pulse and blood pressure
• Examine your tummy, and gently look at the cervix if it is safe to do so
• Do an ultrasound to see where the pregnancy is and check the baby's heartbeat
• Do blood tests, including your blood group and pregnancy hormone levels
• Take a swab to look for infection

If you are Rh negative, tell the doctor, as you may need extra care after bleeding. The doctor will explain what treatment, if any, you need.

Questions women ask

Is bleeding in pregnancy normal?

Light spotting is common, especially in the first trimester, and many women go on to have healthy pregnancies. But it is never something to ignore. Always tell your gynaecologist, so they can check you and rule out anything serious.

Is bleeding in the first month of pregnancy a period?

You do not have a true period once you are pregnant. Spotting in the first month is often implantation bleeding, but it can also be an early sign of miscarriage or an ectopic pregnancy, so a doctor should check it.

Is bleeding at 6 weeks of pregnancy a problem?

It can be harmless, but at 6 weeks a doctor will usually want to do an ultrasound to see where the pregnancy is and whether it is growing as expected. Go the same day, and straight away if you have pain or feel faint.

What does bleeding in the 4th month of pregnancy mean?

Bleeding in the second trimester is less common and should be checked promptly. It can come from the cervix, a low-lying placenta, the placenta separating, or early labour. Call your doctor or go to the hospital the same day.

How can I tell bleeding in pregnancy from a miscarriage?

You cannot tell from the bleeding alone. Heavier bleeding with cramps or clots makes a miscarriage more likely, but many women with these signs have a pregnancy that continues. An ultrasound is the only way to know.