Bleeding in early pregnancy is quite common, and isn’t always a sign of a problem; however, if you are bleeding heavily, or your bleeding is accompanied by severe pain, you need to call an ambulance immediately.
Spotting, or light bleeding, is fairly common in early pregnancy, and much of the time the pregnancy continues without problems. An implantation bleed can occur very early on, roughly when your period would have been due, but has also been reported later in the first trimester.
If you have early bleeding, notify your midwife (if booked already) or GP, who will refer you to an Early Pregnancy assessment unit for a scan and blood test to try to rule out miscarriage. (A miscarriage is when a pregnancy spontaneously ends before 24 weeks, although most occur before 12 weeks. Bleeding in association with pain or cramping is more likely to be a sign of impending miscarriage). If the pregnancy is very early, it may not be possible to visualise using an abdominal scanner. In this situation, the sonographer will offer you an internal scan, where a long probe is inserted into the vagina, to enable a clearer picture of the uterus.
Unfortunately there isn’t anything that can be done to prevent most miscarriages at this early stage, but many people find it helpful to know either way. If a scan confirms you currently have a viable pregnancy, you may be booked a second scan a few weeks later to check that the embryo is still developing. If you have a history of repeated miscarriages, you may be offered progesterone treatment to try to prevent miscarriage.
Another common reason for minor bleeding in pregnancy is due to changes to your cervix. Pregnancy hormones cause the tissue to be softer, and increase the blood flow to the area, so it is relatively easy to damage the surface and cause some bleeding. If you have had penetrative sex, it is common to have a little spotting shortly after, usually found as dried/brown blood on wiping after urination. If there is bright red blood in your underwear or you need a pad, notify your healthcare provider immediately.
Sometimes light bleeding is caused by a urinary tract infection. This is more likely to show up in a dipstick test as red blood cells, rather than be visible to you, but if you think you might have a UTI, notify your midwife.
Second and third trimester bleeding
Any bleeding later in pregnancy should be reported to your healthcare provider straight away. Some of the common causes are outlined below.
A small amount of blood or spotting may be your mucus plug coming away from your cervix, also known as a “show”. During pregnancy, there is a thick mucus in your cervix, which acts as a barrier and protects your baby from any infection reaching your uterus. When you are approaching the end of your pregnancy, the cervix starts to soften and so the mucus plug can come away. It is usually a thick, snot-like consistency and should be clear or whitish. It is common to have streaks of blood in, due to the softness and high blood flow in the cervix. If it is smelly or greenish then this can be a sign of infection so notify your midwife. Having a show isn’t necessarily a sign that you are going to go into labour immediately, and if you have a show earlier in pregnancy, it can regenerate so don’t worry unless you have other signs of labour.
Placenta praevia: a low-lying placenta, where part or all of the cervix is covered, can lead to vaginal bleeding. Often this will have been diagnosed during a scan, but if you have new bleeding later in pregnancy then your healthcare provider will check for this. As your uterus grows, the placenta usually moves up and away from your cervix, but if a scan in later pregnancy shows that part or all of the cervix is still covered, then you will be recommended a caesarean section for the birth of your baby.
Placental abruption: this is a rare but very serious condition where the placenta detaches from the lining of the uterus. It usually causes heavy bleeding and severe pain, but sometimes there isn’t any visible bleeding, so any sudden severe pain needs to be investigated immediately.