This information is for women experiencing bleeding or spotting in early pregnancy.
Bleeding in early pregnancy can be very worrying. This leaflet aims to provide some information and guidance, and answer some commonly asked questions, which we hope will provide some reassurance for you at this uneasy time.
What is bleeding and spotting in early pregnancy?
Bleeding or spotting in early pregnancy is a common occurrence, with up to 25% of women experiencing spotting or bleeding in the first 12 weeks of pregnancy. Unfortunately it is sometimes an indication that you are having a miscarriage, but around half of women who experience bleeding or spotting in early pregnancy carry on to have a normal pregnancy.
Spotting in pregnancy is often identified when a woman notices spots of blood on her underwear or on tissue after wiping.
You may also notice some pink, brown, red or dark red blood. Sometimes women may pass fresh red blood, or clots. Some women also notice some string like tissue coming from their vagina.
Bleeding is sometimes associated with pain, but not all the time.
What can cause bleeding in early pregnancy?
- Implantation bleed (normal pregnancy). Many women experience bleeding when the pregnancy implants in the womb.
- Threatened miscarriage. This is where there is vaginal bleeding in women under 24 weeks pregnant, with no dilation of the cervix. The pregnancy continues as normal - this occurs in around 20% of all pregnancies.
- Miscarriage.
- Ectopic pregnancy. This is a pregnancy which develops outside of the uterus, this occurs in 1 in 80 pregnancies
- Bleeding from the cervix. Hormonal changes in pregnancy result in changes to the cervix, this commonly causes bleeding.
- No obvious cause. Sometimes it is not possible to identify the cause of bleeding.
Bleeding is not caused by anything you have done - even if you have had a miscarriage. Most miscarriages occur because there is something wrong which cannot be prevented.
What can I expect whilst in the Emergency Department?
Streaming
After you arrive in the Emergency Department you will be asked some brief questions by one of our experienced nurses.
If you do not need emergency treatment, the streaming nurse may be able to refer you directly to a specialist service who will assess you within 72 hours. This avoids the need for you to wait in the Emergency Department.
Triage
If there is any uncertainty as to whether you need emergency treatment, a second experienced nurse will triage you. They will need to know the date of your last period, any symptoms you have, and any medical history. You will be asked for a urine sample and the nurse will check your pulse and blood pressure.
They may also take some blood samples and insert a cannula (drip) but this isn’t necessary for all women.
You may then be asked to wait to see an Emergency Department clinician, or be referred to the Early Pregnancy Clinic if you are well enough.
What next?
6-12 weeks pregnant
If your bleeding is not too heavy and you feel well in yourself, you will be referred to the Early Pregnancy Clinic. This usually involves a phone call the following working day (Monday, if this is a weekend) where the specialists will discuss your symptoms and either give you advice over the phone, or make an appointment to come into hospital for assessment. This may include blood tests and an ultrasound scan, but not every woman needs these.
If bleeding is heavy, you are unwell, or have severe pain, you will be triaged and assessed by a clinician in the Emergency Department or referred directly on to the Gynaecology Team.
Over 12 weeks pregnant or in severe pain
Depending on your symptoms you may be seen in the Emergency Department, referred directly to the gynaecology ward or, if you are over 12 weeks with light bleeding you may be referred to the Early Pregnancy Clinic.
This usually involves a phone call the following working day (Monday, if this is a weekend) where the specialists will discuss your symptoms and either give you advice over the phone, or make an appointment to come into hospital for assessment.
Less than 6 weeks pregnant
Follow-up appointments are not routinely arranged if you are under 6 weeks pregnant. This is because light bleeding is fairly common at this stage and it is usually too early to see anything on a scan.
You should take a further pregnancy test in 1 week and contact your GP or call 111 for advice at this point if you are still worried. If you have worsening pain or bleeding at any point you should also call 111 or contact your GP.
How will I know if this is a miscarriage?
It may not be possible to tell straight away whether you are having a miscarriage, depending on your symptoms and your stage of pregnancy, even if you have an ultrasound scan.
You may asked to come back to clinic for a repeat scan after 1-2 weeks or you may be advised to have a blood test. This can be an upsetting time and it may help to share your feelings with a partner or trusted friend or family member. There are also some support websites at the end of this leaflet which you may find helpful.
What can be done?
Unfortunately, if a miscarriage is going to happen, there is no medical treatment that can prevent it. 90% of miscarriages are due to a problem with fetal development and would never continue to be a normal pregnancy.
Most women who miscarry can expect to experience bleeding like a period for up to 2 weeks.
If the bleeding is not due to miscarriage, it may settle on its own, or if it continues you may need to be monitored more frequently by your midwife.
If you have had your third miscarriage, there is sometimes an underlying cause which can be treated – speak to your GP who can refer you to a specialist.
If there is heavy bleeding you may need to be monitored in hospital, or if we think you may have an ectopic pregnancy you will need further assessment with an ultrasound scan. A specialist will discuss the treatment options with you.
What if I become more unwell, or the bleeding increases after I am discharged?
If you have any of the following symptoms, you should come back to the Emergency Department to be re-assessed:
- Bleeding: If you are filling more than 2 large pads per hour, or passing clots the size of your palm.
- Fainting or feeling faint.
- Severe or increasing pain in your pelvis, abdomen, or shoulder.
Frequently asked questions
Have I done anything to cause the bleeding?
No. Bleeding is not caused by anything you have done - even if you have had a miscarriage. Most miscarriages happen because there is something wrong which cannot be prevented.
Should I use tampons or pads?
Sanitary pads are the safer and better option. Please ensure they are changed regularly.
Can I still have sex?
Whilst sexual intercourse is safe during pregnancy, we advise waiting until any spotting or bleeding has completely stopped until resuming sex.
Can I still go to work?
It is not necessary to stay off of work, however ensure you are getting adequate rest if you are tired. You can self-certificate for 3-7 days, after this you will need to contact the GP who can assist you.
Can I have a bath?
Although showers are more hygienic whilst you are bleeding, it is safe for you to have a warm bath.
If you need any further advice or information
Useful organisations and websites
The Miscarriage Association
For support and information:
Phone: 01924 200799 (Monday to Friday, 9am to 4pm)
Email: info@miscarriageassociation.org.uk
The Miscarriage Association: Pregnancy Loss Information & Support
Ectopic Pregnancy Trust
Phone: 01895 238 025
Email: ept@ectopic.org
The Ectopic Pregnancy Trust - Support For You And Your Loved Ones
The Willow Tree Centre
A local charity offering support for parents after the loss of their pregnancy.
Willow Tree Centre | Thewillowtreecentre.org.uk |Bristol
Mothers for mothers
Bristol based help line, online support and a directory of services for all parents
Mothers for Mothers | Postnatal mental health support
© North Bristol NHS Trust. This edition published June 2024. Review due June 2027. NBT003376.
Contact Emergency Department (ED)
Gate 35, Level 0
Brunel building
Southmead Hospital
Southmead Road
Westbury-on-Trym
Bristol
BS10 5NB
Emergency Department Main Reception Gate 35: 0117 4145100 or 0117 4145101