Bleeding during the first month of pregnancy

Vaginal bleeding - NHS

Bleeding during pregnancy is relatively common and does not always mean there's a problem – but it can be a dangerous sign.

Urgent advice: Call your midwife or GP immediately if:

• you have any bleeding from your vagina

Causes of bleeding in early pregnancy

Implantation bleeding

In early pregnancy, you might get some harmless light bleeding, called "spotting". This is when the developing embryo plants itself in the wall of your womb. This type of bleeding often happens around the time your period would have been due.

Cervical changes

Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding – after sex, for example.

Miscarriage or ectopic pregnancy

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy.

However, if you bleed at this stage of pregnancy it's likely you will go on to have normal and successful pregnancies.

Treating bleeding in early pregnancy

You may be offered a medicine called progesterone to stop bleeding in early pregnancy. This will only be recommended if you've had a scan to confirm you're pregnant and you've had a miscarriage before.

Your doctor may recommend you take the medicine twice a day until you're 16 weeks pregnant.

Miscarriage

If a pregnancy ends before the 24th week, it's called a miscarriage. Around 1 in 5 pregnancies ends this way.

Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can also be other causes of miscarriage, such as hormone or blood clotting problems.

Most miscarriages occur during the first 12 weeks (3 months) of pregnancy and, sadly, most cannot be prevented. Other symptoms of miscarriage include:

• cramping and pain in your lower abdomen
• a discharge or fluid from your vagina
• a discharge of tissue from your vagina
• no longer experiencing the symptoms of pregnancy, such as feeling sick

If you have bleeding or any of the symptoms above, contact your midwife or GP straightaway.

Ectopic pregnancy

An ectopic pregnancy is when a fertilised egg implants outside the womb – for example, in the fallopian tube.

It can cause bleeding and is dangerous because the fertilised egg cannot develop properly outside the womb. The egg has to be removed, which can be done through an operation or with medicines.

Symptoms of an ectopic pregnancy tend to develop in the 6th week of pregnancy but can happen later.

Other signs of ectopic pregnancy can include:

• tummy pain low down which may be on one side
• vaginal bleeding or a brown, watery discharge
• pain in the tip of your shoulder
• discomfort when peeing or pooing

Call 111 if you have symptoms of an ectopic pregnancy.

Causes of bleeding in later pregnancy

Cervical changes

These can lead to bleeding, particularly after sex.

Vaginal infections

Your midwife or doctor can discuss tests and treatment with you.

A 'show'

This is when the plug of mucus that has been in the cervix during pregnancy comes away, signalling that the cervix is getting ready for labour to start. It may happen a few days before contractions start or during labour itself.

Find out about the signs of labour and what happens in labour.

Placental abruption

This is a serious condition in which the placenta starts to come away from the womb wall. Placental abruption usually causes stomach pain, and this may occur even if there is no bleeding.

Low-lying placenta (placenta praevia)

This is when the placenta is attached in the lower part of the womb, near to or covering the cervix. Bleeding from a low-lying placenta can be very heavy, and put you and your baby at risk.

You may be advised to go into hospital for emergency treatment, and a caesarean section will usually be recommended. The Royal College of Obstetricians and Gynaecologists has more information on placenta praevia.

Vasa praevia

This is a rare condition where the baby's blood vessels run through the membranes covering the cervix.

When your waters break, these vessels may be torn and cause vaginal bleeding. The baby can lose a life-threatening amount of blood.

Finding out the cause of bleeding in pregnancy

To work out what is causing the bleeding, you may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels.

Your doctor will also ask you about other symptoms, such as cramp, pain and dizziness. Sometimes it might not be possible to find out what caused the bleeding.

If your symptoms are not severe and your baby is not due for a while, you'll be monitored and, in some cases, kept in hospital for observation.

How long you need to stay in hospital depends on the cause of the bleeding and how many weeks pregnant you are.

Being in hospital allows staff to keep an eye on you and your baby, so they can act quickly if there are further problems.

Find the answers to common health problems in pregnancy

Video: What should I do if I start bleeding during early pregnancy?

In this video, a midwife tells you what to do if you start to bleed during early pregnancy.

Media last reviewed: 20 March 2020
Media review due: 20 March 2023

Bleeding and spotting from the vagina during pregnancy

Bleeding and spotting from the vagina during pregnancy are common

If you bleed or spot during pregnancy, it doesn’t always mean there’s a problem but in some cases they may be signs of a problem for you or your baby’s health

If you have heavy bleeding, call your health care provider right away

Tell your provider about any bleeding or spotting you have during pregnancy

Bleeding and spotting from the vagina during pregnancy are common. Up to 1 out of 4 (up to 25%) of all pregnant women have some bleeding or spotting during their pregnancy.

Bleeding and spotting in pregnancy don’t always mean there’s a problem, but they can be a sign of miscarriage or other serious complications. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy.

Call your health care provider if you have any bleeding or spotting, even if it stops. It may not be caused by anything serious, but your provider needs to find out what’s causing it.

What’s the difference between bleeding and spotting?

Bleeding or spotting can happen anytime, from the time you get pregnant to right before you give birth. Spotting is light bleeding. It happens when you have a few drops of blood on your underwear. Spotting is so light that the blood wouldn’t cover a panty liner. Bleeding is when the blood flow is heavier, enough that you need a panty liner or pad to keep the blood from soaking your underwear and clothes.

What should you do if you have bleeding or spotting during pregnancy?

Call your health care provider if you have any kind of bleeding during pregnancy and do these things:

• Keep track of how heavy your bleeding is, if it gets heavier or lighter, and how many pads you are using.
• Check the color of the blood.  Your provider may want to know. It can be different colors, like brown, dark or bright red.
• Don’t use a tampon, douche or have sex when you’re bleeding.

Call your health care provider right away at any time during pregnancy or go to the emergency room if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis

What causes bleeding or spotting early in pregnancy?

It’s normal to have some spotting or bleeding early in pregnancy. Bleeding or spotting in the first trimester may not be a problem. It can be caused by:

• Having sex
• An infection
• Implantation. When a fertilized egg (embryo) attaches to the lining of the uterus (womb) and begins to grow.
• Hormone changes. Hormones are chemicals made by the body.
• Changes in your cervix. The cervix is opening to the uterus that sits at the top of the vagina.
• Certain types of testing during pregnancy like an amniocentesis or Chorionic villus sampling (CVS).  These are tests that are done to check for genetic abnormalities in your baby.  Genetic abnormalities are changes in the genes that are passed down to a baby from mom or dad. These genetic changes can cause health problems for a baby.
• Problems related to smoking.  If you smoke, it’s best to stop before pregnancy or as soon as you know you’re pregnant.

Sometimes bleeding or spotting in the first trimester is a sign of a serious problem, like:

• Miscarriage.  Almost all women who miscarry have bleeding or spotting before the miscarriage.
• Ectopic pregnancy. This is when a fertilized egg implants itself outside of the uterus and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman.
• Molar pregnancy. This is when a mass of tissue forms inside the womb, instead of a baby. Molar pregnancy is rare.

What causes bleeding or spotting later in pregnancy?

Bleeding or spotting later in pregnancy may be caused by:

• Labor
• Having sex
• An internal exam by your health care provider
• Problems with the cervix, like an infection, growths, inflammation or cervical insufficiency. This is when a woman’s cervix opens too early.  Inflammation of the cervix is when it may be painful, swollen, red or irritated.

Bleeding or spotting later in pregnancy may be a sign of a serious problem, like:

• Preterm labor. This is labor that happens too early, before 37 weeks of pregnancy.
• Placenta previa. This is when the placenta lies very low in the uterus and covers all or part of the cervix.
• Placenta accreta.   This is when the placenta grows into the wall of the uterus too deeply.
• Placental abruption. This is when the placenta separates from the wall of the uterus before birth.
• Uterine rupture. This is when the uterus tears during labor. This happens very rarely. It can happen if you have a scar in the uterus from a prior cesarean birth (also called c-section) or another kind of surgery on the uterus. A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

How are bleeding and spotting treated?
Your treatment depends on what caused your bleeding. You may need a medical exam and tests.

Most of the time, treatment for bleeding or spotting is rest. Your provider may also suggest treatments like:

• Take time off from work and stay off your feet for a little while
• You may need medicine to help protect your baby from Rh disease. Rh disease is when your blood and baby’s blood are incompatible (can’t be together). This disease can cause serious problems — even death — for your baby.
• Don’t have sex, douche or use tampons
• If you have heavy bleeding, you may need a hospital stay or surgery

Last reviewed April 2020

Pathological and physiological causes of bleeding during early pregnancy

The gestation period is a complex process that does not always go well. Every second woman has various complications. Most often, women go to the doctor with complaints of spotting. Why does bleeding occur during early pregnancy, how dangerous is it?

Causes of bleeding in pregnancy

Blood in the first trimester of pregnancy in the vaginal secretion is observed in 30% of expectant mothers. Bleeding can be weak, spotting, plentiful. nine0003

Most often, blood during early pregnancy is observed during implantation of the fetal egg. When the egg is attached, the vessels are often damaged, which leads to the appearance of blood secretions. They are similar to menstruation, last 1-2 days. This process is considered natural, does not indicate any pathologies.

Any bloody discharge during early pregnancy is a reason for an urgent appeal to a gynecologist. Even if there is no additional discomfort. At a remote consultation, our doctor will collect an anamnesis, draw up a clinical picture in order to identify the cause of bleeding. And he will select effective methods to eliminate the problem. nine0003

Blood during pregnancy - other common causes

In addition to the main ones, there are some other reasons why pathology can develop.

Bleeding in the first trimester can be caused by causes that appear at any gestational age. These are fibroids, polyps in the uterus and cervical canal, cardiovascular pathologies that are associated with a weakening of the endothelium. nine0003

Physiological or pathological bleeding during gestation - differences

Clinical manifestations of bleeding in pregnant women depend on the causes. Physiological discharge of blood from the genital tract in the early stages of gestation proceeds without deterioration in well-being. With bleeding caused by erosion, fibroids and polyps, there are also no additional discomfort. In this case, only a few drops of blood are released, it bleeds for a short time. nine0003

Abundant bleeding, similar to menstruation, against the background of a general satisfactory condition, occurs with a deficiency of progesterone.

Bleeding with spontaneous interruption is accompanied by constant or periodic pain in the lumbar region, abdomen. Disturbed by nausea, bouts of dizziness, slightly increased body temperature. Bleeding can be weak or intense, and clots are often observed in the discharge.

Learn more about implantation bleeding

Why does it bleed at the initial stages of gestation? Most often, the appearance of spotting during pregnancy is associated with the implantation of the embryo. They occur 6-12 days after conception and are often one of the first signs of conception.

Usually, the appearance of spotting at the beginning of pregnancy coincides with the time of the onset of menstruation, if the cycle is regular. But discharge in pregnant women is not as abundant as menstrual bleeding. Duration - from several hours to three, with the first pregnancy up to 5 days. nine0003

How does implantation bleeding manifest?

• weak, pulling pain in the lower abdomen;
• headache, dizziness;
• sudden change of mood;
• bouts of nausea;
• increased sensitivity, swelling of the mammary glands;
• fatigue, drowsiness.

Important! When the embryo is implanted, little blood is released, usually these are small spots. The discharge may be pink, brown, orange, and there should be no clots. nine0003

Possible causes of early bleeding by week

The first months of pregnancy are the most difficult and dangerous. It is in the early stages that various pathologies and complications often appear.

Why blood may appear in the early stages during pregnancy:

1. At the 4th week of pregnancy, discharge with an admixture of blood may appear - this is implantation bleeding. Heavy bleeding is a dangerous sign, most often indicates a miscarriage. Spontaneous abortion can be caused by exercise, fever, infections, drugs or alcohol. Such bleeding is profuse, painful, blood clots are present. nine0156
2. The appearance of sanious discharge at the 5th week of pregnancy may be a sign of a missed pregnancy. The reasons are overwork, Rh conflict, bad habits, bacterial and viral diseases of the reproductive system, genetic disorders in the embryo. Symptoms - causeless fever, severe pain in the lower back and lower abdomen, the disappearance of signs of toxicosis.
3. Blood in the discharge at the 6th week of pregnancy appears with an ectopic attachment of the fetal egg, fetal fading, Rhesus conflict. Discharge with blood at 6 weeks of pregnancy is a reason for an urgent visit to the gynecologist. nine0156
4. At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
5. From the 8th week of pregnancy, one of the most dangerous periods of pregnancy begins. The formation of the placenta begins, the hormonal background changes. Bloody discharge appears with the threat of miscarriage or spontaneous abortion. Pregnancy is often not saved.

Pay attention! nine0170 In the second trimester, bleeding occurs only in 5-10% of women. Most often this is due to late spontaneous abortion, isthmic-cervical insufficiency. The appearance of blood in the third trimester mainly occurs with presentation, placental abruption.