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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

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Contact your doctor or midwife if you notice bleeding from your vagina at any time during your pregnancy. If you have very heavy bleeding, strong pain or feel very unwell, call triple zero (000) immediately and ask for an ambulance.

Is it normal to bleed during pregnancy?

Bleeding during pregnancy, especially in the early stages, is quite common. About 1 in 4 women will experience vaginal spotting or bleeding during the first trimester. Many of these women will go on to have healthy pregnancies.

However, vaginal bleeding may be the first sign of a problem, so it’s important to contact your doctor or midwife if you experience vaginal bleeding at any stage of your pregnancy for advice on what to do next.

What are the causes of bleeding during pregnancy?

The causes of bleeding during pregnancy are generally divided into two categories — bleeding before 20 weeks and bleeding after 20 weeks gestation.

Before 20 weeks gestation, causes of bleeding may include:

  • Implantation bleeding — in very early pregnancy (4 to 5 weeks gestation) some women may experience bleeding when the pregnancy implants itself in the lining of the uterus (womb).
  • Miscarriage — bleeding may be the first sign of a miscarriage. About 1 in 15 women who experience bleeding in early pregnancy end up having a miscarriage.
  • Ectopic pregnancy — a rare but serious cause of bleeding when a fertilised egg starts growing outside the uterus (womb). An ectopic pregnancy can rupture (burst) and cause heavy bleeding, and may be life-threatening.

Bleeding in later pregnancy (after 20 weeks) is usually caused by problems with the placenta such as:

  • Placenta previa — also known as a 'low lying placenta', when the placenta implants close to the cervix (neck of the uterus). If the cervix starts to open or the uterus contracts, this can cause bleeding.
  • Placental abruption — when the placenta starts to separate from the uterus during pregnancy but before birth, causing bleeding from the place where the placenta has peeled away. Bleeding caused by placental abruption is usually associated with sudden, severe abdominal pain.

Less common causes of bleeding, which may happen at any stage of pregnancy, may include:

  • genital tract infections
  • injuries to the genital tract
  • growths or tumours of the reproductive system
  • bleeding from vulvovaginal varicosities (varicose veins in the vulva or vagina)

What should I do if I bleed during pregnancy?

If you bleed during pregnancy, contact your doctor or midwife. Your antenatal care provider can give you advice about what to do next.

It can be helpful to note down details about what you have been experiencing. This may include:

  • the amount and colour of any discharge
  • whether you have passed any clots
  • whether you have had any abdominal pain

If you are having heavy bleeding, it’s a good idea to keep your pads or stained clothes to show your doctor or midwife.

How will my doctor or midwife diagnose the cause of my bleeding?

Your doctor or midwife will ask you questions about the bleeding, any other symptoms you have been having and about your pregnancy and general health. Your doctor or midwife may also perform a vaginal examination to check the bleeding and look for any visible cause.

You may be referred for a blood test to check your human chorionic gonadotropin (hCG) level. hCG is a hormone made by the placenta that can be found in your blood and urine. Your hCG level can give your doctor important information about how your pregnancy is progressing.

You may also be referred for an ultrasound scan, which may be used to:

  • check your baby’s heartbeat
  • check for signs of a miscarriage
  • look for signs of an ectopic pregnancy
  • check the position and health of the placenta

It may take some time to work out what is causing your bleeding. You may need to have several blood tests or ultrasound scans over a few days or weeks. This can be a stressful time, so consider seeking support from your partner or someone else you trust.

In some situations, your bleeding may resolve on its own without your doctor or midwife finding a cause.

When should I seek medical attention?

If you have bleeding at any stage of pregnancy, contact your doctor or midwife for advice and support.

You should contact your doctor urgently, or visit the nearest emergency department, if:

  • your bleeding becomes very heavy
  • you have strong pains
  • you feel dizzy or faint
  • you feel short of breath

If you have very heavy bleeding, strong pain or feel very unwell, call triple zero (000) immediately and ask for an ambulance.

Does bleeding mean I am having a miscarriage or might lose my baby?

Bleeding in early pregnancy is very common and does not necessarily mean you are having a miscarriage. Many women who experience bleeding in early pregnancy go on to have healthy babies.

In some cases, bleeding can be the first sign of a miscarriage. If you are experiencing bleeding in early pregnancy, contact your doctor or midwife for advice.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
The Royal Women's Hospital (Bleeding in early pregnancy), Safer Care Victoria (Bleeding in early pregnancy), Royal Women's Hospital (Placenta problems), Safer Care Victoria (Antepartum haemorrhage: assessment and management), Australian Family Physician (Early pregnancy bleeding)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2022


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Need more information?

Bleeding or pain in early pregnancy

One in 4 women will experience bleeding and/or pain during their first 12 weeks of pregnancy. Unfortunately half of these pregnancies may also end in miscarriage, which cannot be prevented.