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
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Causes of bleeding in early pregnancy
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.
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.
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.
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
These can lead to bleeding, particularly after sex.
Your midwife or doctor can discuss tests and treatment with you.
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.
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.
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
Vaginal bleeding in early pregnancy: MedlinePlus Medical Encyclopedia
Vaginal bleeding during pregnancy is any discharge of blood from the vagina. It can happen any time from conception (when the egg is fertilized) to the end of pregnancy.
Some women have vaginal bleeding during their first 20 weeks of pregnancy.
Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.
Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.
Ask your health care provider more about the difference between spotting and bleeding at one of your first prenatal visits.
Some spotting is normal very early in pregnancy. Still, it is a good idea to tell your provider about it.
If you have had an ultrasound that confirms you have a normal pregnancy, call your provider the day you first see the spotting.
If you have spotting and have not yet had an ultrasound, contact your provider right away. Spotting can be a sign of a pregnancy where the fertilized egg develops outside the uterus (ectopic pregnancy). An untreated ectopic pregnancy can be life-threatening for the woman.
Bleeding in the 1st trimester is not always a problem. It may be caused by:
The fertilized egg implanting in the uterus.
Other factors that will not harm the woman or baby.
A threatened miscarriage. Many threatened miscarriages do not progress to pregnancy loss.
More serious causes of first-trimester bleeding include:
A miscarriage, which is the loss of the pregnancy before the embryo or fetus can live on its own outside the uterus. Almost all women who miscarry will have bleeding before a miscarriage.
An ectopic pregnancy, which may cause bleeding and cramping.
A molar pregnancy, in which a fertilized egg implants in the uterus that will not come to term.
Your provider may need to know these things to find the cause of your vaginal bleeding:
How far along is your pregnancy?
Have you had vaginal bleeding during this or an earlier pregnancy?
When did your bleeding begin?
Does it stop and start, or is it a steady flow?
How much blood is there?
What is the color of the blood?
Does the blood have an odor?
Do you have cramps or pain?
Do you feel weak or tired?
Have you fainted or felt dizzy?
Do you have nausea, vomiting, or diarrhea?
Do you have a fever?
Have you been injured, such as in a fall?
Have you changed your physical activity?
Do you have any extra stress?
When did you last have sex? Did you bleed afterward?
What is your blood type? Your provider can test your blood type. If it is Rh negative, you will need treatment with a medicine called Rho(D) immune globulin to prevent complications with future pregnancies.
Most of the time, the treatment for bleeding is rest. It is important to see your provider and have testing done to find the cause of your bleeding. Your provider may advise you to:
Take time off work
Stay off your feet
Not have sex
Not douche (NEVER do this during pregnancy, and also avoid it when you are not pregnant)
Not use tampons
Very heavy bleeding may require a hospital stay or surgical procedure.
If something other than blood comes out, call your provider right away. Put the discharge in a jar or a plastic bag and bring it with you to your appointment.
Your provider will check to see if you are still pregnant. You will be closely watched with blood tests to see if you are still pregnant.
If you are no longer pregnant, you may need more care from your provider, such as medicine or possibly surgery.
Call or go to your provider right away if you have:
Bleeding with pain or cramping
Dizziness and bleeding
Pain in your belly or pelvis
If you cannot reach your provider, go to the emergency room.
If your bleeding has stopped, you still need to call your provider. Your provider will need to find out what caused your bleeding.
Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.
Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.
Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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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.
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.
Blood during pregnancy - other common causes
In addition to the main ones, there are some other reasons why pathology can develop.
Excessive exercise, deep penetration during intercourse. If the cervix is damaged, slight red discharge occurs, which disappears within two hours.
Progesterone deficiency. With a low level of the hormone, the body starts the process of menstruation. Bloody discharge during pregnancy appears when the uterine mucosa is exfoliated. The situation may adversely affect the implantation of the fetal egg.
Miscarriage - occurs in 2-8% of pregnant women. It is characterized by pain in the lower abdomen, which is rapidly increasing, bloody discharge at the beginning of pregnancy. The causes of the pathological condition can be different - infectious diseases, fetal malformations that are incompatible with life, dehydration, abdominal trauma, taking certain drugs.
Ectopic pregnancy. Dangerous condition, urgent hospitalization is required.
A failed miscarriage. Blood discharge during pregnancy, abdominal pain are the main manifestations of intrauterine development of the fetus.
Infections. To avoid dangerous complications, it is necessary to treat diseases. Parents of both sexes should be tested.
Full or partial hydatidiform mole. Pathology of the chorion, in which the size of the villi increases, bubble expansions form. The risk group includes women with ovarian dysfunction, inflammatory diseases of the reproductive system, and a history of cystic mole. Bleeding is profuse and constant, characteristic blisters are present. The symptoms of early toxicosis are very pronounced, the size of the uterus, the hCG indicators do not correspond to the gestational age.
Cervical cancer. Pregnant women are rarely diagnosed. The risk group includes women with a large number of abortions and childbirth, often changing sexual partners.
Subchorionic hematoma. Hemorrhage around the placenta most often resolves on its own. But it increases the risk of preterm birth and other complications.
Cervical erosion. Detected in 50% of women. For pregnant women, the disease is not dangerous, but constant medical supervision is needed.
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.
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.
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.
When a fertilized egg is fixed outside the uterus, internal bleeding often occurs, and discharge from the genital tract may appear much later. Characteristic manifestations - acute pain in the abdomen radiates to the anal region, right or left side, blood pressure decreases, cold sweat appears, fainting is possible. Significant blood loss leads to the development of a state of shock with a high probability of death.
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.
How does implantation bleeding manifest?
weak, pulling pain in the lower abdomen;
sudden change of mood;
bouts of nausea;
increased sensitivity, swelling of the mammary glands;
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.
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:
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.
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.
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.
At the 7th week of pregnancy, discharge with blood is not the norm. May indicate a miscarriage, missed or ectopic pregnancy.
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! 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.
Early bleeding after IVF
The appearance of blood discharge during pregnancy on the 8-10th day after IVF is not considered a pathology, provided that the woman feels normal. After the introduction of the embryo into the uterine cavity, minor damage to the small uterine vessels often occurs. Brown, dark cream, pale pink, odorless discharge most often indicates a successful transplant, pregnancy.
If spotting after IVF is observed for 1-2 days, slight pulling pains in the lower abdomen are disturbing, this may be due to a progesterone deficiency. After the examination, the doctor will adjust the hormonal maintenance therapy.
Pink discharge on the 16th day after the transfer is a dangerous symptom. It may be a sign of detachment of the fetal egg, the threat of termination of pregnancy.
According to studies, uterine bleeding in the first trimester is a common occurrence in pregnancy after IVF. Discharge does not affect the incidence of adverse reproductive outcomes. The number of embryo rejections in women with and without uterine bleeding is approximately the same. Consult with our doctors by phone for more details.
If blood has gone from the genitals of a pregnant woman, the doctor conducts an external and gynecological examination.
Analyzes and examinations:
general and biochemical blood test;
general urine analysis;
tests for hCG, other hormones;
Ultrasound of the pelvic organs;
CTG is performed to assess the vital activity of the fetus.
Methods of treatment depend on the results of the examination.
Bloody discharge in the first trimester - causes and therapeutic measures:
Cleansing the uterus.
Diagnostic laparoscopy, removal of residual fetal tissues, antibiotic therapy.
Risk of miscarriage
Hospitalization, bed rest, prescribing drugs to maintain pregnancy, sedatives and tocolytics to reduce uterine tone.
Curettage of the uterine cavity.
Polyp injury, cervical erosion
Expectant management, if the condition does not worsen, removal and cauterization is carried out after childbirth.
Damage to the uterus
Complete bed rest.
Depending on the type of pathogen - antibiotics, antiviral or antifungal drugs.
Complications and consequences
It is impossible to ignore bloody impurities in vaginal discharge during pregnancy. Without proper and timely assistance, the following complications may occur:
intrauterine fetal death;
the development of an infectious process, sepsis due to the remainder of dead tissues in the uterine cavity;
profuse blood loss can lead to death.
Important! Urgent medical attention is needed in case of heavy bleeding, discharge of bright scarlet blood, presence of blood clots in the discharge. In life-threatening and fetal conditions, severe pain in the abdomen, lower back, convulsions, profuse cold sweat, and loss of consciousness are disturbing.
Methods of prevention
If there is blood in the first trimester, it is important to remain calm. Stress and anxiety will only exacerbate the situation. But any health problem is easier to prevent than to treat.
How to avoid bleeding during childbearing - recommendations from a gynecologist:
eat right and balanced, give up junk and junk food, eat more fresh vegetables and fruits;
observe the drinking regime;
in the absence of contraindications, moderate physical activity is indicated - yoga, swimming, special gymnastics for pregnant women;
more time to walk in the fresh air;
avoid stress, overwork, observe the daily routine, get enough sleep;
give up bad habits, do not be in smoky rooms;
timely visit a gynecologist;
according to the doctor's prescription, take vitamin complexes for pregnant women;
do not self-medicate.
The prognosis for bleeding during gestation depends on the causes and timely visit to the doctor. Properly provided medical care can save the life of the fetus and the woman.
Why is there blood from the genital tract during gestation?
The causes of bleeding in early pregnancy are different. Most often, spotting appears when the fetal egg is fixed, progesterone deficiency, with erosion of the cervix and polyps. Dangerous causes - ectopic, molar, miscarriage, miscarriage.
What to do if there is bleeding during pregnancy?
Much depends on the amount of blood released, general well-being. If the bleeding is not strong, not for long, the general condition is normal, it is enough to lie down and rest. Write down the date of the attack, inform the doctor at the next visit. But if even slight spotting during early pregnancy lasts more than 72 hours, is accompanied by cramping or acute pain, fever, you should immediately visit a gynecologist or call an ambulance.
How can you recognize a miscarriage?
With the threat of interruption, spotting is scanty, pain in the lower abdomen is absent or may be dull, aching. The condition is considered reversible, with timely treatment, pregnancy can be saved. If a miscarriage has begun, bleeding intensifies, cramping pain appears. The general condition is satisfactory. Urgent hospitalization is required, the probability of maintaining pregnancy is decided on an individual basis.
Bleeding during pregnancy is a dangerous symptom. Sometimes spotting can be caused by physiological reasons. But often such a symptom appears in life-threatening conditions for the woman and the fetus.
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Menshikova Maria Viktorovna obstetrician-gynecologist
Experience 38 years
Specialist with extensive practical experience. He has a certificate of a mammologist, a certificate of professional certification. Participates in foreign business trips and individual training programs (Los Angeles).
2009 - 2013 Pereslavl Central District Hospital, women's consultation - obstetrician-gynecologist
2020 to present Teledoctor24 LLC - doctor - consultant (gynecologist)
Bleeding in the first half of pregnancy - Information
Clinics of Chelyabinsk
Doctors of Chelyabinsk
Pregnancy is a complex physiological process that can be accompanied by various complications, including those that cause uterine or vaginal bleeding. As a rule, the first and last trimester of pregnancy, more precisely, the very first and last weeks of it, are the most dangerous from this point of view.
Strange as it may seem, but not any bleeding at the beginning of pregnancy indicates a pathology that needs immediate medical intervention.
Moreover, it can be said that in the very early stages of pregnancy, slight bleeding is considered a common symptom that is not a cause for concern and does not pose a danger to the normal course of pregnancy.
The first weeks of pregnancy are the time of a global restructuring of a woman's body, hormonal and physiological.
What could be the reasons for the discharge of blood from the genital tract of a pregnant woman?
First of all, during the fixation of the ovum in the wall of the uterus, small fragments of its mucous membrane can be shed, which causes the appearance of small bloody discharge from the vagina. This vaginal discharge may be brown, brown, or intensely red. Most often, the discharge is not plentiful and does not last longer than a few days. Sometimes they are accompanied by minor spasms, sometimes they are completely painless for a pregnant woman.
It is this kind of bleeding that sometimes becomes the first indication of pregnancy. We repeat that this does not happen when the pregnancy has already been established, but during the implantation of the fetal egg, that is, when the “real” uterine pregnancy has not yet begun.
Most often, such spotting coincides with the time of the next menstruation, which leads to a fairly common belief that not everyone stops menstruating with the onset of pregnancy.
However, after the pregnancy is established, any bleeding should alert the pregnant woman and cause her to immediately report to the obstetrician-gynecologist leading the pregnancy.
A fairly common cause of bleeding from the genital tract in pregnant women in early pregnancy is cervical erosion. This also happens for a completely understandable reason: due to increased blood flow to the uterus during pregnancy, the cervical mucosa may begin to bleed, turning into some kind of inflammatory ulcer.
In case of cervical erosion in pregnant women, blood from the genital tract appears after sexual contact or without any apparent reason at all, such bleeding is not accompanied by pain, is insignificant and quickly stops spontaneously.
In addition to erosion, the cause of bleeding in pregnant women in the first trimester of pregnancy can be polyps of the cervical canal and decidual polyps - harmless tumors that grow in the uterus or cervix. Bleeding is also insignificant and is not accompanied by pain.
Depending on the situation, the doctor may remove the polyp or wait for the polyp to fall off on its own, as is most often the case. Removal of a bleeding polyp does not harm the course of pregnancy, since curettage of the uterine cavity is not required when it is removed. In parallel with the removal of the polyp, treatment is necessarily carried out aimed at replenishing blood loss and maintaining pregnancy.
However, there are other cases when bleeding in the first trimester of pregnancy serves as a signal that "not all is well in the Kingdom of Denmark. "
In particular, such severe complications of the first trimester of pregnancy as spontaneous miscarriage and ectopic pregnancy can begin with vaginal bleeding.
In addition, the discharge of blood from the genital tract of a pregnant woman may indicate the development of any severe pathology of the cervix, up to oncological neoplasms.
Other causes of bleeding include varicose veins in the vulva, vaginal infections.
Once again, in order not to miss the first signs of these complications, any bleeding in a pregnant woman should be a reason to see a doctor.
Spontaneous miscarriage is a very serious complication of pregnancy that occurs early in pregnancy and usually begins with bleeding. Bleeding indicative of an incipient miscarriage may be minor and painless. However, it does not stop after a short time, but continues to grow both in intensity and in the unpleasant sensations that accompany it.
Spontaneous miscarriage occurs in several stages: threatened miscarriage, incipient miscarriage, abortion in progress, incomplete and complete miscarriage. These stages differ just in the intensity of bleeding and the presence of pain.
In a threatened miscarriage, bloody discharge from the genital tract of a pregnant woman is extremely scarce, pain is usually absent or is manifested by aching sensations in the lower abdomen. At the same time, the uterus has not yet been changed, and with active and timely treatment, pregnancy can be maintained.
A miscarriage that has begun is characterized by slow bleeding, cramping pains. The cervix at this stage of the miscarriage may already be slightly shortened, and the external os is ajar. At the same time, the woman's condition remains satisfactory, and with proper treatment, pregnancy can be maintained. If this moment is also missed, then it is almost impossible to maintain the pregnancy, and, in addition, severe bleeding during an abortion in the course causes the need for urgent hospitalization, during which the uterine cavity is scraped, with compensation for blood loss, depending on its volume and the condition of the woman.
Bloody discharge in incomplete miscarriage is significant, usually dark red in color, clots can be seen in them. Bleeding is accompanied by cramping pains in the lower abdomen. Emergency care consists in scraping the uterine cavity, removing the remnants of the fetal egg; compensation for blood loss, depending on its volume and the condition of the woman.
If there is a complete miscarriage, then there is no bleeding, since the fetal egg is completely released from the uterus. The only thing that the doctor should do in this case is to scrape the uterine cavity so that there are no parts of the fetal egg left there.
Sadly, spontaneous miscarriages are a fairly common cause of uterine bleeding during pregnancy.
Another cause of bleeding in pregnant women can be an ectopic pregnancy, that is, a situation in which the fetal egg is fixed not in the body of the uterus, but in the tubes or in the cervix. An ectopic pregnancy not noticed in time can lead to cervical rupture and even death.