Bleeding in early pregnancy

Bleeding from the vagina during early pregnancy (the first 12 weeks) is common. It is thought to occur in almost one in four pregnancies.

What is bleeding in early pregnancy?#

It is not always possible to find out why bleeding happens. It may be light or heavy, come and go or stay constant, and be painless or painful.

One cause of bleeding in early pregnancy is an implantation bleed. This happens as the pregnancy implants (buries) itself into the lining of the uterus (womb). It often lasts a few days and then stops.

Many women who bleed in early pregnancy go on to have a healthy baby. Some, however, will have a miscarriage – the loss of a pregnancy before the developing baby (fetus) can survive outside the womb. Miscarriage usually happens in the first 12 weeks, and most occur without a clear cause.

Pregnancy is a complex process, and if something goes wrong it can sometimes fail. When bleeding is due to a threatened miscarriage, medical care does not change the likelihood of pregnancy loss. This can be an emotional and stressful time for you and your partner, and counselling and support are available.

Ectopic pregnancy emergency#

In rare cases, bleeding is caused by an ectopic pregnancy – when the pregnancy grows outside the uterus, usually in a fallopian tube. An ectopic pregnancy can also cause pain, often in the lower abdomen or the tip of the shoulder, along with dizziness.

An ectopic pregnancy is an emergency. If you have these symptoms, see a doctor as soon as possible.

Most women who bleed in early pregnancy do not need to be admitted to hospital, and surgery is rarely needed.

Treatment#

Your condition may change while you are waiting to be seen. The following symptoms need urgent assessment, so make sure the health professional caring for you knows if you have them:

• Heavy bleeding
• Severe pain
• Dizziness or faintness

These can be signs of an ectopic pregnancy or of very heavy blood loss that needs urgent treatment.

Diagnostic tests#

It can take time to find out why you are bleeding. You may need several tests, including:

• Blood tests to check your blood group and the level of pregnancy hormone in your blood. If your blood group is Rhesus (Rh) negative, you may be given an injection of anti-D immunoglobulin to prevent problems with the Rh factor in future pregnancies
• An ultrasound scan
• A vaginal examination

Ultrasound scan#

An ultrasound scan uses sound waves to look at the pregnancy. In early pregnancy (less than 12 weeks), the scan most often needs to be done internally, using a probe inside the vagina, but it can sometimes be done externally, using a probe on the outside of your abdomen. A scan takes about 15–20 minutes.

A scan can be arranged through your doctor or an emergency or urgent care service. Scans before six weeks cannot assess a baby’s heartbeat, but they may help if there is concern that the pregnancy could be ectopic. Many women are keen to know quickly what is happening, but there is usually no urgency and the scan can be done in the days ahead.

Vaginal examination#

A vaginal examination may be needed to check the size of the uterus and the amount of bleeding. A speculum examination, using an instrument similar to the one used for a cervical screening test, may also be done. The examination lasts a few minutes and may cause some discomfort.

Home care#

No specific treatment can prevent a miscarriage, but some general measures may help:

• Use pads rather than tampons while you are bleeding
• Avoid sex while you are bleeding. You can resume sex once the bleeding has stopped, or once a health professional advises it is fine
• Take mild pain relief, such as paracetamol (acetaminophen), if needed. Anti-inflammatory medicines such as diclofenac or ibuprofen are not recommended during pregnancy
• Use a heat pack on your abdomen to help ease pain. Apply it for up to 20 minutes every hour as needed, and check your skin after five minutes; if a rash or irritation appears, remove the heat pack
• Tell your doctor about any changes, such as increased pain, bleeding or fever
• Seek medical care urgently if you develop severe pain, heavy bleeding, a fever or dizziness
• Attend any follow-up appointments you are offered. Follow-up confirms the diagnosis, explains what is happening and the likely outcome, monitors your progress and advises on treatment. You may also need further tests to track your pregnancy hormone levels

What to expect#

The bleeding may be light and stop within a day or two, and many people go on to have a normal pregnancy.

Sometimes bleeding becomes heavy and progresses to a miscarriage. If this happens, the uterus usually empties on its own and no specific treatment is needed. Occasionally some pregnancy tissue remains inside, and you may be offered treatment to help the uterus empty. Your doctor will advise whether you need further treatment.

How will I feel?#

It is normal to feel a range of emotions, such as grief, guilt and anxiety. It is very unlikely that the bleeding was caused by anything you did or did not do. Talking to family or friends about how you feel may help.

Your doctor or the staff at an emergency or urgent care service can give you information about counselling and support.

Key points#

• Bleeding in early pregnancy is common, and many women go on to have a healthy baby.
• Most miscarriages happen in the first 12 weeks and occur without a clear cause.
• Severe pain, heavy bleeding, dizziness or shoulder-tip pain may signal an ectopic pregnancy, which is a medical emergency.
• No specific treatment can prevent a miscarriage, but simple self-care measures can help.

Seeking help#

In a medical emergency call an ambulance – dial your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) #

Seek urgent care promptly if:

• You have severe pain in your abdomen or shoulder
• You are losing a lot of blood (for example, soaking two pads an hour or passing clots the size of golf balls)
• You have a fever
• You are dizzy or collapse
• Your vaginal discharge smells offensive

For other medical problems or any concerns#

See your doctor or another health professional.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).