When is it normal to spot during pregnancy

During pregnancy, it is quite common to have bleeding from the vagina. This symptom does not always mean that there is something wrong.

But occasionally it can be a sign of an ectopic pregnancy or a miscarriage.

Causes of vaginal bleeding in the first trimester

The causes of bleeding from your vagina during the first trimester (0 to 12 weeks) include:

Implantation bleeding

This is light bleeding (also known as 'spotting'). It happens very early on in your pregnancy (after 6 to 10 days), around the time that your period would have been due. It is caused by the fertilised egg attaching to the inner lining of your womb.

Hormonal changes

The hormones of pregnancy can cause changes to your cervix (the neck of the womb). These changes may mean that you bleed more easily, for example after sex.

Threatened miscarriage

If you have bleeding with or without tummy pain in the first trimester, you will often be referred for an ultrasound scan.

You may be diagnosed with a 'threatened miscarriage' if the pregnancy is developing normally and no other cause is found. Many women who have a threatened miscarriage go on to have a healthy baby. You may be offered a follow-up scan.

Miscarriage

Unfortunately sometimes bleeding in pregnancy may mean that you are having a miscarriage. During the first trimester, this is sometimes called 'an early miscarriage'. This means the loss of a pregnancy during the first 12 weeks.

Signs of miscarriage

Ectopic pregnancy

Occasionally bleeding from the vagina can be a sign that you have an ectopic pregnancy. This means that the pregnancy is developing outside the womb.

Ectopic pregnancy symptoms

A molar pregnancy or hydatidiform mole

This is a rare condition where the placenta is not normal and the pregnancy does not develop as it should. Abnormal cells develop in your womb.

A molar pregnancy is usually treated by a simple procedure. This removes the abnormal cells from your womb. You may have appointments afterwards with your obstetrician for blood tests and/or ultrasound scans. These are to make sure all the cells have been removed.

Molar pregnancy

Causes of vaginal bleeding in second and third trimesters

Many women have vaginal bleeding during the second (13 to 26 weeks) and third trimester (26 to 40 weeks).

This does not always mean that there is something wrong. But it can be a sign that there is a problem with your pregnancy. You should always contact your GP, midwife or obstetrician urgently if you experience any bleeding.

Possible causes of bleeding in the second and third trimesters include:

'Late' miscarriage

In the second trimester, bleeding from the vagina can be a sign of a late miscarriage. This is the term used to describe the loss of a pregnancy between 12 and 23 weeks.

Problems with the cervix or neck of the womb

This includes infection or inflammation.

Placenta praevia

This is a condition where the placenta or afterbirth is located lower in the womb than normal. This partially or completely blocks the birth canal.

Placenta praevia can cause bleeding which may be severe at times. If you have placenta praevia you will be advised to have a caesarean birth if the placenta does not move up the womb.

Placental abruption

This is a rare and very serious condition. The afterbirth separates from the inner lining of the womb. It can cause bleeding and severe tummy pain and can be dangerous for you and for your baby.

A 'show'

Bleeding from your vagina can be a sign that you are going into labour, particularly if you also have tightenings or pains in your lower tummy. If you are less than 37 weeks pregnant, this could be a sign of preterm or premature labour.

Spotting is light vaginal bleeding that can happen when you're pregnant. It is a very common and tends to happen in early pregnancy, during the first trimester.

Spotting is usually red or pink in colour. It can also look brown, like old blood or like the bleeding at the start and end of your period. The amount of blood you lose when spotting is small – less than a light period bleed.

Causes of spotting

The main causes of spotting during early pregnancy include:

• implantation bleeding - caused by the fertilised egg attaching to the inner lining of your womb
• hormonal changes - pregnancy hormones can cause changes to your cervix

Spotting can also be a sign that your pregnancy is not developing properly and may be a sign of a miscarriage or an ectopic pregnancy.

Seeing your GP about spotting

Your GP will ask you about your bleeding.

They may ask you:

• when your last period was
• how many weeks pregnant you are
• if it's your first pregnancy
• what the bleeding or spotting is like
• if you have any other symptoms such as stomach pain or dizziness

Be honest with your GP. There's nothing to be embarrassed about. Tell them about the colour, any clotting, and how heavy the bleeding was. Be as graphic as you need to. Remember, your GP sees people with personal issues like bleeding all the time.

Examination

Your GP may ask to give you a physical examination.

This may include:

• checking your blood pressure
• checking your pulse
• pressing on your stomach

Tests

Your doctor may also do some tests, such as a:

• urine test - to check for infection
• pregnancy test - if it's their first time seeing you during your pregnancy
• blood test - to measure the levels of pregnancy hormone (βhCG) in your blood

If you get a blood test done in your GP's surgery, it'll be sent to the lab in the hospital.

Referral

What happens next depends on:

• the stage of the pregnancy you're at
• if you have had bleeding before
• anything your GP found out at your appointment

If your maternity hospital has an Early Pregnancy Unit (EPU), your GP may refer you to investigate the spotting. You may also need to go to your maternity hospital for an ultrasound scan.

Sometimes they may refer you to the emergency department if you have severe stomach pains or heavy vaginal bleeding.

EPUs and emergency departments are usually quite busy. Bring a magazine or a book to keep you busy. It's also good to bring a support person in case you receive bad or unexpected news. Be aware that your hospital may have COVID-19 restrictions on partners and support persons.

Going to the maternity hospital about spotting

You may have tests and examinations at the hospital. This is to try and find out the cause of the bleeding.

Pelvic or vaginal examinations

Your doctor or obstetrician might want to examine your cervix. This is to check the bleeding. It's normal to feel a little uneasy about this. Sometimes you can have a midwife there to support you.

They may need to use a speculum. This is an instrument used to gently open your vagina so your doctor can see your cervix more easily.

Your doctor may also ask your consent to do a vaginal examination. This is when they insert their gloved fingers into the vagina to see if there is any pain. It helps then to make a correct diagnosis.

Blood tests

You may need to have a blood test, even if your GP did blood tests. Sometimes your doctor will want to compare your pregnancy hormone to the levels in the blood taken by your GP. Occasionally, blood tests are repeated 2 days later. The combined results can help with the correct diagnosis.

Ultrasound scan

An ultrasound scan is often needed. In early pregnancy, this is usually a transvaginal ultrasound. It's the best way to get a clear picture of your baby.

In the second and third trimesters, it'll usually be an abdominal ultrasound instead.

What happens next

This depends on what is causing the bleeding. You may need to be admitted to hospital for observation or treatment. Most women with spotting are discharged home.