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.
Information:
Other warning signs during pregnancy
There are other warning signs to watch out for during pregnancy. They could mean you're experiencing pregnancy complications or a medical emergency.
They can also be signs of a common ailment during pregnancy.
Warning signs include:
- Stomach pain
- Change in your baby's movements
- Severe headaches
- Distress and thoughts of self-harm
- Breathlessness or chest pain
- Leg pain and swollen calf
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.