Bleeding and spotting in pregnancy

What is bleeding or spotting in pregnancy?

Spotting is light vaginal bleeding and is brown or pink in colour, much like the bleeding seen at the beginning or end of your normal period. If the colour is bright red then you have bleeding. The amount of blood is also key; spotting will most likely be a few drops but bleeding will be much heavier, possibly soaking a sanitary towel or panty liner. 

Is bleeding or spotting in pregnancy the sign of a miscarriage?

Bleeding or spotting (especially during the first 12 weeks) doesn’t always mean that you are having a miscarriage or that it is going to happen. 

Bleeding and spotting may in fact be more common than you think. A study by the National Institute of Health found that 1 in 4 of the women participating in the study reported bleeding and 8% of the women experienced heavy bleeding. Most of these episodes lasted less than 3 days and occurred between weeks 5 and 8 of pregnancy. Subsequent miscarriage was experienced by 8% of women with bleeding and 13% of those without.

What should I do if I experience bleeding during pregnancy?

All bleeding during pregnancy should be reported to your doctor or midwife. Be prepared that you may be told to rest or ‘wait and see’ if the bleeding is light, a small amount or if you are in the early part of your pregnancy.

If the bleeding is heavy or contains clots and is accompanied with pain contact your hospital's pregnancy or maternity unit immediately. 

Some causes of bleeding and spotting in pregnancy

Threatened or actual miscarriage

Studies indicate that around one third of pregnancies end in miscarriage but don’t fret – these figures refer to the first 12 weeks of pregnancy and include very early miscarriages that many women won’t even be aware of. Besides bleeding, other symptoms of miscarriage include mild to severe stomach cramps, back pain and loss of pregnancy symptoms such as nausea and passing tissue or clots. 

Implantation bleeding

Implantation bleeding can sometimes be one of the first signs of pregnancy and actually affects up to 1 in 3 women. This kind of bleeding occurs when the fertilised egg attaches to the uterine wall roughly 6 to 12 days after conception. Implantation bleeding is generally lighter than a period, but women have been known to experience significant spotting. Implantation bleeding can also cause cramping, but these will be mild with the cramps from your period feeling much more intense.

Breakthrough bleeding

Some women may experience what is known as breakthrough bleeding around the time when their period would have normally been due. Breakthrough bleeding is generally light and likely to be accompanied by some common period symptoms such as back ache, cramps and feeling bloated.

Breakthrough bleeding can last for around three months and some women may experience bleeding throughout their whole pregnancy and still go on to have completely healthy babies.

Bleeding after sex

Bleeding after sex is one of the most common causes of bleeding. This is completely harmless and is caused by an increased blood supply and softening of the cervix. This type of bleeding should of course be reported to your doctor or midwife, but be prepared to be honest about your activities! “Have you had sex?” is often the first question asked when bleeding is reported. But don’t worry this doesn’t mean that sex with your partner should be taken off the table, read more about sex during pregnancy. 

Ectopic Pregnancy

Less common than a miscarriage, around 1 in 100 pregnancies are ectopic and bleeding can be a sign. An ectopic pregnancy occurs when the fertilised egg implants outside of the uterus, usually in the fallopian tube. Other symptoms of an ectopic pregnancy include severe pain down one side of your abdomen, feeling faint and nausea. The pain may suddenly disappear if the tube ruptures but it will return soon enough and you will feel very unwell. If you have any signs of an ectopic pregnancy do seek medical advice immediately. Read more about ectopic pregnancy symptoms and treatments.

Molar Pregnancy

About 1-3 in 1000 pregnancies result in a molar pregnancy. A molar pregnancy is a very rare complication of pregnancy. It occurs when something goes wrong during the fertilisation process, and is caused by an abnormal cell growth of all or part of the placenta. With a molar pregnancy you will most likely have normal pregnancy symptoms early on, but eventually you will experience spotting or bleeding between 6 and 12 weeks. 

Bleeding from the placenta

Bleeding may be caused by the placenta being very low down on the uterine wall and occasionally right over the cervix. This is called placenta praevia and it occurs in about 2% of women. You will normally find out if you have this condition at your 20 week scan. If diagnosed with placenta praevia, you will be need additional ultrasounds to monitor your condition. 

Another cause of bleeding later in pregnancy is placental abruption (which occurs in around 1 in 200 pregnancies). This is where the placenta partially or completely separates from the wall of the uterus. Symptoms can include severe pain and heavy bleeding. If you smoke, have high blood pressure, kidney problems or pre-eclampsia you will be more at risk. This condition will require immediate hospital admission.