Bleeding During Pregnancy: When Should You Worry?

Bleeding During Pregnancy: When Should You Worry?

Bleeding during pregnancy can be frightening. Seeing blood when you are expecting a baby naturally causes anxiety. However, bleeding does not always mean that you are losing the pregnancy or that something serious has happened.

At the same time, bleeding during pregnancy should never simply be ignored. The cause can range from relatively minor cervical changes to conditions that require urgent treatment. Getting assessed at the right time is important for the health of both mother and baby.

Is bleeding during pregnancy normal?

Some women experience spotting or light bleeding, particularly during early pregnancy. Early pregnancy bleeding is relatively common and many pregnancies continue normally. (RCOG)

However, it is not possible to determine the cause simply by looking at the amount or colour of blood. Any new bleeding in pregnancy should be discussed with your obstetrician or healthcare professional.

What can cause bleeding in early pregnancy?

The possible causes depend on how many weeks pregnant you are.

1. Implantation bleeding

Very early in pregnancy, some women may notice light spotting around the time the pregnancy implants in the uterus.

It is usually light and short-lived, but bleeding at this stage should still be discussed with your doctor if you are unsure.

2. Changes in the cervix

Pregnancy increases blood flow to the cervix. As a result, the cervix can bleed more easily, sometimes following sexual intercourse or a vaginal examination. Cervical infection can also cause bleeding. (nhs.uk)

3. Subchorionic haematoma

Sometimes blood collects between the pregnancy membranes/placenta and the wall of the uterus. This is called a subchorionic haematoma.

It can cause spotting or bleeding and is often identified during an ultrasound examination.

4. Threatened miscarriage

Bleeding and cramping in early pregnancy can sometimes be associated with a threatened miscarriage.

Importantly, bleeding does not automatically mean a miscarriage. If an ultrasound confirms that the pregnancy is developing normally, many women who have early pregnancy bleeding go on to have a healthy baby. (RCOG)

5. Miscarriage

Unfortunately, bleeding can sometimes be a sign of miscarriage. An ultrasound and, when appropriate, blood tests may be required to establish what is happening.

Most early miscarriages are not caused by anything the mother did or did not do.

6. Ectopic pregnancy

An ectopic pregnancy occurs when the pregnancy develops outside the uterus, most commonly in a fallopian tube.

Bleeding accompanied by one-sided abdominal pain, shoulder-tip pain, dizziness or fainting can be an emergency and requires immediate medical assessment. (RCOG)

What about bleeding later in pregnancy?

Bleeding after the first trimester has different possible causes and deserves prompt assessment.

Possible causes include:

• Placenta previa – when the placenta lies close to or covers the cervix

• Placental abruption – when the placenta separates from the uterine wall prematurely

• Changes in the cervix

• Vaginal or cervical infection

• Beginning of labour, particularly when a blood-stained mucus discharge or “show” occurs

Some causes can be serious even when the amount of bleeding initially appears small. (nhs.uk)

When is bleeding an emergency?

Seek immediate medical care if bleeding is accompanied by:

• Heavy bleeding or rapidly soaking a pad

• Passing large clots

• Severe abdominal or pelvic pain

• Severe or persistent cramps

• Shoulder-tip pain

• Dizziness, weakness or fainting

• Feeling very unwell

• Reduced or absent fetal movements in a pregnancy where you normally feel movements

These symptoms can indicate a significant complication and should not be managed at home. (RCOG)

What should you do if you notice bleeding?

If you notice bleeding:

1. Stay calm.

Bleeding does not automatically mean that something is wrong with your baby.

2. Note the amount and colour.

Tell your doctor whether it is spotting, light bleeding or heavy bleeding, and whether you are passing clots.

3. Note any associated symptoms.

Pain, cramps, fever, dizziness, fainting or reduced fetal movements are important details.

4. Contact your obstetrician.

Do not wait for the bleeding to become heavy before seeking advice.

5. Do not self-medicate.

Avoid taking medicines, including hormonal medicines, without medical advice.

How will your doctor find the cause?

Your doctor may ask about:

• How many weeks pregnant you are

• When the bleeding started

• The amount and colour of bleeding

• Whether you have pain or cramps

• Previous pregnancies and miscarriages

• Any medical conditions or pregnancy complications

Depending on your stage of pregnancy and symptoms, assessment may include an ultrasound scan, blood tests, urine testing and examination of the cervix. (RCOG)

A transvaginal ultrasound may sometimes be recommended during early pregnancy because it provides a clearer view. RCOG patient guidance states that a transvaginal scan does not increase the risk of miscarriage. (RCOG)

Does bleeding always mean miscarriage?

No.

This is one of the most important things to remember.

Bleeding in early pregnancy can occur in pregnancies that continue normally. However, because miscarriage and ectopic pregnancy are also possible causes, the only safe approach is appropriate medical assessment rather than assuming that the bleeding is harmless. (RCOG)

What should you remember?

Bleeding during pregnancy can have many causes.

Light bleeding does not always mean miscarriage.

Heavy bleeding, severe pain, dizziness, fainting or shoulder pain require urgent assessment.

Bleeding later in pregnancy should be assessed promptly.

Early evaluation helps identify problems early and allows appropriate treatment when needed.

When in doubt, get checked.

If you experience bleeding during pregnancy, contact your obstetrician rather than worrying alone.

Anurag Women Health Care

Compassionate Care. Every Woman. Every Stage.

Chembur, Mumbai

88509 11046

This article is for patient education and does not replace an individual medical consultation. The appropriate evaluation depends on your gestational age, symptoms and medical history.

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