Is it normal to bleed during pregnancy?

Bleeding during pregnancy, especially in the early stages, is quite common. About 1 in 4 women will experience vaginal spotting or bleeding during the first trimester. Many of these women will go on to have healthy pregnancies.

However, vaginal bleeding may be the first sign of a problem, so it’s important to contact your doctor or midwife if you experience vaginal bleeding at any stage of your pregnancy for advice on what to do next.

What are the causes of bleeding during pregnancy?

The causes of bleeding during pregnancy are generally divided into two categories — bleeding before 20 weeks and bleeding after 20 weeks gestation.

Before 20 weeks gestation, causes of bleeding may include:

• Implantation bleeding — in very early pregnancy (4 to 5 weeks gestation) some women may experience bleeding when the pregnancy implants itself in the lining of the uterus (womb).
• Miscarriage — bleeding may be the first sign of a miscarriage. About 1 in 15 women who experience bleeding in early pregnancy end up having a miscarriage.
• Ectopic pregnancy — a rare but serious cause of bleeding when a fertilised egg starts growing outside the uterus (womb). An ectopic pregnancy can rupture (burst) and cause heavy bleeding, and may be life-threatening.

Bleeding in later pregnancy (after 20 weeks) is usually caused by problems with the placenta such as:

• Placenta previa — also known as a 'low lying placenta', when the placenta implants close to the cervix (neck of the uterus). If the cervix starts to open or the uterus contracts, this can cause bleeding.
• Placental abruption — when the placenta starts to separate from the uterus during pregnancy but before birth, causing bleeding from the place where the placenta has peeled away. Bleeding caused by placental abruption is usually associated with sudden, severe abdominal pain.

Less common causes of bleeding, which may happen at any stage of pregnancy, may include:

• genital tract infections
• injuries to the genital tract
• growths or tumours of the reproductive system
• bleeding from vulvovaginal varicosities (varicose veins in the vulva or vagina)

What should I do if I bleed during pregnancy?

If you bleed during pregnancy, contact your doctor or midwife. Your antenatal care provider can give you advice about what to do next.

It can be helpful to note down details about what you have been experiencing. This may include:

• the amount and colour of any discharge
• whether you have passed any clots
• whether you have had any abdominal pain

If you are having heavy bleeding, it’s a good idea to keep your pads or stained clothes to show your doctor or midwife.

How will my doctor or midwife diagnose the cause of my bleeding?

Your doctor or midwife will ask you questions about the bleeding, any other symptoms you have been having and about your pregnancy and general health. Your doctor or midwife may also perform a vaginal examination to check the bleeding and look for any visible cause.

You may be referred for a blood test to check your human chorionic gonadotropin (hCG) level. hCG is a hormone made by the placenta that can be found in your blood and urine. Your hCG level can give your doctor important information about how your pregnancy is progressing.

You may also be referred for an ultrasound scan, which may be used to:

• check your baby’s heartbeat
• check for signs of a miscarriage
• look for signs of an ectopic pregnancy
• check the position and health of the placenta

It may take some time to work out what is causing your bleeding. You may need to have several blood tests or ultrasound scans over a few days or weeks. This can be a stressful time, so consider seeking support from your partner or someone else you trust.

In some situations, your bleeding may resolve on its own without your doctor or midwife finding a cause.

When should I seek medical attention?

If you have bleeding at any stage of pregnancy, contact your doctor or midwife for advice and support.

You should contact your doctor urgently, or visit the nearest emergency department, if:

• your bleeding becomes very heavy
• you have strong pains
• you feel dizzy or faint
• you feel short of breath

Does bleeding mean I am having a miscarriage or might lose my baby?

Bleeding in early pregnancy is very common and does not necessarily mean you are having a miscarriage. Many women who experience bleeding in early pregnancy go on to have healthy babies.

In some cases, bleeding can be the first sign of a miscarriage. If you are experiencing bleeding in early pregnancy, contact your doctor or midwife for advice.