Is it normal to bleed during pregnancy?

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

It is important to contact your doctor or midwife if you experience vaginal bleeding at any stage of your pregnancy for advice and support.

What are the causes of bleeding during pregnancy?

The causes of spotting or bleeding during pregnancy generally depend on when the bleeding occurs.

Causes of early pregnancy bleeding (usually occurring in the first trimester) include the following:

• Implantation bleeding — In very early pregnancy (4 – 5 weeks gestation), some people experience spotting or light bleeding for a few days as the pregnancy implants itself in the lining of the uterus (womb).
• Miscarriage — Bleeding may be a sign of a miscarriage.
• Ectopic pregnancy — A rare but serious cause of bleeding that occurs when a fertilised egg starts growing outside the uterus. An ectopic pregnancy can cause heavy bleeding and may be life-threatening.
• Molar pregnancy (hydatidiform mole) — A rare form of pregnancy that occurs when an egg is fertilised, but a baby does not develop (complete molar pregnancy) or does not develop normally (partial molar pregnancy). The cells that would normally become the placenta grow bigger than normal and are full of cysts (sacs of fluid). This often causes bleeding during early pregnancy.

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

• Placenta praevia — Also known as a 'low-lying placenta', this is when the placenta implants close to the cervix (neck of the uterus). This can cause bleeding if the cervix starts to open or the uterus contracts.
• Placental abruption — When part of or all of your placenta separates from your uterus during pregnancy and before you have given birth. This causes bleeding from the place where the placenta has peeled away. It is usually associated with sudden and severe abdominal pain.
• Vasa Praevia — A rare complication that can cause severe blood loss for your baby. This happens when blood vessels from your baby's umbilical cord pass through the opening of your cervix. When your waters break during labour, the blood vessels can burst. This can cause severe blood loss or death for your baby. If your doctor diagnoses this during pregnancy, they will monitor you carefully and may also recommend an elective caesarean section.

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)
• cervical changes — because you have extra blood flow to your cervix during pregnancy, sexual intercourse can occasionally trigger bleeding from your cervix

What should I do if I bleed during pregnancy?

If you bleed during pregnancy, contact your doctor or midwife. Your antenatal care provider can advise you 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 try to diagnose the cause of your bleeding by doing the following:

• Asking questions — about your bleeding, any other symptoms you have, your pregnancy and general health.
• Vaginal examination — to assess any ongoing bleeding, size of your uterus and look for a visible cause.
• Blood tests — to check your pregnancy hormone (human chorionic gonadotropin (hCG) levels). hCG is made by your placenta and is normally found in your blood and urine. Your hormone levels can give your doctor or midwife important information about how your pregnancy is progressing.
• Referring you for an ultrasound scan — to assess your baby's heartbeat, signs of a miscarriage or ectopic pregnancy, position and health of your 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 spotting or bleeding may stop on its own without your doctor or midwife finding a cause.

Learn about the checkups, tests and scans available during your pregnancy.

When should I seek medical attention?

If you are bleeding at any stage of your 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 (soaking 2 pads per hour or passing blood clots the size of golf balls)
• you have strong pains in your stomach or shoulder
• you feel dizzy or faint
• you feel short of breath
• your vaginal discharge smells bad

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

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

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

Resources and sources:

• Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7 am to midnight (AET), 7 days a week (including public holidays).
• Visit or contact PANDA national helpline (Monday to Saturday) 1300 726 306 if you are feeling anxious or depressed.

Do you prefer to read in languages other than English?

• The Royal Women's Hospital website has information pages about bleeding in early pregnancy in Arabic, Chinese, Vietnamese Turkish, Urdu and Somali.