Bleeding During Pregnancy: What It Can Mean and What to Do

Bleeding at any stage of pregnancy should be reported to your obstetrician the same day. That said, bleeding is common — particularly early on — and does not automatically mean something is wrong. Understanding the possibilities helps you act calmly.

If you are bleeding now

• Note the amount (spotting, like a period, heavier than a period), the colour, and whether there is pain, clots or tissue.
• Do not use tampons; use a pad so the amount can be assessed.
• Call the clinic or go to the hospital emergency department — do not wait for your next appointment.
• Go immediately if bleeding is heavy, you have severe pain, dizziness, fainting, or you know you are Rh-negative.

First trimester (up to 12 weeks)

Implantation bleeding

Light spotting around the time the period was due, as the embryo embeds. Harmless.

Cervical causes

The cervix becomes softer and more vascular in pregnancy; spotting after intercourse or an internal examination is common and usually harmless.

Threatened miscarriage

Bleeding with a viable pregnancy on ultrasound. Around half of these pregnancies continue normally. Progesterone support may be advised in some situations.

Miscarriage

Heavier bleeding with cramping and passage of tissue. Miscarriage occurs in 10–20% of recognised pregnancies, most often due to chromosomal problems in the embryo, not anything the mother did.

Ectopic pregnancy

A pregnancy outside the uterus, usually in the tube. Bleeding with one-sided pain, shoulder-tip pain or fainting is an emergency. Ultrasound and blood hCG levels make the diagnosis.

Second and third trimester

Placenta praevia

A placenta lying over or near the cervix, causing painless bright red bleeding, often after 28 weeks. Diagnosed on ultrasound; usually needs a planned caesarean.

Placental abruption

Separation of the placenta before delivery, causing bleeding with constant pain and a hard, tender uterus. Requires urgent hospital care.

Cervical changes and "show"

Mucus streaked with blood near term is often the mucus plug releasing as labour approaches.

Preterm labour

Bleeding with regular contractions before 37 weeks needs immediate assessment.

How bleeding is evaluated

An ultrasound to check the pregnancy, the placenta and the cervix; a speculum examination where appropriate; blood tests including blood group and, early in pregnancy, hCG levels. Rh-negative mothers may need an anti-D injection.

Reducing your risk

Attend all antenatal visits, report bleeding promptly, and follow advice about activity if placenta praevia is diagnosed. Many causes cannot be prevented — but almost all can be managed better when they are known early. See pregnancy care and high-risk pregnancy care.

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