Bleeding during pregnancy

Bleeding during pregnancy can range from spotting (small amount of pink, red, or brown blood on your underwear, or when you use the toilet) to full-on bleeding (like your periods, or even heavier). It can feel scary, and depending on when and how much the bleeding is, you may need to see your gynaecologist or go to the Emergency Department immediately.

Bleeding in the first trimester 

25% of pregnant women experience spotting during the first 12 weeks of pregnancy. The reasons include:

• Implantation bleeding
  This occurs 6-12 days after conception when the embryo implants onto the lining of the uterus and is usually light pink to dark brown, lasts between few hours up to 3 days, and will stop on its own. Not every woman will experience implantation bleeding.

• Ectopic pregnancy
  This is a dangerous condition where the embryo implants outside the womb, most commonly in the fallopian tubes. Bleeding or spotting when one has an ectopic pregnancy can be associated with abdominal or pelvic pain, weakness, dizziness or fainting.
  Contact your doctor immediately if you suspect that you may have an ectopic pregnancy as there is a risk of life-threatening abdominal bleeding. 

• Early pregnancy loss/miscarriage
  This can occur in up to 20% of pregnancies and typically occurs within the first 12 weeks. Bleeding/spotting may be associated with:

• • Abdominal pain/cramps 
  • Tissue-like material passing from your vagina 

Your doctor may need to do serial blood tests to check your pregnancy hormones (b-hcg). Most women with previous miscarriages will not have difficulties getting pregnant in future. 

• Others/ Unknown 
  Spotting due to hormonal changes, changes to your cervix, after sex, infection may cause mild spotting in some women. 

Bleeding in the second/third trimester 

This may be caused by cervical irritation e.g. after sex, as during pregnancy there is increased blood supply to the cervix. This is common and usually not a cause for concern. Another reason could be a cervical polyp, which is a benign growth on the cervix – your doctor will do a cervical check to rule this out. If you are nearing your due date, it can be due to “show” – a sign that labour may be starting.

If bleeding is heavy, there are several things which need to be ruled out:

1. Placenta previa
   This is a condition where the placenta is low-lying (either near or covering the cervical opening). You may have been told of this in your previous ultrasound scans. Bleeding in such situations can be painless.

2. Placenta abruption
   This is an emergency situation where the placenta separates from your uterus prematurely. Other than bleeding, it is also associated with abdominal pain and reduced fetal movements. 

3. Late miscarriage or premature labour
   Signs of this may include passage of blood stained mucus plug, bleeding, contraction pains, or water bag leaking.

You should contact your doctor or go to Emergency Department immediately if you experience bleeding in the second/third trimester or other associated symptoms such as:

• No or reduced fetal movements
• Abdominal cramps/pain 
• Fluid/tissue passing from the vagina

What checks do I need to get done if I have bleeding during pregnancy?

Depending on how far along you are in your pregnancy, your doctor may need to do blood tests, a vaginal examination, and/or an ultrasound scan to check on you and your baby.  

If you have been diagnosed with a pregnancy loss, know that it is not your fault and that it is okay to ask for support during this difficult time. Grieving is normal. If you intend to get pregnant again, speak to your doctor on how long you should wait before trying for your next pregnancy and what you should be looking out for.