Bleeding in the first trimester

Bleeding in pregnancy can be very worrying. Experiencing some bleeding is quite common and does not always mean there is anything wrong, but it is important to get checked out if you are concerned.

 In the very early stages of pregnancy, you may experience some spotting or light bleeding. This is implantation bleeding, which happens when the developing embryo implants on the wall of your womb, and will only last one or two days.

As implantation bleeding happens at around the time your period would have been due, many women confuse it with menstruation and assume they are not pregnant. It is usually lighter in colour than your period and you may only notice it when you wipe.

Some tests are now able to detect the pregnancy hormone hCG in your urine several days before your period is due. This means you may have taken a test and found out you are pregnant before any implantation bleeding occurs. 

The sight of blood just after you’ve found out you are pregnant can be very frightening but if the flow is very light and it stops within a couple of days, it is usually nothing to worry about.

What else can cause bleeding in the first 12 weeks of pregnancy?

Between 15% and 25% of women will experience some bleeding in early pregnancy. During this time, your cervix is going through some changes and more blood vessels are developing in this area. This can mean it is more prone to bleeding and you may notice some spotting after sex or an internal examination like a smear test. 

If you experience anything more than spotting or very light bleeding, it is important to seek medical advice. Bleeding can be a sign of infection, ectopic pregnancy and miscarriage so see your GP or midwife who may refer you to an early pregnancy unit (EPU), which cares for women during their first trimester. 

In some areas, you will able to contact your local EPU directly for an appointment. The team there will be able to carry out an assessment, which may include an internal ultrasound scan, to see if your pregnancy is developing as it should. 

Keep a record of your bleeding – how long you have bled for, how much blood you have passed and what it looked like – to tell your doctor or midwife.

Is there anything which can stop bleeding in early pregnancy?

If you have had a miscarriage in the past and you start bleeding before 12 weeks of pregnancy, you may be given progesterone, a hormone which can help maintain a healthy pregnancy. However, this treatment will not be offered if this is your first pregnancy and you have no history of miscarriage.

There is no guaranteed way of stopping bleeding and around one in five pregnancies will end in miscarriage. However, resting can help so take it easy and avoid doing any strenuous exercise, lifting anything heavy or having sex.

What causes a miscarriage in the first trimester?

Miscarriages are not caused by anything you may have done and most cannot be prevented. Pregnancy loss in the first trimester is usually caused by a problem with the foetus which means it cannot grow and develop as it should.

Some women may also experience miscarriage if they have issues with their hormone levels or blood clotting problems. If you are having a miscarriage, the bleeding may be accompanied by pains or cramps in your lower abdomen. 

You may also feel like you are no longer pregnant and notice that the symptoms you experienced like nausea or sore breasts have gone away. If you think you may be having a miscarriage, contact your midwife or GP immediately or, if it is outside normal hours, call the NHS 111 service for advice.

What is an ectopic pregnancy?

Bleeding in the first trimester can be a sign of ectopic pregnancy. This needs immediate treatment as it can be very dangerous.

An ectopic pregnancy is when the fertilised egg has implanted somewhere outside your womb like the fallopian tube. The egg cannot grow and develop as it should unless it is in the womb so it is not safe for the pregnancy to continue and the egg will need to be removed.

You will usually start experiencing symptoms of an ectopic pregnancy at around six weeks although it can be later. As well as bleeding, you may feel a pain low down and on one side of your abdomen and it may be uncomfortable to go to the toilet.

If you are concerned you may have an ectopic pregnancy you will need medical attention quickly so call 111 or attend your local accident and emergency department. If it is left untreated, your fallopian tube will eventually rupture as your pregnancy advances and this can cause life-threatening internal bleeding.

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