Bleeding during pregnancy

Bleeding or spotting during pregnancy can be distressing, yet it’s common and not necessarily a sign of problems with the baby. It’s estimated one in four pregnancies involve bleeding in the early stages – here’s what you need to know about bleeding during pregnancy. 

It’s an expectant mum’s worst nigthmare, and while bleeding during pregnancy can sometimes be an indication of miscarriage, many women who experience it go on to have healthy babies. 

If you do discover spotting during pregnancy, it’s important to speak to your midwife or doctor immediately in case ongoing monitoring is required. If bleeding during pregnancy is accompanied by pain in the lower abdomen or shoulder, or dizziness, seek urgent medical help because this may due to an ectopic pregnancy, where the pregnancy has implanted outside the uterus. 

Why would I be bleeding during pregnancy? 

Obstetrician Dr Bernadette White from Melbourne’s Mercy Hospital for Women says the causes of spotting during pregnancy depend on the stage of pregnancy. 

“In the first couple of months a small amount of bleeding is very common,” says Dr White. “Our advice to women is not to panic, because in a lot of cases it’s not serious. For some women though, it’s a sign of a threatened miscarriage and may mean there’s a problem with your pregnancy, so do get it checked out.”

After the 12-week mark, some of the most common causes of bleeding during pregnancy include:

  • Changes in the cervix: It’s normal for the cells of the cervix to change during pregnancy, particularly after sex
  • A ‘show’: When the plug sealing the cervix starts to come away during late pregnancy, this can result in blood mixed with mucus, indicating labour isn’t far away
  • Placental abruption: A serious condition where the placenta starts to come away from the inside of the uterine wall
  • Placental praevia: Sometimes called a low-lying placenta, this is where the placenta is near or covering the cervix, meaning your baby will need to be born by caesarean
  • Vasa praevia: A rare and serious condition where the blood vessels of the umbilical cord run through the membranes covering the cervix. When the membranes rupture and the waters break, the vessels may be torn, causing blood loss for the baby. 

“In the second and third trimester tiny amounts of bleeding, like spotting during pregnancy, is rarely significant but it’s always worth having an assessment done to see what’s causing it,” Dr White says. “In some it will be a case of placenta praevia and that has ongoing implications for your pregnancy. In some it will mean your placenta isn’t too healthy and your pregnancy may need ongoing monitoring to make sure the baby is growing OK. If it’s just a little bit of bleeding that settles down you might never know why it happened.”

The main methods doctors use to investigate the causes of bleeding during pregnancy include:

  • Ultrasound: A vaginal ultrasound, where a narrow tube placed inside the vagina, offers the best possible view of your pregnancy. This will determine whether a pregnancy is in the fallopian tubes (an ectopic pregnancy) or has stopped growing, and sometimes indicates whether a miscarriage has begun.
  • Blood tests: A blood test measures the level of the pregnancy hormone hcG (human chorionic gonadotropin) which can indicate whether a pregnancy is growing normally
    Pelvic examination: This is how a doctor determines the size of the uterus and the extent of the bleeding. It may involve a speculum examination, similar to a pap smear.

Although spotting during pregnancy can be an emotional experience, remember that it’s unlikely to have been caused by anything you have or haven’t done. 

“As a general rule, fresh, bright red blood is always going to be more concerning than a darkish or pinkish discharge, and bleeding associated with pain is always going to be more of a worry,” says Dr White, who is on the council of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. “Fresh bleeding suggests a greater volume of bleeding whereas dark bleeding suggests a bit of old blood that’s found its way out so is generally less concerning. But each case needs to be assessed to see what’s going on.”

Rule of thumb? Get it checked out, for your peace of mind as much as anything else. 

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