Bleeding or spotting in early pregnancy: when is it an emergency?

English version

What is the difference between spotting and bleeding?

Spotting is usually a small amount of pink, red or brown blood on toilet paper or underwear that does not fill a pad. Bleeding is a larger amount that may require a pad and can be continuous or intermittent. Clots or tissue may sometimes be present. Colour and amount are useful information, but cannot establish the cause by themselves.

What can cause bleeding in early pregnancy?

• Changes in the cervix, including bleeding after sex or an examination.
• Infection affecting the vagina, cervix or urinary tract.
• A small collection of blood near the pregnancy.
• A pregnancy developing normally despite bleeding, sometimes called a threatened miscarriage.
• An early miscarriage.
• An ectopic pregnancy, where the pregnancy develops outside the uterus.
• Less commonly, a molar pregnancy or another pregnancy-related condition.

Very early bleeding is sometimes described as implantation bleeding, but bleeding should not automatically be given this label without considering the pregnancy dates, symptoms and need for assessment.

Does bleeding mean miscarriage?

No. Many women with light bleeding in early pregnancy continue to have a healthy pregnancy. Bleeding can, however, be a symptom of miscarriage. The likelihood cannot be determined from the bleeding pattern alone; pregnancy duration, pain, ultrasound findings and sometimes repeat pregnancy-hormone tests are needed. Most early miscarriages are not caused by routine activity, travel or something the woman ate.

Why must ectopic pregnancy be considered?

An ectopic pregnancy most commonly develops in a fallopian tube and cannot continue normally. Warning signs can include one-sided lower-abdominal or pelvic pain, shoulder-tip pain, increasing abdominal pain, dizziness, marked weakness, fainting, or bleeding with significant pain. These symptoms can begin before an ultrasound has confirmed the pregnancy’s location.

What information should you give the doctor?

• The first day of your last period and when the pregnancy test became positive.
• Whether the pregnancy followed fertility treatment.
• When the bleeding started, its colour and approximate amount.
• Whether there are clots or tissue.
• Any abdominal, pelvic or shoulder pain, dizziness, fainting, fever or urinary symptoms.
• Previous miscarriage or ectopic pregnancy, your blood group if known, medicines and medical conditions.

Use a sanitary pad rather than a tampon to observe how quickly it becomes soaked.

What tests may be advised?

Assessment may include pulse and blood-pressure checks, pregnancy testing, pelvic or speculum examination, abdominal or transvaginal ultrasound, beta-hCG blood tests, blood group and haemoglobin, and urine or infection tests. A transvaginal ultrasound can give a clearer view in very early pregnancy and does not increase miscarriage risk.

What if the ultrasound does not show a pregnancy?

A positive pregnancy test with no clearly visible pregnancy may be described as a pregnancy of unknown location. It may be too early to see the pregnancy, an early miscarriage may have occurred, or an ectopic pregnancy may not yet be visible. Follow-up can involve repeat beta-hCG tests and another ultrasound. Continue the recommended follow-up even if bleeding stops.

What should you do while awaiting advice?

• Note the amount and colour of bleeding and whether pain is present.
• Use pads rather than tampons and keep hydrated.
• Avoid intercourse if it increases bleeding or discomfort.
• Use only pregnancy-safe pain relief advised by a clinician.
• Continue folic acid and essential prescribed medicines unless advised otherwise.
• Do not self-start progesterone, hormonal medicine or “pregnancy-saving” injections.
• Do not depend on bed rest or home remedies to treat an undiagnosed cause.

If your blood group is Rh-negative or unknown, tell the healthcare team.