Bleeding in pregnancy

There are many reasons for bleeding in pregnancy. Not all are serious or mean your baby’s at risk. Here's some info you might need about bleeding

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Most pregnant women who experience bleeding go on to have a successful pregnancy. But the sight of blood always makes us worry about miscarriage, so what are the likely causes?

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Implantation bleeding

“Any bleeding around 4 weeks could be implantation bleeding, which is probably due to the egg burying itself into the lining of the womb. It’s not uncommon to see spotting when this is happening,” says Virginia Beckett, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists.

Breakthrough bleeding

You may also experience ‘breakthrough bleeding’ (caused by the hormonal changes brought about by pregnancy) around the time when your period is due, which again usually shows as spotting.

Spotting due to infection

Vaginal infection is another possible cause of light spotting in the first few weeks of pregnancy.

Ectopic pregnancy

One possible reason for bleeding at around 9 weeks is an ectopic pregnancy, where the egg has started to grow in one of the Fallopian tubes or outside the uterine cavity. It occurs in one in 150 pregnancies.

“An ectopic pregnancy does not cause significant bleeding – the liquid is often described as looking like prune juice,” says consultant obstetrician Virginia Beckett. “But, unfortunately, if it is ectopic, the pregnancy is not viable and will have to be removed.”

So it’s important to get the bleeding checked out by your doctor or midwife as soon as possible.

Also get medical help if you’re experiencing pain, or the bleeding is heavier than spotting, as this needs to be taken seriously.

Mum’s story

“I cancelled my trip due to bleeding”

“I had a little bit of bleeding at week seven and at first I wasn’t too worried because I knew it was quite common. However, I was still bleeding a little bit a week later so I asked my doctor if he thought it would be OK to fly. As a precaution he said to avoid flying at that point, so I cancelled a trip I had planned, and happily my pregnancy was fine anyway.”

Kim, 26, mum of Jules, 3 

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Spotting after sex is common in later pregnancy – it doesn’t necessarily mean your unborn baby has been hurt by sex.

Sex and spotting

The most common cause of vaginal bleeding in the second half of pregnancy is changes in the cervix (the neck of the womb), called cervical ectropion. This usually occurs after sex.

“It’s likely you’ll get spotting immediately after sex or an hour or so later, and it’s usually fresh blood. As long as no more bleeding occurs, then this is nothing to worry about – it’s very common,” says Virginia Beckett, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists.

Placenta praevia

Placenta praevia, which is when the placenta implants into the lower part of the uterus and blocks the entrance to the cervix, can often cause bleeding.

“This is usually diagnosed during the second scan, which you will have between 18 weeks and 24 weeks . Sometimes it can be missed, though, particularly if you’re very overweight or don’t have a full enough bladder when you have your scan.

Usually, your placenta will move out of the way as the pregnancy progresses, which means that it’s possible to give birth vaginally, ” says consultant obstetrician Virginia Beckett.

In about 5% of cases it doesn’t move up by itself. You’ll be admitted to hospital and monitored if it’s severe, and you’ll probably be advised to have a caesarean.

Mum’s story

“Coughing brought on my bleeding”

“I contracted a flu bug when I was 32 weeks pregnant and lost my voice. I couldn’t sleep either, and I had it for two weeks so I was exhausted. Then I got a really bad cough, which hurt my tummy so much it made me cry out. That’s when I noticed the blood.

“I was a bit worried, but it was my second pregnancy and I’d read up on everything, so even though I bled again a few days later, I knew it was only spotting. As it didn’t continue, common sense told me it wasn’t serious. The worst thing was, as I’d lost my voice I couldn’t phone my midwife until a few days after it happened.

“I had a 34-week scan and. I was told a small capillary breaking from the force of my coughing probably caused the bleed – but they said I should have got in touch earlier. My advice to anyone would be to phone your midwife or GP immediately even if it’s only slight bleeding. You can always phone NHS Direct for instant advice. It’s better to be reassured that things are OK than to leave it unchecked.”

Talia, 36, mum to David, 5, and Suzannah, 9 months

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Bleeding in pregnancy can be a sign of something serious, especially if it’s heavy bleeding or you’re in pain, so it’s best to seek medical advice.

Placental abruption

Sometimes the placenta can detach from the womb, which usually results in a major bleed, called placental abruption. It can cause significant problems for both you and your baby.

Placental abruption can be more of a risk if:

  • You have high blood pressure (a sign of pre-eclampsia)
  • You’re overweight
  • You have an infection in the placenta
  • You’re having a multiple pregnancy

“Although this can be frightening, it’s not always catastrophic,” reassures consultant obstetrician Virginia Beckett.

“If you have symptoms and your baby is far enough along to be viable, you’re likely to be induced or advised to have a caesarean,” says Virginia.

Some women get warning bleeds – one or two little bleeds, called partial abruptions, which will then be followed by a big abruption.

“This is why bleeding in pregnancy is always taken seriously. If you have a couple of bleeds you’ll be monitored to check that your baby is growing and developing healthily,” says Virginia.

Miscarriage

Bleeding in pregnancy can sometimes mean you’re having a miscarriage.

One estimate suggests that as many as 60% of conceptions end in miscarriage, usually very early on in the pregnancy.

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“Women now find out they’re pregnant much earlier than they used to, so they feel the loss, which can be devastating for them – but they mustn’t blame themselves,” says Gail Johnson, midwife and spokesperson for The Royal College of Midwives.

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