Bleeding in early pregnancy (before 24 weeks)
Spotting or light bleeding without pain is not uncommon before 12 weeks and is often not serious, but you should contact your doctor immediately to be checked. If it is accompanied by a severe pain in one side of your stomach or pain in your shoulder tip, diarrhoea or bowel pain, it may be a sign of an ectopic pregnancy and needs to be checked urgently by your maternity unit. Bleeding combined with back or stomach pain may be a sign of miscarriage. Call your doctor immediately.
Bleeding in late pregnancy (after 24 weeks)
Some women may experience a light bleed later on in their pregnancy. This is may not be from inside the womb, but from the cervix, for example. Postcoital (after sexual intercourse) bleeding can occur due to this. This may settle and doesn’t necessarily mean there is a problem, but you should always let your midwife or doctor know of any bleeding.
There are two more serious causes of bleeding in late pregnancy:
• placenta praevia (a low-lying placenta). You may experience sudden, painless bleeding that can be light to heavy. Most women who have placenta praevia will already know their placenta is low from their ultrasound scans, although most women with a low placenta do not go on to have placenta praevia.
• placental abruption (abruptio placentae). Bleeding with discomfort or pain could mean you have had a placental abruption, which happens when the placenta starts to separate from the wall of your uterus. It is likely to be accompanied by cramps and tenderness when you press your stomach.
Contact your midwife, doctor or maternity unit immediately if you are bleeding in late pregnancy.
National Institute for Health and Care Excellence, Pain and bleeding in early pregnancy, quality standards briefing paper, London NICE, 2014. Also available at: https://www.tommys.org/pregnancy-information/symptom-checker/i-am-bleeding-pregnancy (accesssed 29 April 2014)
London Royal College of Obstetricians and Gynaecologists, Ectopic pregnancy – information for you, London RCOG, 2010. Also available at: http://www.rcog.org.uk/ectopic-pregnancy-information-for-you (accessed 29 April 2014)
London Natonal Institute for Health and Care Excellence, Ectopic pregnancy and miscarriage, clinical guideline 154, London NICE, 2012
Macdonald S, Magill-Cuerden J, Mayes’ midwifery, fourteenth edition, Edinburgh Bailliere Tindall Elsevier, 2012