Bleeding in early pregnancy
What causes bleeding in pregnancy?
In the first few weeks of pregnancy bleeding and spotting is experienced by many women and may or may not signify concerns. It can mean the start of a miscarriage but many women also experience bleeding in pregnancy and go on to have healthy babies. In the UK, bleeding or pain in early pregnancy means that you are eligible to be reviewed in an Early Pregnancy Assessment Unit (EPAU or EPU). These are run by qualified clinicians and are usually within an NHS hospital. Some units allow self referrals (you can call and make an appointment yourself) however most of them require you to be referred by a medical practitioner such as your GP or a midwife. To find where you nearest EPAU is see https://www.aepu.org.uk/find-a-unit/.
What is implantation bleeding?
A few women experience some light bleeding or spotting when the fertilised egg implants itself into the wall of the uterus. This is relatively unusual and most women do not notice any symptoms during implantation, however if you do, it is likely to be very light and would occur 1-2 weeks after conception and only last a day or two.
Is bleeding the start of a miscarriage?
Bleeding is often the first sign that a pregnancy has stopped developing. If this is the case, unfortunately there is nothing at all that you can do to stop a miscarriage. Bleeding may be erratic and stop and start, it may just be spotting or very light bleeding if the pregnancy is very early on, or it may be like a period. You may pass some clots or stringy tissue. Some women, especially if you are over six weeks pregnant, may pass an obvious small pregnancy sac.
Sometimes bleeding or spotting may signify other complications such as an ectopic pregnancy or a molar pregnancy. Neither of these can result in a viable foetus and you would need to be treated by your EPAU. However, both of these are quite unusual and your healthcare team will be able to assist in a diagnosis.
How heavy is bleeding in a miscarriage?
Every miscarriage is different and every woman is different. Many miscarriages are manageable at home as long as you feel safe. A lot of women describe very early miscarriage as just like a period. If you are only 4 or 5 weeks pregnant you may even only have light bleeding. It is even possible for some pregnancy tissue to be reabsorbed so you may not bleed as much as you envisaged and may well not pass an obvious pregnancy sac. The further along you are in your pregnancy the heavier your bleeding is likely to be. If you do pass an obvious pregnancy sac, most women find that their bleeding starts to settle relatively quickly afterwards. It is advisable to wear pads and not tampons to minimise the risks of infection. If you believe you have miscarried, healthcare professionals usually advise you to take a urine pregnancy test after two or three weeks just to confirm that this is definitely negative and that you have not retained any tissue.
Heavy Bleeding in pregnancy
If you are experiencing very heavy bleeding and soaking through pads every 20 minutes or so, or passing very large clots, NHS advice is to seek urgent medical help and attend A&E. Likewise if you are in severe pain and paracetamol is not helping, please seek help.
What is a haematoma in pregnancy?
Sometimes your sonographer may diagnose a subchorionic haemotoma; this is effectively an area of bleeding within the womb. Sometimes a haemotoma, particularly a large one, may increase the risk of you miscarrying especially if the bleeding is very near the embryo. You may be offered follow up in terms of regular follow up scans to monitor both the location and the size of the bleed. Many women do go on to have healthy babies despite having a haemotoma in the womb.
How common is bleeding in pregnancy?
Studies have shown that up to one in four women experience bleeding or spotting in early pregnancy.
Does taking progesterone help bleeding in pregnancy?
Many women who are experiencing bleeding in pregnancy ask whether they should be prescribed progesterone. New NICE guidelines published in late 2021 advise that women should be prescribed 400mg of progesterone to be taken vaginally twice a day if they have a history of a previous miscarriage and are experiencing bleeding in pregnancy. However, patients must have had an ultrasound confirming an intrauterine pregnancy. If a fetal heartbeat is seen then they can be prescribed pessaries up until they are 16 weeks.
It is worth mentioning that it is a mixed picture with taking progesterone. Effectively this hormone encourages your body to hang on to the pregnancy (IVF patients are given progesterone to help prepare their womb lining to receive an embryo). Therefore, if the pregnancy stops developing, or there is something wrong which means that a miscarriage is inevitable, you may not begin to bleed and may not realise that the pregnancy has stopped developing. There are no medications, including progesterone, that will effectively stop a miscarriage.
Can sex make you bleed in early pregnancy?
During pregnancy your cervix becomes more vascular. This can give rise to bleeding occasionally, including after sex.
Why won’t my EPAU see me?
Sometimes, even if you are bleeding in pregnancy, your referral may get rejected by your Early Pregnancy Unit. If so, the clinic should be able to explain to you over the phone why they cannot offer an appointment. Some of the time referrals are rejected because a patient is too early in their pregnancy to be assessed. If you are only 4 or even 5 weeks pregnant it is very unlikely that you would be offered a scan as your pregnancy is simply too small to assess and may not be visible at all on scan. If you have bleeding following a positive pregnancy test but are only 4 or 5 weeks pregnant, you may be advised to retake your pregnancy test a couple of weeks later and contact the clinic if it is still positive. If you have had a negative test following some bleeding, your EPAU will also probably not see you, they are not allowed to see new patients who do not have a positive pregnancy test.
In summary, bleeding in early pregnancy is very common but unpredictable and understandbly of concern. There is nothing you can do to stop bleeding in pregnancy and sometimes a reason is never found for it. However it is always advisable to get checked by your healthcare professional and seek advice from your GP, midwife or EPAU.
https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/bleeding-andor-pain-in-early-pregnancy-patient-information-leaflet/
https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/vaginal-bleeding/
https://www.aafp.org/pubs/afp/issues/2019/0201/p166.html
https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Women%20and%20Children_s/Maternity/Bleeding%20in%20Pregnancy%20(349).pdf