Bleeding in early pregnancy

Patient Information Leaflet

Introduction

This leaflet is for women who are having bleeding in early pregnancy. It gives information about what causes this, what will happen next and what you need to do when you get home.

What should I do if I bleed during pregnancy?

Bleeding during pregnancy is quite common, but it can be a dangerous sign, so you should contact your midwife or GP immediately if it happens to you.

In early pregnancy some women get light bleeding, called spotting, which is harmless. This occurs when the developing embryo plants itself in the wall of your womb.

It can also happen about the time your first period would have been due. This is called hormonal bleeding and you do not usually get this after the first 12 weeks. However, some women do have hormonal bleeding each month throughout their pregnancy.

If you get heavy bleeding, bad pains in your abdomen or start to pass blood clots, you should visit your GP or call the Early Pregnancy Assessment Clinic (EPAC) on 01384 244584. Do not go to the Emergency Department unless you are seriously ill.

If your bleeding lasts more than two weeks or you have a new occurrence of heavy bleeding, you should contact your GP or EPAC on 01384 244584.

Why am I bleeding?

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy. However, many women who bleed at this stage of pregnancy go on to have normal and successful pregnancies.

Miscarriage

If a pregnancy ends before the 24th week, it is known as a miscarriage. Miscarriages are quite common in the first three months of pregnancy. About one in five pregnancies ends this way.

Many miscarriages occurring before 14 weeks of pregnancy happen because there is something wrong with the baby. There are other causes of miscarriage, such as hormone or blood clotting problems. Most miscarriages occur during the first 12 weeks of pregnancy and, sadly, most cannot be prevented.

Symptoms of a miscarriage include heavy bleeding, bad pain in the abdomen and passing blood clots.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised egg implants outside the womb, for example, in the fallopian tube.  It is much less common than a miscarriage; however, it is much more serious to the health of the mother. Symptoms may include bleeding, sometimes pain in one side of the abdomen; and some women experience pain spreading out to their shoulder blades.

As the fertilised egg cannot develop properly outside the womb, the egg has to be removed. This can be through an operation or with medicines. Your GP or midwife will discuss this with you.

What will happen now?

If you have visited the Emergency Department, the healthcare practitioner will ask you questions about your symptoms and examine you. He/she may do a pregnancy test and test your urine for other possible causes of your symptoms, such as an infection.

If your doctor thinks you need to have your symptoms investigated further, he/she will arrange an appointment in the Early Pregnancy Assessment Clinic (EPAC) for you to be assessed, and for an ultrasound scan.

The ultrasound scan is carried out in the EPAC as they cannot be carried out in the Emergency Department. Scans are not needed for all cases of bleeding in pregnancy.

What is EPAC?

EPAC is where women who are less than 20 weeks pregnant go for assessment. During your appointment, the nurse may undertake:

• An examination and ask you questions
• A pregnancy test
• An abdominal and/or transvaginal scan if necessary

After you have had your tests, the nurse will discuss your results with you.

Why am I not able to go to EPAC now?

EPAC is open five days a week, 9am to 5pm so the doctor in ED will make an appointment for you. Bleeding in early pregnancy cannot be prevented or stopped by medical treatment; therefore, there is no need to have a scan urgently.

What should I do when I get home?

If you have an Early Pregnancy Assessment Centre appointment, it is a good idea to rest until after the appointment.

However, if you feel well, you can continue with your usual activities and go back to work when you feel ready.

When you are bleeding:

• Do not use tampons – use sanitary towels.
• Avoid having sex until the bleeding has stopped. However, usually having sex during pregnancy will not cause any harm.

Can I find out more?

You can find out more from the following weblink:

NHS Choices: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/vaginal-bleeding-pregnant.aspx

If you need help when you return home, you can:

• Call your midwife or your GP
• Visit the EPAC at Russells Hall Hospital or call on

01384 244584 (9am to 5pm, Monday to Friday)

• Call NHS 111 service (24 hours, 7 days a week)

If you have any feedback on this patient information leaflet, please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Originator: Joanne Taylor Date reviewed: June 2022 Next review due: August 2026 Version: 2 DGH ref: DGH/PIL/01348