Vaginal bleeding in early pregnancy

Spotting is when you notice a few drops of blood every now and then on your underwear. It is not enough to cover a panty liner.

Bleeding is a heavier flow of blood. With bleeding, you will need a liner or pad to keep the blood from soaking your clothes.

Ask your health care provider more about the difference between spotting and bleeding at one of your first prenatal visits.

Some spotting is normal very early in pregnancy. Still, it is a good idea to tell your provider about it.

If you have had an ultrasound that confirms you have a normal pregnancy, call your provider the day you first see the spotting.

If you have spotting and have not yet had an ultrasound, contact your provider right away. Spotting can be a sign of a pregnancy where the fertilized egg develops outside the uterus (ectopic pregnancy). An untreated ectopic pregnancy can be life-threatening for the woman.

Bleeding in the 1st trimester is not always a problem. It may be caused by:

• Having sex.
• An infection.
• The fertilized egg implanting in the uterus.
• Hormone changes.
• Other factors that will not harm the woman or baby.
• A threatened miscarriage. Many threatened miscarriages do not progress to pregnancy loss.

More serious causes of first-trimester bleeding include:

• A miscarriage, which is the loss of the pregnancy before the embryo or fetus can live on its own outside the uterus. Almost all women who miscarry will have bleeding before a miscarriage.
• An ectopic pregnancy, which may cause bleeding and cramping.
• A molar pregnancy, in which a fertilized egg implants in the uterus but will not come to term.
• Formation of a blood clot between the amniotic sac and the wall of the womb called a subchorionic hematoma.

Your provider may need to know these things to find the cause of your vaginal bleeding:

• How far along is your pregnancy?
• Have you had vaginal bleeding during this or an earlier pregnancy?
• When did your bleeding begin?
• Does it stop and start, or is it a steady flow?
• How much blood is there?
• What is the color of the blood?
• Does the blood have an odor?
• Do you have cramps or pain?
• Do you feel weak or tired?
• Have you fainted or felt dizzy?
• Do you have nausea, vomiting, or diarrhea?
• Do you have a fever?
• Have you been injured, such as in a fall?
• Have you changed your physical activity?
• Do you have any extra stress?
• When did you last have sex? Did you bleed afterward?
• What is your blood type? Your provider can test your blood type. If it is Rh negative, you will need treatment with a medicine called Rho(D) immune globulin to prevent complications with future pregnancies.

Most of the time, the treatment for bleeding is rest. It is important to see your provider and have testing done to find the cause of your bleeding. Your provider may advise you to:

• Take time off work
• Stay off your feet
• Not have sex
• Not douche (NEVER do this during pregnancy, and also avoid it when you are not pregnant)
• Not use tampons

Very heavy bleeding may require a hospital stay or surgical procedure.

If something other than blood comes out, call your provider right away. Your provider will do an exam to look at your cervix.

Your provider will check to see if you are still pregnant. You will be closely watched with blood tests to see if you are still pregnant.

If you are no longer pregnant, you may need more care from your provider, such as medicine or possibly surgery.

Call or go to your provider right away if you have:

• Heavy bleeding
• Bleeding with pain or cramping
• Dizziness and bleeding
• Pain in your belly or pelvis

If you cannot reach your provider, go to the emergency room.

If your bleeding has stopped, you still need to contact your provider. Your provider will need to find out what caused your bleeding.

Miscarriage - vaginal bleeding; Threatened abortion - vaginal bleeding

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 18.

Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 173.

Updated by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.