Bleeding During the First Trimester of Pregnancy

Light spotting can occur when the cervix is irritated, including after sex or an examination. Bleeding can also accompany infection, early pregnancy loss or an ectopic pregnancy. The colour or amount alone cannot identify the cause.

Pregnancy increases the blood supply to the cervix, which can make it bleed more easily. Pink, red or brown discharge may come from the cervix or vagina, while heavier bleeding and cramping may occur with an early pregnancy loss. Ectopic pregnancy can present with vaginal bleeding, often alongside pelvic or abdominal pain, although symptoms vary. Symptoms cannot confirm where a pregnancy is located.

A clinician may ask about your last menstrual period, pain, previous pregnancies and how the bleeding has changed. Depending on your situation, assessment may include an examination, blood tests and an ultrasound. Sometimes repeat testing is needed before the cause or pregnancy location becomes clear.

Contact your obstetrician, maternity unit or early-pregnancy service promptly, even if the bleeding is light. Tell them how much blood you have noticed, its colour, whether there are clots or tissue, and whether you have pain, dizziness, fever or unusual discharge. Use a sanitary pad rather than a tampon so you can monitor the flow.

Follow the activity and medicine advice given by your clinician. Do not stop prescribed medicine or take a new medicine for pain without checking that it is suitable during pregnancy. If your blood group is known, have that information available because it can affect the care offered after bleeding.

Go to the nearest emergency department or call local emergency services if bleeding is heavy, pain is severe or one-sided, you have shoulder-tip pain, or you feel faint, dizzy, weak or collapse. These symptoms can occur with significant blood loss or internal bleeding and need immediate assessment.

Seek urgent clinical advice for bleeding with persistent abdominal cramps, fever, chills, unpleasant-smelling discharge or fluid leaking from the vagina. Escalate again if the bleeding increases or new pain develops while you are waiting to be seen.

Ask what the assessment has shown about the pregnancy location, whether an ultrasound or blood test needs repeating, which changes should take you directly to emergency care, and whom to contact if symptoms return outside clinic hours. You can also ask whether your blood group affects the treatment plan.