What should you know about cramping and bleeding during pregnancy?

Cramping and bleeding during pregnancy should be assessed promptly because the source, amount, pain and stage of pregnancy affect urgency. Blood from the vagina is different from blood on toilet paper or in stool, so identify where it is coming from if you can.

Mild cramping can occur as the uterus changes, but bleeding may also signal a pregnancy complication. Vaginal bleeding with one-sided or severe pain, shoulder pain, dizziness or faintness is especially concerning. Blood from the bowel may come from irritation, haemorrhoids or a gastrointestinal condition such as Crohn's Disease, Ulcerative Colitis, Diverticular Disease or Gastroenteritis; it does not automatically come from the pregnancy. Bowel Cancer and Rectal Cancer are uncommon explanations for a new symptom, but persistent or unexplained blood still needs review.

Contact your maternity team, obstetric clinician or urgent care service as soon as bleeding occurs in pregnancy. Note the colour, whether blood is vaginal or rectal, whether clots or tissue are present, and when the cramps began. Rest while arranging advice, avoid inserting anything into the vagina until assessed, and do not drive if faint or in severe pain. If blood is clearly from the bowel, mention pregnancy when seeking medical advice.

Seek emergency care for heavy or increasing vaginal bleeding, severe or one-sided abdominal pain, fainting, marked dizziness, shoulder-tip pain, fever, or feeling very unwell. Urgent review is also needed for rectal bleeding with severe abdominal pain, black stool, repeated vomiting or weakness. Do not wait for a routine appointment if symptoms are escalating.

Ask what source of bleeding is most likely, whether an examination or ultrasound is needed, and which symptoms should bring you back urgently. Tell the clinician how far along the pregnancy is, your blood group if known, and any previous pregnancy or bowel problems.