Cramping and spotting in pregnancy: what to know

Light spotting may come from the cervix, which can bleed more easily in pregnancy, including after sex or an examination. Mild, short-lived cramps can occur as the uterus changes. However, bleeding is also a presentation of miscarriage or ectopic pregnancy, so symptoms cannot be judged by colour alone. A pregnancy test result, estimated gestation, pain location, and examination help a clinician assess the situation. Bleeding between periods has other possible causes outside pregnancy, including infection, cervical changes, polyps, or fibroids; these should not be assumed from symptoms alone.

Note when the spotting began, its colour, whether it is increasing, and whether tissue or clots are present. Record where the cramps are felt and whether they come in waves. Use a pad so you can observe the amount, and avoid inserting anything into the vagina until a clinician advises you. Contact your maternity service or doctor for advice, particularly if you have not yet had the pregnancy location confirmed. Do not start or stop medicines without checking that they are suitable in pregnancy.

Seek emergency care for heavy or rapidly increasing bleeding, severe or one-sided abdominal pain, fainting, marked weakness, dizziness, or pain at the shoulder tip. Prompt assessment is also needed with fever, feeling very unwell, or bleeding after a positive pregnancy test. If spotting continues, returns, or is accompanied by worsening cramps, arrange same-day clinical advice even when the pain is manageable.

Ask whether you need an ultrasound or blood tests, what bleeding pattern should prompt a return visit, and which pain relief options are appropriate. Tell the clinician your last menstrual period, pregnancy test result, blood group if known, medicines, and any history of ectopic pregnancy or miscarriage.