What should you know about first trimester light bleeding?

Spotting may be pink, brown or red and can appear on toilet paper or a liner. It may follow sex or an examination because the cervix is more sensitive in pregnancy. Bleeding can also occur with changes in the pregnancy that need assessment, including miscarriage or an ectopic pregnancy, where a pregnancy develops outside the womb. The amount, colour, timing, pain and any associated symptoms help a clinician judge what to do next.

Note when the bleeding began, its colour, whether it is increasing, and whether you have cramps, one-sided pain, dizziness or shoulder-tip pain. Use a pad or liner so you can observe the amount; avoid tampons. Contact your obstetric or maternity service, even if the bleeding settles, and tell them how far along the pregnancy is and whether your blood group is known. Do not drive yourself if you feel faint.

Seek urgent medical help for heavy or rapidly increasing bleeding, severe or one-sided abdominal pain, fainting, marked weakness, shoulder-tip pain, fever, or pain with a pregnancy that has not yet been confirmed inside the womb. These symptoms can signal an emergency such as an ectopic pregnancy. If symptoms are mild but continue or recur, arrange prompt assessment rather than waiting for a routine appointment.

Ask whether you need an examination, pregnancy-hormone testing or an ultrasound; what changes should prompt another call; and whether you should alter activity, sex or medicines while the bleeding is being assessed.