Heavy bleeding during the first trimester

Heavy bleeding during the first trimester is not something to assess at home. Bleeding can arise from the cervix, a threatened or ongoing miscarriage, or a pregnancy developing outside the womb. The amount, colour, clots, pain, and how you feel help clinicians judge urgency.

Some bleeding occurs when the cervix is sensitive, but heavy flow requires examination. An ectopic pregnancy can cause bleeding with one-sided lower abdominal pain, shoulder-tip pain, faintness, or collapse; read more about [Ectopic Pregnancy](/conditions/ectopic-pregnancy/). Bleeding may also be accompanied by tissue or cramping when a miscarriage is occurring.

Contact your maternity service, gynaecology clinic, or emergency service promptly. Note when the bleeding began, how quickly pads become soaked, whether clots or tissue are present, and any pain. Do not drive if you feel faint. Use pads rather than tampons so the amount can be observed, and avoid putting anything in the vagina until assessed.

Seek emergency care immediately for fainting, severe or worsening abdominal pain, pain at the tip of the shoulder, marked weakness, confusion, breathlessness, or bleeding that is rapidly soaking pads. These signs can indicate significant blood loss or an ectopic pregnancy and need rapid assessment.

Ask whether you need an ultrasound, blood tests, or repeat testing; whether the pregnancy is inside the womb; what symptoms should bring you back urgently; and whether your blood group affects the care plan.