Spotting during pregnancy and miscarriage

Spotting can appear as pink, red or brown marks on underwear or toilet tissue. Colour and appearance may change as blood leaves the body, so a photograph cannot show where the bleeding came from or whether a pregnancy is developing normally. Some people with a miscarriage have bleeding and cramps, while others may have few symptoms; bleeding in pregnancy can also have other explanations.

A clinician may use your history, an examination, pregnancy hormone testing and a Transvaginal Ultrasound. The scan can help assess the pregnancy and uterus, but timing may affect what can be seen, so follow-up can be part of safe assessment.

Contact a maternity or medical service for advice, particularly if bleeding is new or increasing. Record the colour, amount, clots, pain and when symptoms began. Use pads rather than tampons while you are bleeding, and avoid inserting anything into the vagina until a clinician advises that it is appropriate.

Do not use an online image to compare bleeding or to decide that a miscarriage has occurred. If a miscarriage is confirmed, your clinician can explain waiting, Medical Management of Miscarriage or Surgical Management of Miscarriage according to your symptoms and findings.

Go to urgent care for heavy bleeding, severe pain, one-sided pain, shoulder-tip pain, fainting, dizziness, fever, chills or a sudden deterioration. Seek prompt assessment for bleeding with pain even when the amount seems small, because an ectopic pregnancy and other complications need medical review.

Ask whether you need a scan or blood tests, what amount of bleeding is expected, how to manage cramps, when to repeat testing, and exactly where to go if pain or bleeding worsens.