Spotting during early pregnancy

Spotting is light vaginal bleeding that can happen when you're pregnant. It is a very common and tends to happen in early pregnancy, during the first trimester.

Spotting is usually red or pink in colour. It can also look brown, like old blood or like the bleeding at the start and end of your period. The amount of blood you lose when spotting is small – less than a light period bleed.

Important

Contact your GP, midwife or obstetrician if you are bleeding from your vagina. Spotting is usually harmless. But in some cases it can be a sign that something could be wrong.

Causes of spotting

The main causes of spotting during early pregnancy include:

  • implantation bleeding - caused by the fertilised egg attaching to the inner lining of your womb
  • hormonal changes - pregnancy hormones can cause changes to your cervix

Spotting can also be a sign that your pregnancy is not developing properly and may be a sign of a miscarriage or an ectopic pregnancy.

Seeing your GP about spotting

Your GP will ask you about your bleeding.

They may ask you:

  • when your last period was
  • how many weeks pregnant you are
  • if it's your first pregnancy
  • what the bleeding or spotting is like
  • if you have any other symptoms such as stomach pain or dizziness

Be honest with your GP. There's nothing to be embarrassed about. Tell them about the colour, any clotting, and how heavy the bleeding was. Be as graphic as you need to. Remember, your GP sees people with personal issues like bleeding all the time.

Examination

Your GP may ask to give you a physical examination.

This may include:

  • checking your blood pressure
  • checking your pulse
  • pressing on your stomach

Tests

Your doctor may also do some tests, such as a:

  • urine test - to check for infection
  • pregnancy test - if it's their first time seeing you during your pregnancy
  • blood test - to measure the levels of pregnancy hormone (βhCG) in your blood

If you get a blood test done in your GP's surgery, it'll be sent to the lab in the hospital.

Referral

What happens next depends on:

  • the stage of the pregnancy you're at
  • if you have had bleeding before
  • anything your GP found out at your appointment

If your maternity hospital has an Early Pregnancy Unit (EPU), your GP may refer you to investigate the spotting. You may also need to go to your maternity hospital for an ultrasound scan.

Sometimes they may refer you to the emergency department if you have severe stomach pains or heavy vaginal bleeding.

EPUs and emergency departments are usually quite busy. Bring a magazine or a book to keep you busy. It's also good to bring a support person in case you receive bad or unexpected news. Be aware that your hospital may have COVID-19 restrictions on partners and support persons.

Going to the maternity hospital about spotting

You may have tests and examinations at the hospital. This is to try and find out the cause of the bleeding.

Pelvic or vaginal examinations

Your doctor or obstetrician might want to examine your cervix. This is to check the bleeding. It's normal to feel a little uneasy about this. Sometimes you can have a midwife there to support you.

They may need to use a speculum. This is an instrument used to gently open your vagina so your doctor can see your cervix more easily.

Your doctor may also ask your consent to do a vaginal examination. This is when they insert their gloved fingers into the vagina to see if there is any pain. It helps then to make a correct diagnosis.

Blood tests

You may need to have a blood test, even if your GP did blood tests. Sometimes your doctor will want to compare your pregnancy hormone to the levels in the blood taken by your GP. Occasionally, blood tests are repeated 2 days later. The combined results can help with the correct diagnosis.

Ultrasound scan

An ultrasound scan is often needed. In early pregnancy, this is usually a transvaginal ultrasound. It's the best way to get a clear picture of your baby.

In the second and third trimesters, it'll usually be an abdominal ultrasound instead.

What happens next

This depends on what is causing the bleeding. You may need to be admitted to hospital for observation or treatment. Most women with spotting are discharged home.

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This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.

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