Spotting, bleeding and getting help

Bleeding in Early Pregnancy: What to Do and Red Flags

Finding blood when you’re pregnant can make everything else stop for a moment. You might have seen a little pink on the toilet paper, brown marks in your underwear or bleeding that feels more like a period. Whatever it looks like, you do not need to work out the cause before asking for help.

Bleeding does not automatically mean miscarriage. It can happen in a pregnancy that continues normally, but it can also signal a problem that needs treatment. The next step is to tell the care team what is happening, rather than try to match it to a photograph online.

When should you get urgent help?

Call 999 for bleeding with emergency symptoms

The NHS emergency signs include severe tummy pain, pain in your shoulder, feeling sick, dizziness, faintness or loss of consciousness, and heavy bleeding that soaks a period pad soon after you put it on.

Severe pain means pain that stops you doing daily tasks or concentrating on something such as a book or television. You do not have to have every symptom on the list. A small amount of visible blood does not make severe pain or faintness safe to ignore.

Get urgent advice for light bleeding too

Spotting with no pain, or with mild pain, still needs advice. So does bleeding with diarrhoea or pain or pressure when you pee or poo. Call your maternity unit. If you’re under 20 weeks, an early pregnancy unit may be able to help; look in your maternity notes or on your NHS trust’s website. Call 111 if you cannot contact one.

Tell the person answering if you have lower tummy pain mainly on one side, shoulder-tip pain, or feel faint. An ectopic pregnancy can cause symptoms before you’ve had a positive test. If you think you might be pregnant, mention that too.

Is it spotting or bleeding, and does the colour matter?

Spotting usually means small marks seen when you wipe or on your underwear. Light bleeding is more than a few spots but does not soak through a pad. Heavy bleeding soaks a pad and may include clots.

Blood can look pink, red or brown. Those details help the team understand your symptoms, but colour is not a diagnosis. Dark, watery bleeding can occur with an ectopic pregnancy, for example. Brown blood is not a reason to skip the call.

If there are clots, tissue-like pieces or fluid coming from your vagina, tell the unit. They can occur with miscarriage, but symptoms alone cannot establish what is happening to your pregnancy. Describe what you see rather than trying to decide whether it “counts”.

A useful description is: “I’m about six weeks pregnant. It started this morning. I’m seeing marks when I wipe, and I have mild cramps.” Add whether it is increasing, whether you’re using a pad and whether you have any of the emergency symptoms above.

What if you’ve been bleeding for seven days?

Ask the maternity or early pregnancy team for advice if bleeding has lasted a week. There is no universal number of days that makes unexplained bleeding safe. If you have not been assessed, do not wait for it to reach a particular day before calling.

If you’ve already had an assessment, tell the team that it is continuing and follow the plan they gave you. New pain, heavier bleeding or feeling unwell changes what they need to know, even if an earlier scan or blood test was reassuring.

You may see advice online about waiting 14 days. NICE gives that advice in a particular situation: a scan has confirmed a pregnancy in the womb with a heartbeat, there is bleeding, and there has been no previous miscarriage. In that situation, return for assessment if bleeding worsens or lasts beyond 14 days. It is not permission to leave new bleeding unchecked for two weeks.

What can cause bleeding in early pregnancy?

Several different things can cause it, and sometimes tests do not find a clear explanation. You cannot reliably separate them by the colour of the blood or the number of days alone.

• Very early implantation bleeding. Light spotting can happen around the time a period would have been due as the pregnancy implants. That is a possible explanation, not something to assume whenever you see blood.
• Changes to the cervix. The entrance to the womb becomes more sensitive during pregnancy and can bleed after sex.
• A collection of blood near the pregnancy. You may hear the term subchorionic haematoma. It describes blood collecting around the pregnancy sac; your team can explain a scan finding and whether follow-up is needed.
• An infection. A urine or vaginal infection can cause bleeding and may need treatment.
• Miscarriage. Bleeding, cramping, passing tissue or fluid can happen with pregnancy loss. A chemical pregnancy is a very early loss, but it still needs to be distinguished from other causes.
• Ectopic pregnancy. This means the pregnancy is growing outside the womb, usually in a fallopian tube. It can be dangerous and needs medical assessment.
• Molar pregnancy. An uncommon problem with how the pregnancy develops, often found on a scan.

The word threatened miscarriage can sound especially frightening. It is used when there has been bleeding or pain but the scan shows the pregnancy progressing normally. Many women in this situation go on to have a healthy baby. Ask what the findings mean for you and whether another appointment is needed.

What happens at an early pregnancy assessment?

The team will ask about the bleeding, any pain, your last period, your health and previous pregnancies. Say if you’ve had a previous miscarriage, ectopic pregnancy or fertility treatment. Bring maternity notes if you have them, plus a list of medicines you take.

You may be offered a urine test, blood tests, an examination or an ultrasound. Blood tests can include your blood group and hCG, the pregnancy hormone. Which tests you need depends on your symptoms and how far along the pregnancy may be.

Will the scan be internal?

A transvaginal scan uses a probe gently placed inside the vagina. It often gives a clearer view in early pregnancy than scanning through the tummy. Neither type increases the risk of miscarriage. You should be offered a chaperone for a vaginal examination or internal scan, and you can bring someone for support.

If an internal scan is not acceptable to you, tell the team. NICE says an abdominal scan should be offered and its limitations explained. Our early pregnancy scan guide explains what the different scans can show.

The dates calculated from your last period do not always match the pregnancy’s development. Not seeing a heartbeat on one very early scan is not, by itself, enough to diagnose miscarriage. The measurements and scan method matter, and a repeat scan may be needed.

What does “pregnancy of unknown location” mean?

PUL means a test is positive but the scan has not located the pregnancy. It may be a pregnancy in the womb that is too early to see, an early miscarriage or an ectopic pregnancy. The label describes an unanswered question; it does not settle which of those is happening.

Follow-up is important until the team has an answer. NICE recommends two hCG blood tests as close as possible to 48 hours apart, but not earlier, to guide what happens next. The hormone level alone cannot tell the team where the pregnancy is.

The next scan is arranged around the findings. Some early scan results need at least seven days before a repeat internal scan, and some abdominal-scan findings need at least 14 days, before a diagnosis can be made. Ask for your own appointment date and what to do if symptoms change.

Waiting for the planned repeat scan does not harm the pregnancy’s outcome. New or worsening symptoms still need prompt reassessment: do not wait for the appointment, or for a hormone level to become “bad enough”, before getting help.

Can treatment stop the bleeding?

Treatment depends on the cause. An infection may need medicine; a pregnancy progressing normally may need monitoring rather than treatment. If miscarriage is confirmed, the team can discuss waiting, medicines or a procedure, depending on your circumstances. Confirmed pregnancy loss and unexplained spotting are different situations.

When is progesterone offered?

NICE recommends vaginal micronised progesterone when you have bleeding, a previous miscarriage and a pregnancy confirmed inside the womb on a scan. Tell the team about any previous loss so they can check whether this applies.

If a heartbeat is confirmed, the recommendation is to continue prescribed treatment until 16 completed weeks. It is not a general treatment for everyone who spots, and it is not given on the assumption that an unlocated pregnancy is in the womb. Ask your clinician about eligibility and use the prescription they give you.

What if your blood group is RhD-negative?

Mention it to the team, particularly if you do not have your notes. NICE’s current anti-D guidance for ectopic pregnancy, miscarriage and threatened miscarriage does not recommend it up to and including 11 weeks and 6 days.

At 12 weeks to 12 weeks and 6 days, anti-D is offered to RhD-negative women having medical or surgical treatment for ectopic pregnancy or miscarriage. It may also be considered for threatened miscarriage with heavy or recurrent bleeding. Your team uses the scan dates and your circumstances to decide; other situations, such as injury to your tummy, need their own advice.

What helps while you’re waiting for an answer?

Use pads rather than tampons while bleeding and change them regularly. It is easier to describe the amount if you note when you changed a pad and whether it was spotted, stained or soaked. Do not put off an urgent call to collect a perfect record.

Before leaving an assessment, ask:

1. What do we know, and what is still uncertain? Ask whether the pregnancy has been located and what the scan could confirm.
2. What is the next step, and when? Write down the date of any blood test or repeat scan.
3. Who do I call overnight or if things change? Ask for the 24-hour contact number and the symptoms that should prompt another call.
4. What should I do about work, activity, sex and medicines? Get advice for your situation rather than borrowing somebody else’s treatment plan.

North Bristol NHS Trust advises waiting until spotting or bleeding has stopped before resuming sex. If you’ve been assessed, follow your own team’s advice, including any instructions after treatment.

You do not have to pretend the wait is easy. Ask someone you trust to come with you, help remember the plan or keep you company afterwards. If the worry is taking over your day, our pregnancy anxiety guide has ways to get support.

Quick questions about early pregnancy bleeding

Can you bleed and still have a healthy pregnancy?

Yes. Bleeding does not inevitably mean pregnancy loss. A scan and, where needed, follow-up tests help establish what is happening in your pregnancy.

What if there is no pain?

Get advice anyway. An ectopic pregnancy can have no symptoms at first, and light bleeding without pain is included in NHS urgent-advice guidance.

Should you wait for your routine scan?

No. Contact your maternity or early pregnancy team about the bleeding. The routine pregnancy scan timetable is for planned care; a new symptom needs its own advice.

Is a pregnancy test enough to check everything is okay?

No. A test can detect pregnancy hormone without telling you where the pregnancy is or whether it is progressing normally. Follow the assessment and follow-up plan, even if a home test is still positive.

Sources

• NHS: vaginal bleeding in pregnancy and urgent help
• NHS: miscarriage symptoms, assessment and treatment
• NHS: ectopic pregnancy symptoms
• RCOG: bleeding and pain in early pregnancy
• NICE: early scans and pregnancy of unknown location
• NICE: threatened miscarriage and progesterone
• NICE: anti-D guidance updated in June 2026
• NICE: support, information and follow-up
• North Bristol NHS Trust: practical advice for early bleeding
• Tommy’s: possible causes of bleeding and spotting