Bleeding and /or pain in early pregnancy Gynaecology service Information for patients

Gynaecology service
Bleeding and /or pain in early pregnancy
Information for patients
May 2014
Great Staff – Great Care – Great Future
This leaflet has been produced to give you general information about your
condition. Most of your questions should be answered by this leaflet. It is not
intended to replace the discussion between you and your nurse/doctor, but may
act as a starting point for discussion. If after reading it you have any concerns or
require further explanation, please discuss this with a member of the healthcare
team who has been caring for you.
Vaginal bleeding is common in early pregnancy and does not always mean there
is a problem. However, bleeding can be a warning sign of a miscarriage.
What are the causes of early bleeding?
There are a number of causes of bleeding in early pregnancy which include:
Spotting or bleeding may occur shortly after conception, this is known as an
implantation bleed. It is caused by the fertilised egg embedding itself in the lining
of the womb. This bleeding is often mistaken for a period, and it may occur
around the time your period is due.
Hormonal bleeding is when some women experience a light bleed at around four
to eight weeks of pregnancy, or around the time their period would have been
due. This can be very confusing for women who are pregnant and is the reason
many women do not realise they are pregnant for a while. Again, it is totally
normal. This usually settles around the 13th week of pregnancy as by this time
the placenta is sufficiently developed to produce all of the hormones needed to
sustain the pregnancy.
After the egg is fertilised, the fertilised egg then goes on to implant itself into the
lining of the womb (uterus). Sometimes this results in a little bleeding that shows
up on an early scan as a haematoma(collection of blood). This isn't anything to
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
worry about. When it happens the woman may notice a small amount of vaginal
bleeding, but this is not necessarily the case.
The haematoma will gradually disappear and in most cases, the pregnancy
remains safe.
Cervical Erosion (alternatively known as cervical ectropion) may be a source of
spotting or bleeding. The blood supply to the womb and cervix is increased
during pregnancy and the cervix may bleed harmlessly and painlessly. An
erosion may cause bleeding following sexual intercourse; therefore this type of
bleeding must always be reported to your doctor.
Not all bleeding in pregnancy is harmless, and it can be the first sign of a
miscarriage. As many as 1 in 5 pregnancies are thought to end in miscarriage.
The cause of miscarriage is not always known, but researchers have shown that
in some cases there is a problem with the developing pregnancy, which means it
is unable to develop normally. For most women, miscarriage is a very sad and
upsetting experience.
Experiences of miscarriage vary. In some cases there may be only very slight
spotting, in other cases bleeding may stop and start or heavier bleeding with
clots and cramping period type pains can occur. Sometimes there may be no
bleeding at all.
For further information relating to miscarriage, please ask your nurse for further
If you experience bleeding, it is wise to have this checked out. If you have been
seen on Early Pregnancy Assessment Unit (EPAU) during your pregnancy,
you may contact us directly, up to 15 weeks of pregnancy. Your GP or
midwife can also help you.
If you have been seen in the EPAU and you then experience more bleeding
contact the EPAU. Depending on how much bleeding and for how long the
nursing staff will decide if you need to be seen again.
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
If you experience pain that does not go away, or which you feel is becoming
more sever, you should seek advice from your doctor, nurse or midwife. It is
important that any serious causes of pain are excluded. For example there is a
need to rule out an ectopic pregnancy (this is where the pregnancy develops
outside the womb).
What kind of pain may I feel?
Some women experience abdominal (tummy) pain in early pregnancy. This may
be low cramping pain, similar to that felt during a period, or a stitch like or
stabbing pain on one or both sides of the tummy. Aches and pains may come
and go or be present continuously.
What are the causes of abdominal and back pain?
Some of the aches and pains experienced during pregnancy are thought to be
due to hormonal changes. Large amounts of the hormone progesterone are
produced, which are needed to sustain pregnancy. In addition to this,
progesterone acts on the muscles, ligaments and joints causing them to become
slacker and more flexible. This hormonal effect is thought to be responsible for
some of the stitch like pains that some women experience in the lower part of the
tummy and in some cases this can be quite severe. The same hormones can be
responsible for constipation during pregnancy; this can also cause abdominal
The enlarging womb is made up of layers of muscles and is held in place in the
pelvis by supporting ligaments. As the womb expands to accommodate the
developing baby, it can pull on the ligaments and muscles, to cause these
“growing pains”.
The backache that some women get in early pregnancy is also thought to be due
to a hormonal effect, and the supporting muscles are softer.
Abdominal and/or backache can also be a sign of a urine infection. This may also
cause burning or stinging when passing urine and the need to pass urine more
frequently. You must inform your doctor of these symptoms, so that a urine test
can be obtained and treatment given if needed.
Pain on its own does not mean that a miscarriage will occur. However if you
experience bleeding as well as pain this could indicate a threatened miscarriage
and you should always seek advice from your doctor, nurse or midwife.
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
Can I take pain killers during pregnancy?
If you find that you need to take painkillers to relieve any pain, it is safest to use
something simple such as paracetamol. Drugs such as aspirin and ibuprofen
should be avoided. If you find that you need a stronger painkiller, you must
always check with your doctor, nurse or midwife first.
An ultrasound scan is used during pregnancy for a number of reasons. In the first
three months of pregnancy it can be used to check the presence of the baby’s
heartbeat, which can be reassuring if you have experienced a problem, such as
vaginal bleeding or pain. A scan will also be used to check to see if the
pregnancy is in the correct place and to accurately predict the estimated date of
delivery (the date the baby is due) by measuring the end points (size) of the
embryo or fetus.
Will I have an ultrasound scan?
Yes, if the nurse/doctor thinks it is appropriate for you to have a scan.
What is an ultrasound scan?
Ultrasound uses high frequency sound waves that are sent out from a transducer
or probe. These sound waves are received back and converted into an image on
a screen.
Below is an ultrasound image of a nine-week-old fetus:
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
Is it safe to have a scan in early pregnancy?
Yes it is safe, there is so far no evidence to suggest that an ultrasound scan is
What type of scan will I have?
A vaginal scan is the best method in early pregnancy (under 8 weeks) as it gives
us a more accurate result at an earlier stage in pregnancy than an abdominal
scan. It may be a little uncomfortable but it is safe to be done, you do not need a
full bladder when having a vaginal scan. If you have concerns about a vaginal
scan, please let the nurse, midwife doctor know.
What will the scan tell us?
A scan can only tell us how your pregnancy is at that particular time.
Unfortunately it is no guarantee that your pregnancy will continue successfully. If
your symptoms persist or become worse, you must contact EPAU, midwife or
your GP.
In later pregnancy ultrasound scanning is used to look more closely at the
anatomy and organs of the developing baby. This is usually done between 18 –
21 weeks.
If the scan confirms that you have miscarried, the choices of how we can
manage this will be discussed with you.
Occasionally, the scan may pick up an unexpected finding such as a cyst on the
ovary. If this is the case, the staff will explain the findings and any necessary
follow up.
Common abbreviations use on scans
LMP -Last menstrual period
FH - Fetal heart-rate
EDD- Estimated date of delivery
FM - Fetal movement
USS -Ultrasound scan
YS - Yolk sac
CRL - Crown to rump length (a measurement of the embryo/fetus used in early
BPD - Bi-Parietal Diameter
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
HC Head circumference - both of these measurements of the fetus
are used in later pregnancy - after 12-14 weeks.
Should you require further advice on the issues contained in this leaflet, please
do not hesitate to contact the:
Early Pregnancy Assessment Unit/
Emergency Gynaecology Unit
Women and Children’s Hospital
01482 608767
Gynaecology Ward
Women and Children’s Hospital
01482 604387
Useful information
Information on Gynaecology Services at Hull and East Yorkshire Hospitals
NHS Trust can be found at:
Information on Maternity Services at Hull and East Yorkshire Hospitals NHS
Trust can be found at:
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017
Most of your questions should have been answered by this leaflet/booklet, but
remember that this is only a starting point for discussion with your doctor. You
will be asked to sign a consent form and you should be satisfied that you have
received enough information before going ahead.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek
your consent or permission. In order to make a decision, you need to have
information from health professionals about the treatment or investigation which
is being offered to you. You should always ask them more questions if you
do not understand or if you want more information.
As part of your care, when you come to the hospital, information about you is
shared between members of a healthcare team, some of whom you may not
meet. It may be used to help train any staff involved in your care. Information
we collect may also be used after you have been treated to help us to maintain
and improve the quality of our care, to plan services, or to research into new
We may pass on information to other health organisations to help improve the
quality of care provided by the NHS generally.
All information is treated as strictly confidential, and is not given to anyone who
does not need it. If you have any concerns please ask your doctor, or the person
caring for you.
Under the Data Protection Act (1998), Hull and East Yorkshire Hospitals NHS
Trust is responsible for maintaining the confidentiality of any information we hold
on you.
This leaflet was produced by the Gynaecology Service, Hull and East Yorkshire
Hospitals NHS Trust and will be reviewed in May 2017.
Ref: HEY13/2014
Leaflet reg: ……..Title: Early pregnancy pain and bleeding
Author E Morris
Review date May 2017