Vaginal bleeding and pelvic pain in pregnancy (under 20 weeks)

The first thing to ensure is that you and your baby are okay. Please call your midwife or GP immediately, so we can assess you.

Bleeding during pregnancy is relatively common and doesn’t always mean there’s a problem, but we need to make sure straight away.

If you have been assessed and miscarriage or ectopic pregnancy has been excluded, you will be referred to the hospital to help us to find the cause. Although it’s not classed as normal bleeding and/ or pain in early pregnancy is quite common.

And, although vaginal bleeding is often described as a threatened miscarriage, it’s not always a sign there’s a serious problem and many women who have bleeding early in pregnancy will go on to have a healthy baby.

Ultrasound scans

As part of your initial assessment, we will give you an abdominal or internal vaginal ultrasound scan to look for the position of the pregnancy, measure your baby and check their heartbeat. The sonographer will also check the amniotic fluid levels, the position of the placenta, and looked for bleeding around the pregnancy sac, ovarian cysts or internal bleeding in your pelvis.

You may be worried about the risks of ultrasound in pregnancy, especially internal vaginal scans, but there is no risk to you or your baby.

It may be necessary to perform further investigation into the cause of your bleeding or pain, once miscarriage and ectopic pregnancy has been ruled out.

Other investigations

As well as a scan, your GP, Practice Nurse, or health care professional at the hospital may need to carry out some additional investigations. These may include:

• Urine tests – to check for signs of infection
• Internal vaginal examination – to look at your cervix to check if it has closed, or has signs of any abnormality, such as cervical erosion, polyps, or inflammation. This can only be carried out through an internal vaginal inspection, using a plastic instrument called a speculum, like you’ve probably seen during your smear test. There’s no risk to your baby and it can provide useful information about why you’re bleeding. While it’s similar to a smear test, it’s not advisable to have an actual smear test while pregnant. If yours is due, let your GP know you’re pregnant and they can book you in after you’ve had your baby.
• Vaginal swabs – to check for vaginal infections. These will be taken at the same time as your internal examination

Common causes of vaginal bleeding and pain during pregnancy

There can be several reasons why you may experience vaginal bleeding while pregnant, including:

• Bleeding inside the uterus, next to the pregnancy sac. This will have been seen at the time of your scan. It’s sometimes called intrauterine haemorrhage, subchorionic haematoma, perigestational bleed, or implantation bleeding. This sort of bleeding can cause period-type pain and is often seen in early pregnancy scan but no-one fully understands why it occurs. It is not an indication that you are going to miscarry.
• Abnormalities of the cervix – these are identified with an internal vaginal examination, using a plastic speculum. These may include:
  • Cervical erosions are common in pregnancy and may cause bleeding, especially after sex. They also cause increased vaginal discharge. Cervical erosions are harmless and do not need treatment in pregnancy. They usually disappear after you have had your baby.
  • Vaginal infections such as chlamydia can cause inflammation and bleeding from the cervix. Vaginal infections are usually diagnosed by taking a vaginal swab of the discharge from your cervix with a cotton bud. Swabs are usually taken at the same time as your internal vaginal examination, with a plastic speculum. There’s no risk to you or your baby, and the results can take up to seven days.
• Urine infections may cause vaginal bleeding, pelvic pain and back pain. Checks can be done on a urine sample with a urine dipstick test, in the clinic or ward, or by sending a mid-stream urine sample to the pathology lab. These results can take up to four days
• Constipation is a very common problem during early pregnancy and can be very painful. There are simple things you can do to avoid constipation, such as drinking plenty of fluids, gentle exercise, and eating a high fibre diet. If these do not help, discuss your symptoms with your chemist, GP, Practice Nurse or midwife
• Ovarian cysts are also very common in early pregnancy and are easily seen on ultrasounds scans. A cyst – called the Corpus Luteum – is a normal finding during most pregnancy scans in the first 12 weeks. It produces a hormone that helps to reduce the chances of miscarriage. It’s very rare for them to cause a serious problem and they usually disappear after the 12^th week of pregnancy. We’ll monitor this at your routine pregnancy scans and they do not need to be treated unless they grow very large or twist, which would be extremely painful.
• Muscular pain is very common in pregnancy due to the effect of the pregnancy hormone on the muscles and ligaments in your pelvis
• Unexplained vaginal bleeding and pain is also very common and, despite all investigations, it’s often the case that we cannot explain the cause.

What can I do prevent miscarriage?

The sad fact is that there’s nothing you can do to prevent a miscarriage from happening.

We know that taking folic acid, avoiding smoking and following the advice of medical professionals can help to maintain a healthy pregnancy. If you need further information or support, please contact your midwife or GP.

Although, sadly, one in four pregnancies will end in miscarriage, if we have seen a live pregnancy on your scan, there is a very good chance you will not miscarry.

It’s not necessary to rest or avoid sex unless you have been specifically advised to do so by your GP.

What if I keep bleeding or the pain doesn’t settle?

Bleeding and pain may continue for several days but, as long as the bleeding is less than you’d usually see in your period, there is probably nothing to worry about.

If there is more bleeding than a period or you pass clots larger than a 10 pence piece, please contact your GP or midwife for further advice.

If you have increasing pain, it’s safe to take Paracetamol in pregnancy. If this is not helping, please contact your GP for advice.