Bleeding in the first trimester of pregnancy: causes and what to do

Is bleeding in early pregnancy common?

Yes, bleeding is common in the first trimester (up to 14 weeks of pregnancy, counted from the first day of your last period). It may be just brownish spotting, pinkish discharge or heavier bleeding.

Bleeding does not necessarily mean a miscarriage. Light, isolated, painless bleeding often has no consequences. On the other hand, heavy bleeding, especially with pain, is more often linked to pregnancy loss.

Whatever it looks like, bleeding should be checked by a doctor to find the cause. Monitoring of your pregnancy up to the birth is described on the Giving birth in Paris page.

What causes bleeding in the first trimester?

Threatened miscarriage and miscarriage

This is the most common situation. 15 to 20% of pregnancies end in miscarriage, most often in the first trimester and because of a chromosomal abnormality in the embryo that happens by chance. Sex and usual physical activity do not cause miscarriage.

Ectopic pregnancy

The embryo implants outside the womb, usually in a fallopian tube. Without treatment, the tube can rupture and cause internal bleeding. This is the main reason why any bleeding in early pregnancy must be investigated. See ectopic pregnancy.

Other causes

In a twin pregnancy, bleeding may be due to one of the embryos stopping developing early on. Lesions of the cervix (ectropion, polyp, infection) bleed easily on contact. A smear test can be done during pregnancy if your screening is not up to date.

Which tests are done for bleeding in early pregnancy?

• Clinical examination: blood pressure, pulse, feeling the abdomen, and a speculum examination to see where the bleeding is coming from and the state of the cervix.
• Pelvic ultrasound, often transvaginal: it locates the pregnancy, checks the heartbeat and measures the embryo.
• Blood test for the hormone hCG, sometimes repeated 48 hours later when the scan cannot yet give an answer (this is called a "pregnancy of unknown location").
• Blood group and rhesus factor, if you do not have a complete blood group card.
• Sometimes a blood count to check for anaemia.

When the pregnancy is very early, a second scan 7 to 14 days later is often needed to reach a conclusion, depending on what the first one shows. The wait is hard, but it avoids jumping to conclusions too soon.

What if I am rhesus negative and bleeding in pregnancy?

If your blood group is rhesus negative and the baby's father is rhesus positive or his blood group is unknown, bleeding can allow the baby's red blood cells to pass into your bloodstream. Your body may then make antibodies that could affect a rhesus-positive baby in a later pregnancy.

Before 12 weeks, after bleeding in an ongoing pregnancy, a miscarriage, a missed miscarriage or an abortion, the CNGOF has recommended since 2024 that anti-D immunoglobulin should not be given (weak recommendation, very low-quality evidence). Some teams still give it routinely, in line with the 2021 HAS abortion factsheet; your doctor will explain the approach used. From 12 weeks, an injection may be needed. For an ectopic pregnancy, the evidence is insufficient and the decision is made case by case. To find out more: rhesus incompatibility in pregnancy.

How is bleeding in early pregnancy treated?

Ongoing pregnancy in the womb

No treatment is usually needed. Strict bed rest has not been shown to prevent miscarriage; it is advisable to avoid tiring exertion and to see a doctor again if there is new heavy bleeding or pain. For women who are bleeding and have had one or more previous miscarriages, natural (micronised) vaginal progesterone slightly increases the chance of a live birth, according to a Cochrane meta-analysis; without a previous miscarriage, it brings no benefit.

Miscarriage

There are three options, chosen with you depending on the situation:

• waiting for the pregnancy to pass naturally, often complete within a few days to a few weeks;
• medical treatment (misoprostol, sometimes preceded by mifepristone), which speeds up the process;
• surgical aspiration under anaesthetic, especially if bleeding is heavy, there is an infection or you prefer it. See uterine aspiration and curettage.

Follow-up is described in detail in the article on follow-up after a miscarriage.

Ectopic pregnancy

Depending on the hCG level, the scan and your symptoms: monitoring, a methotrexate injection, or keyhole surgery (laparoscopy). The tube is kept when possible (salpingotomy) or removed if it is too damaged or there is haemorrhage (salpingectomy).

Molar pregnancy

It is treated by aspiration, then monitored with hCG blood tests until levels return to normal, in liaison with a centre specialising in trophoblastic disease.

When is bleeding in early pregnancy an emergency?

Any bleeding in the first trimester calls for a medical appointment the same day. Call 15 (SAMU) or 112 in France, or your local emergency number, or go immediately to the gynaecological or maternity emergency department (if you are already registered, the one at your maternity unit: Sainte-Félicité or Sainte-Thérèse) if:

• the bleeding is heavy (soaking a thick pad in less than an hour, two hours in a row) or comes with large clots;
• you have severe pain in the lower abdomen, especially on one side;
• you have shoulder-tip pain, an urgent need to open your bowels for no reason, dizziness or you feel faint;
• you are pale, with a racing heart;
• you have a fever or foul-smelling discharge;
• you have had an ectopic pregnancy or tubal surgery before, or you are pregnant with a coil (IUD) in place.

How can I cope with the uncertainty after bleeding in early pregnancy?

Bleeding in early pregnancy often causes great anxiety, and waiting for a second scan can feel very long. Do not hesitate to ask all your questions and to ask for the results to be explained.

If the pregnancy ends, please know that it is not your fault. Psychological support can be offered to you and your partner. Information on later pregnancy loss can be found in the article on pregnancy loss and miscarriage.

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.