Bleeding and cramping in early pregnancy: what’s normal and when to call

The NHS says these need immediate help. In the UK, call 999.

• Severe tummy pain, where you can’t focus on TV, reading or daily tasks
• Shoulder pain
• Feeling sick, faint or dizzy, or losing consciousness
• Heavy bleeding, soaking a period pad soon after putting it on

Light bleeding or spotting still needs a call, even with no pain or only mild pain. In the UK, contact your maternity unit or, if you’re under 20 weeks, an early pregnancy unit if there is one. If you can’t reach them, call 111.

In the US, ACOG says to contact your ob-gyn about any bleeding at any time in pregnancy.

ACOG says bleeding happens in 15 to 25 in 100 pregnancies during the first trimester. MedlinePlus says up to 1 in 4 women have some bleeding in pregnancy, and that it’s more common in the first 3 months.

Sometimes no cause is found. Common explanations include:

• Implantation. ACOG says light bleeding or spotting can happen 1 to 2 weeks after fertilisation
• Changes in the cervix, which bleeds more easily in pregnancy, including after sex
• An infection, such as a urine infection or a sexually transmitted infection, which will need treatment

Bleeding can also be a sign of miscarriage or ectopic pregnancy, and sometimes a molar pregnancy. That’s why every bleed needs a call.

Ectopic pregnancy means the pregnancy is growing outside the womb. The NHS says this affects about 1 in 90 pregnancies, and that symptoms usually start between weeks 4 and 12. Get medical advice if you have:

• Tummy pain low down on one side
• Vaginal bleeding or a brown, watery discharge
• Pain in the tip of your shoulder
• Discomfort when you pee or poo
• A sudden, sharp, intense pain, feeling very dizzy or faint, feeling sick or looking pale. These can mean a rupture, so call 999 or go to A&E

Miscarriage means losing a pregnancy before 24 weeks. The NHS lists bleeding, cramping, fluid from your vagina, and pink, grey or white lumps. You may have blood or urine tests and an internal ultrasound to find out what’s happening.

Bleeding doesn’t always mean a miscarriage. Read what the studies say about risk by week.

The NHS says stomach pains are common in pregnancy and usually nothing to worry about, particularly if they’re mild and ease when you change position, rest, do a poo or pass wind. Ligament pain, constipation and trapped wind are harmless causes.

Call your maternity unit straight away, or your GP or early pregnancy unit if you’re under 20 weeks, if you have stomach pain with any of these:

• Vaginal bleeding or spotting
• Regular cramps or tightenings
• Lower back pain
• Unusual discharge or leaking fluid
• Pain when peeing, or a sudden or more frequent need to pee
• Cloudy, pink, red or brown pee
• Severe pain, or pain that doesn’t go after resting for 30 to 60 minutes

ACOG says bleeding later in pregnancy can be more serious. Heavy bleeding may come from a problem with the placenta, and any amount can signal preterm labour. Contact your maternity team or ob-gyn right away or go to the hospital. Close to labour, a “show” can happen, but bleeding heavier than that needs a call straight away.

Tell the team looking after you. The NHS says you may be offered an anti-D injection after a miscarriage at 12 weeks or later, or after an ectopic pregnancy treated with medicine or surgery.