Call now

The NHS is clear that bleeding in pregnancy is not always serious, and equally clear about what to do about it: "It's important to get advice from a healthcare professional."

Call 999 if you are pregnant and bleeding and:

you have severe pain in your tummy — the NHS defines this usefully as pain that means "you cannot focus on TV, read a book or do daily tasks"
you have pain in your shoulder
you feel sick, faint, dizzy or lose consciousness
the bleeding is heavy — soaking a period pad soon after putting it on

Call your maternity unit for any other bleeding or spotting, including light spotting with no pain. From 20 weeks that is your midwife or maternity unit; before then it may be your GP or an early pregnancy unit. If you cannot reach anyone, call NHS 111.

The HSE puts it among the symptoms needing immediate contact and adds the sentence that should settle any hesitation: "But always contact your GP, midwife or obstetrician urgently if you experience any bleeding."

Add one more trigger, because it changes the urgency further: any change in your baby's movements alongside bleeding. That is its own reason to ring immediately.

What counts as bleeding

The NHS describes three levels so you can say which one you mean:

Spotting — spots of pink, red or brown blood on your underwear or toilet paper.
Light bleeding — larger areas of pink, red or brown blood that may need a period pad.
Heavy bleeding — red blood that soaks through a period pad, possibly with clots or lumps.

It adds that bleeding "may be constant, or may come and go", which is why stopping is not a reason to cancel the call. Brown blood is old blood, but old blood still means bleeding happened.

Why it is taken seriously after 24 weeks

RCOG's Green-top Guideline on antepartum haemorrhage defines it as bleeding from or into the genital tract from 24 weeks of pregnancy until the birth, and gives the scale: "APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide." It adds that "up to one-fifth of very preterm babies are born in association with APH".

It also names the two causes that matter most: "The most important causes of APH are placenta praevia and placental abruption, although these are not the most common." That sentence contains the whole logic of the guidance. Most bleeding turns out to be something minor. The reason every episode is assessed is that the serious causes cannot be distinguished from the minor ones by how much blood there is.

What it can be

The NHS and HSE together list the causes for later pregnancy:

Changes to the blood vessels in your cervix, which the NHS notes can cause bleeding after sex, for example. This is common and usually harmless.
Infection or inflammation of the cervix, named by the HSE.
Placenta praevia — the placenta lying low in the womb, covering part or all of the cervix. Classically painless bleeding.
Placental abruption — the placenta coming away from the wall of the womb, usually causing bleeding and pain. The NHS says the pain "can come and go like a contraction, or it can be constant" and that if pain or bleeding is severe, call 999.
Late miscarriage — the HSE defines this as loss between 12 and 24 weeks.
A show — the plug of mucus sealing the cervix coming away, sometimes with blood, which can mean labour is starting.
Preterm labour. The HSE notes bleeding later in pregnancy can be a sign of labour, especially with tightenings or lower tummy pain, and that before 37 weeks this may be premature labour.

The NHS adds an honest closing line: "Sometimes it's not possible to find the cause of vaginal bleeding in pregnancy." That is a real and common outcome, and it does not mean the assessment was pointless.

What happens when you go in

The NHS sets out the assessment. You will be asked about your health, your symptoms, how many weeks pregnant you are, and about any previous bleeding or pregnancies. Take your maternity notes if you have them. Checks may include looking inside your vagina, an ultrasound scan on your tummy or internally, blood tests, and a urine sample.

Expect your baby to be monitored as well — heartbeat, movements, and often a CTG trace. If you are rhesus negative you may be offered anti-D, which is a routine part of managing bleeding rather than a sign of anything additional.

ACOG's patient information takes the same line: bleeding in later pregnancy should be reported to your obstetric team promptly, because assessment is what distinguishes the common causes from the serious ones.

What treatment can involve

The NHS says treatment depends on the cause and on how many weeks pregnant you are, and lists the possibilities: closer monitoring, which may mean being admitted to hospital; medicine; surgery; induction of labour if you are in the later weeks; or a caesarean section if the bleeding is caused by placenta problems, "to help your baby be born safely".

It also says something that is often true and rarely said: "You may not need treatment if tests find the bleeding is not serious and the pregnancy is healthy."

Bleeding after sex

This deserves separating out because it is common and because people talk themselves out of ringing about it. The NHS names changes to the blood vessels in the cervix as a cause of bleeding after sex in pregnancy. The cervix has a richer blood supply while you are pregnant and is more easily irritated, so light spotting afterwards is a recognised and usually harmless event. It is still worth a call, for the same reason as any other bleeding: the cause cannot be assumed from the circumstances, and a quick assessment settles it.

The one thing not to do

Do not wait to see whether it stops. Bleeding that comes and goes is explicitly described by the NHS, and a pad that stays clean for two hours does not tell you which cause you had. The assessment is quick, the maternity unit is staffed around the clock, and no one will think you overreacted.

Bleeding in the Second or Third Trimester