Spotting and cramping in pregnancy

Bleeding and cramping is often nothing serious, but is worth checking out with your doctor or midwife.
Bleeding and cramping is often nothing serious, but is worth checking out with your doctor or midwife. 

Many women experience spotting and cramping in the first trimester of pregnancy – in fact, one out of every two or three pregnant women experience some bleeding. While these symptoms can be nothing to worry about for the majority of women, they can also be signs of miscarriage, so it’s important to monitor them and get medical attention if they happen.

Cramping is any type of abdominal spasm of the front or back muscles. Cramps can be painful or just uncomfortable, but generally they should be irregular and bearable. If the cramps are a sign of something more sinister, they can be sharp and ongoing, and may even pull the muscles taut and tight, like contractions.

Spotting is light bleeding that’s pink or brown in colour, and is different to menstruation blood in both volume and texture. Bleeding that can indicate a miscarriage is likely to be heavy and dark in colour, and might contain clots or clumps of tissue. When spotting first starts, it’s a good idea to wear a pad so you can monitor blood loss (don’t use tampons for bleeding – this increases the chance for uterine infection and toxic shock syndrome, which can impact on the health of your unborn baby). When the amount of blood is the same or more than you’d lose during a period, it’s important to get medical advice. If the blood loss is intermittent and faint it’s less likely there’s a problem, but it’s still a good idea to get advice from your doctor or midwife.

The combination of bleeding and cramping together is a stronger sign that there’s something wrong. When you visit your doctor, she can check whether the pregnancy is healthy by looking for a foetal heartbeat, checking that your hCG levels are correct for the gestation period, and by looking at the growth of the baby via an ultrasound.

Unfortunately, miscarriage is a risk during pregnancy – it’s thought that about 15% of known pregnancies end in this way. Miscarriage most often takes place in the first 12 weeks of pregnancy (but can occur up to 20 weeks), so spotting and cramping in the early stages are more serious. Any bleeding or cramping that takes place after 20 weeks will most likely be related to pregnancy complications such as placental abruption, placental previa, pre-eclampsia and/or preterm labour.

But it’s likely that bleeding and cramping are signs of other things in pregnancy, including:

  • Implantation bleeding, which occurs in the two weeks after conception, once an egg has been fertilised and is implanted into the uterine wall. The bleeding will be very faint and resemble coloured discharge.
  • Ectopic pregnancy occurs when the fertilised egg is implanted outside the uterus, usually in the fallopian tubes but sometimes in the ovaries, cervix or somewhere else in the pelvis, such as the bowel. The resulting internal bleeding can bring about spotting and cramping. An ultrasound can check for ectopic pregnancy – but if you’ve already had a scan and it was fine, this wasn’t the cause of the bleeding and cramping.
  • Growth can cause cramping during pregnancy, as a result of the expansion of the uterus ligaments and the hormonal processes that are needed for the pregnancy to progress. These kinds of cramps are very common during the first trimester.
  • Molar pregnancy occurs when an egg is fertilised but there’s unusual cell growths. This mimics a true pregnancy, with high hCG levels and bleeding, but in a molar pregnancy there’s no embryo and therefore no heartbeat. An ultrasound will rule this out. 
  • Infections such as urinary tract infections, which develop easily during pregnancy, can sometimes lead to blood in the urine from the bladder. Treatment is crucial as urinary tract infections have the potential to turn into a kidney infection, which can lead to premature labour.
  • Minor vaginal tearing during sex can lead to a small amount of blood loss. You might also get cramps after sex, particularly after an orgasm, because hormones are released that cause the uterus to contract.
  • Sub-chorionic hematoma causes bleeding between the placenta and the wall of the uterus, or within the layers of the placenta. It has the potential to lead to miscarriage, and can be detected with an ultrasound.
  • Other medical conditions, such as appendicitis and kidney stones, can lead to cramping and bleeding, so don’t always assume pregnancy is the cause. These symptoms may be completely unrelated to the pregnancy, but it’s a good idea to get them treated to avoid any pregnancy complications.

Facts verified by Dr Raewyn Teirney, a gynaecologist, obstetrician and fertility specialist, and a visiting medical officer at the Royal Hospital for Women in Sydney. Dr Teirney also consults from her private rooms at Maroubra and Kogarah. 

When the amount of blood is the same or more than you’d lose during a period, it’s important to get medical advice