Week 10

Bleeding is not caused by anything you have done – even if you have had a miscarriage. Most miscarriages occur because there is something wrong which cannot be prevented.

Bleeding in early pregnancy

This information is for women experiencing bleeding or spotting in early pregnancy.

Bleeding in early pregnancy can be very worrying. This leaflet aims to provide some information and guidance, and answer some commonly asked questions, which we hope will provide some reassurance for you at this uneasy time.

What is bleeding and spotting in early pregnancy?

Bleeding or spotting in early pregnancy is a common occurrence, with up to 25% of women experiencing spotting or bleeding in the first 12 weeks of pregnancy. Unfortunately it is sometimes an indication that you are having a miscarriage, but around half of women who experience bleeding or spotting in early pregnancy carry on to have a normal pregnancy.

Spotting in pregnancy is often identified when a woman notices spots of blood on her underwear or on tissue after wiping.

You may also notice some pink, brown, red or dark red blood. Sometimes women may pass fresh red blood, or clots. Some women also notice some string like tissue coming from their vagina.

Bleeding is sometimes associated with pain, but not all the time.

What can cause bleeding in early pregnancy?

• Implantation bleed (normal pregnancy). Many women experience bleeding when the pregnancy implants in the womb.
• Threatened miscarriage. This is where there is vaginal bleeding in women under 24 weeks pregnant, with no dilation of the cervix. The pregnancy continues as normal – this occurs in around 20% of all pregnancies.
• Miscarriage.
• Ectopic pregnancy. This is a pregnancy which develops outside of the uterus, this occurs in 1 in 80 pregnancies
• Bleeding from the cervix. Hormonal changes in pregnancy result in changes to the cervix, this commonly causes bleeding.
• No obvious cause. Sometimes it is not possible to identify the cause of bleeding.

Bleeding is not caused by anything you have done – even if you have had a miscarriage. Most miscarriages occur because there is something wrong which cannot be prevented.

What can I expect whilst in the Emergency Department?

Streaming

After you arrive in the Emergency Department you will be asked some brief questions by one of our experienced nurses.
If you do not need emergency treatment, the streaming nurse may be able to refer you directly to a specialist service who will assess you within 72 hours. This avoids the need for you to wait in the Emergency Department.

Triage

If there is any uncertainty as to whether you need emergency treatment, a second experienced nurse will triage you. They will need to know the date of your last period, any symptoms you have, and any medical history. You will be asked for a urine sample and the nurse will check your pulse and blood pressure.

They may also take some blood samples and insert a cannula (drip) but this isn’t necessary for all women.
You may then be asked to wait to see an Emergency Department clinician, or be referred to the Early Pregnancy Clinic if you are well enough.

What next?

6-12 weeks pregnant

If your bleeding is not too heavy and you feel well in yourself, you will be referred to the Early Pregnancy Clinic. This usually involves a phone call the following working day (Monday, if this is a weekend) where the specialists will discuss your symptoms and either give you advice over the phone, or make an appointment to come into hospital for assessment. This may include blood tests and an ultrasound scan, but not every woman needs these.

If bleeding is heavy, you are unwell, or have severe pain, you will be triaged and assessed by a clinician in the Emergency Department or referred directly on to the Gynaecology Team.

Over 12 weeks pregnant or in severe pain

Depending on your symptoms you may be seen in the Emergency Department, referred directly to the gynaecology ward or, if you are over 12 weeks with light bleeding you may be referred to the Early Pregnancy Clinic.

This usually involves a phone call the following working day (Monday, if this is a weekend) where the specialists will discuss your symptoms and either give you advice over the phone, or make an appointment to come into hospital for assessment.

Less than 6 weeks pregnant

Follow-up appointments are not routinely arranged if you are under 6 weeks pregnant. This is because light bleeding is fairly common at this stage and it is usually too early to see anything on a scan.

You should take a further pregnancy test in 1 week and contact your GP or call 111 for advice at this point if you are still worried. If you have worsening pain or bleeding at any point you should also call 111 or contact your GP.

How will I know if this is a miscarriage?

It may not be possible to tell straight away whether you are having a miscarriage, depending on your symptoms and your stage of pregnancy, even if you have an ultrasound scan.

You may asked to come back to clinic for a repeat scan after 1-2 weeks or you may be advised to have a blood test. This can be an upsetting time and it may help to share your feelings with a partner or trusted friend or family member. There are also some support websites at the end of this leaflet which you may find helpful.

What can be done?

Unfortunately, if a miscarriage is going to happen, there is no medical treatment that can prevent it. 90% of miscarriages are due to a problem with fetal development and would never continue to be a normal pregnancy.

Most women who miscarry can expect to experience bleeding like a period for up to 2 weeks.

If the bleeding is not due to miscarriage, it may settle on its own, or if it continues you may need to be monitored more frequently by your midwife.

If you have had your third miscarriage, there is sometimes an underlying cause which can be treated – speak to your GP who can refer you to a specialist.

If there is heavy bleeding you may need to be monitored in hospital, or if we think you may have an ectopic pregnancy you will need further assessment with an ultrasound scan. A specialist will discuss the treatment options with you.

What if I become more unwell, or the bleeding increases after I am discharged?

If you have any of the following symptoms, you should come back to the Emergency Department to be re-assessed:

• Bleeding: If you are filling more than 2 large pads per hour, or passing clots the size of your palm.
• Fainting or feeling faint.
• Severe or increasing pain in your pelvis, abdomen, or shoulder.

Frequently asked questions

Have I done anything to cause the bleeding?

No. Bleeding is not caused by anything you have done – even if you have had a miscarriage. Most miscarriages happen because there is something wrong which cannot be prevented.

Should I use tampons or pads?

Sanitary pads are the safer and better option. Please ensure they are changed regularly.

Can I still have sex?

Whilst sexual intercourse is safe during pregnancy, we advise waiting until any spotting or bleeding has completely stopped until resuming sex.

Can I still go to work?

It is not necessary to stay off of work, however ensure you are getting adequate rest if you are tired. You can self-certificate for 3-7 days, after this you will need to contact the GP who can assist you.

Can I have a bath?

Although showers are more hygienic whilst you are bleeding, it is safe for you to have a warm bath.

Week 10

Welcome to week 10. Pregnancy is divided into 3 chunks, called “trimesters”. You are nearly at the end of your 1st trimester.

By the 2nd trimester you will probably have lots more energy and all those signs of early pregnancy will gradually fade away.

Around now, you may have a booking appointment with a midwife. You’ll be asked lots of questions about your health and medical history. You can ask lots of questions too.

What’s happening in my body?

You may be struggling to do up your jeans. Your uterus (womb) is around the size of a large orange, while your baby is more like the size of an apricot.

You may be feeling bloated and you might find yourself burping or passing wind – this is due to your hormones. The female hormone progesterone is just doing its job – relaxing the muscles in your womb so that it can expand along with your growing baby.

However, in the process, the muscles in your digestive tract also become looser and this can lead to symptoms such as heartburn.

Early pregnancy symptoms (at 10 weeks)

Your signs of pregnancy may include:

• extreme tiredness
• nausea
• mood swings
• a metallic taste in your mouth
• sore breasts
• indigestion and heartburn
• headaches
• dizziness
• new likes and dislikes for food and drink
• a heightened sense of smell
• a white milky pregnancy discharge from your vagina
• light spotting (see your doctor if you get bleeding in pregnancy)
• cramping, a bit like period pains
• darkened skin on your face or brown patches – this is known as chloasma or the –mask of pregnancy–
• greasier, spotty skin
• thicker and shinier hair
• bloating and the feeling of being bloated

If any symptoms are worrying you, talk to your midwife or doctor.

How to beat the bloating

You can help digestive problems such as bloating and burping by changing what you eat. Try making yourself 6 small meals a day and avoid eating late at night.

Eat slowly, sip fluids and avoid smoking and alcohol. A short stroll after meals may help. Some people find their symptoms happen after drinking coffee or eating rich, spicy and fatty foods.

What does my baby look like?

Your baby, or foetus, is now around 30mm long from head to bottom, which is about the size of a small apricot.

The baby will be making jerky movements and baby’s movement can be seen on a scan.

Your baby is going through another huge growth spurt. The head is still too big for the body, but the face is more recognisably in proportion. The eyes are half closed but can react to light.

The ears are starting to form, the mouth now has a delicate upper lip and the nose has 2 little nostrils. The jaw bone is shaping up too, and contains tiny versions of your baby’s milk teeth.

The heart is beating extremely quickly at 180bpm – that’s about 3 times your heart rate.

Your baby is about the size of an apricot.

Action stations

See your midwife or GP

Share the news with your GP or ask for an appointment with a midwife at your doctors’ surgery. Alternatively you can refer yourself to your local hospital – look for contact details on their website.

You’ll need to arrange a booking appointment. This usually takes place between weeks 8 and 12, and takes around an hour.

You can talk about the options for your pregnancy and the birth. Plus you’ll be offered screening tests for infectious diseases, and conditions such as Down’s syndrome. You could ask about the Maternity Transformation Programme and how it could benefit you.

You will get your first dating scan at 8 to 14 weeks.

If it’s your first pregnancy you will probably have around 10 appointments and 2 scans in total. Ask if it’s possible to see the same carer for your entire pregnancy, to give you continuity.

Antenatal classes

Ask your midwife or doctor about online antenatal classes – they may be able to recommend one. The charity Tommy’s has lots of useful information on antenatal classes and preparing you for birth.

Antenatal classes will give you the chance to meet other people and prepare you for parenthood. The NCT offers online antenatal classes with small groups of people that live locally to you.

Smoking, drinking and caffeine in pregnancy

Ask your midwife or GP for support.

Vitamins in pregnancy

Take prenatal vitamins. You’re advised to take 400mcg of folic acid every day, until at least week 12. This helps to form your baby’s nervous system and offers some protection from conditions such as spina bifida.

To keep bones and muscles healthy, we need vitamin D. From late March/early April to the end of September, most people make enough vitamin D from sunlight on their skin.

However, between October and early March, consider taking a daily vitamin D supplement because we cannot make enough from sunlight.

Some people should take a vitamin D supplement all year round – find out if this applies to you on the NHS website.

You just need 10 micrograms (it’s the same for grown-ups and kids). Check if you’re entitled to free vitamins.

Exercising in pregnancy

You could start off with just 10 minutes of daily exercise – perhaps take a brisk walk outside. Check out Sport England’s #StayInWorkOut online exercises (scroll to the pregnancy section).

Listen to your body and do what feels right for you.

Healthy eating

There’s no need to eat for 2. You just need to eat a healthy balanced diet, with a variety of different foods every day, including plenty of fruit and veg. Have a look at our guide to healthy eating in pregnancy.

You may be able to get free milk, fruit and veg through the Healthy Start scheme.

Emotional and mental wellbeing

How are you today? If you’re feeling anxious or low, then talk to your midwife or doctor. They can point you in the right direction to get all the support that you need. You could also discuss your worries with your partner, friends and family.

You may be worried about your relationship, or money, or having somewhere permanent to live.

Don’t keep it to yourself. It’s important that you ask for help if you need it.

Sexually transmitted infections (STIs)

Do you think you or your partner could have an STI? If so, get checked out, as this could affect your baby’s development. Talk to your midwife or GP, or visit a sexual health clinic.

Long-term conditions

If you have a long-term health condition, then let your specialist or GP know you’re pregnant as soon as possible.

Don’t stop taking any regular medication without discussing it with your doctor first.

Want to know when the baby’s due?

Use the NHS’s pregnancy due date calculator. You’ll get a more accurate date from your doctor or midwife when you have a dating scan (usually at 8 to 14 weeks).

More in week-by-week

Week 11

You only have 2 weeks until you start your 2nd trimester. This is when many women start to “glow” and regain their energy as their hormones settle down.