Bleeding later in pregnancy: what can cause it and when to get help

Any bleeding in pregnancy should be checked, even if it’s light. This guide is for bleeding after the first 12 weeks, and explains what the NHS says to do.

What to do if you’re bleeding

The NHS says vaginal bleeding in pregnancy isn’t always serious, but it can sometimes need urgent treatment, so it’s important to get advice. Tommy’s, the pregnancy charity, says bleeding after 12 weeks is not common.

Call your midwife or maternity unit straight away if you have any bleeding or spotting, even if it’s light and you have no pain, or only mild tummy pain that doesn’t stop you doing daily tasks. The NHS says the same applies if you also have diarrhoea, or pain or pressure when you pee or poo.

If you’re under 20 weeks, an early pregnancy unit may also be able to help. Contact details are on your local NHS trust’s website or in your maternity notes.
If you don’t have a maternity unit’s number, call NHS 111.
Don’t wait for your next appointment.

Call 999 if you’re bleeding and:

you have severe tummy pain (the NHS describes this as pain that means you can’t focus on TV, read or do daily tasks)
you have pain in your shoulder
you feel sick, faint or dizzy, or you pass out
the bleeding is heavy, meaning it soaks a period pad soon after you put it on

Tommy’s also says to call 999 if you have heavy bleeding and you know you have a low-lying placenta, or if you have a lot of pain or bleeding that could be a placental abruption.

What bleeding can look like

The NHS describes three kinds:

Spotting: small spots of pink, red or brown blood on your underwear or on 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, sometimes with clots or lumps.

The bleeding may be constant, or it may come and go. Whatever it looks like, get it checked.

What can cause bleeding later in pregnancy

The NHS and Tommy’s list several possible causes. Some aren’t serious, but some need treatment quickly, which is why any bleeding needs checking.

Changes to your cervix. The NHS says changes to the blood vessels in your cervix (the entrance to your womb) can cause bleeding, for example after sex. Tommy’s says this may settle and doesn’t necessarily mean there’s a problem, but you should still contact your maternity unit so you can be checked.
An infection, such as a vaginal infection, a urine infection or a sexually transmitted infection.
A low-lying placenta or placenta praevia. This is when the placenta is low down in the womb, near the cervix or covering it. The NHS says it can cause painless, bright red bleeding in the last 3 months of pregnancy, and the bleeding can be heavy. Your placenta’s position is recorded at your 20-week scan. If it’s significantly low, you’ll usually be offered another scan at about 32 weeks.
Placental abruption. This is when the placenta starts to come away from the wall of the womb. The NHS says it can cause tummy pain, bleeding and frequent contractions. Tommy’s calls it a serious condition. It says bleeding is the most common sign, but not everyone has it. Some people say their tummy feels bruised, and some have severe pain. Your bump may feel tense or hard, and some people have lower back pain.
A show. This is the plug of mucus from your cervix coming away, sometimes with some blood. The NHS says a show can mean labour is starting. See signs of labour.
Vasa praevia. Tommy’s describes this as a rare condition where the baby’s blood vessels run through the membranes covering the cervix. These vessels are delicate. If they tear in labour or when your waters break, this can cause bleeding.
Late miscarriage. Tommy’s uses this term for a miscarriage between 12 and 24 weeks.

Sometimes no cause is found.

Keep an eye on your baby’s movements

Whatever else is going on, call your midwife or maternity unit straight away if your baby’s movements slow down, stop or change. See your baby’s movements in pregnancy.

What happens when you’re checked

The NHS says you’ll be asked about your health, your symptoms, how many weeks pregnant you are, and any bleeding or pregnancies you’ve had before. You may have:

a check inside your vagina
an ultrasound scan, on your tummy or inside your vagina
blood tests
a urine test

Treatment

The NHS says treatment depends on the cause and how many weeks pregnant you are. You may need closer monitoring, sometimes in hospital. Some people don’t need any treatment, if the bleeding isn’t serious and the pregnancy is healthy. Others may need medicine or surgery. In the later weeks of pregnancy, you may be offered an induction of labour. If a problem with the placenta is causing the bleeding, you may be offered a caesarean.

Bleeding in the first 12 weeks

If you’re in the first trimester, see spotting in early pregnancy. It covers early causes and what to do.

Questions people ask

I bled a little after sex. Do I need to call?

Yes. The NHS says changes to the blood vessels in your cervix can cause bleeding after sex. Tommy’s says this may settle and doesn’t necessarily mean there’s a problem, but you should still contact your maternity unit so you can be checked.

The bleeding didn’t hurt. Does that mean it’s nothing to worry about?

Not necessarily. The NHS says a low-lying placenta can cause painless, bright red bleeding, and the bleeding can be heavy. Call your midwife or maternity unit straight away, even if you have no pain.

How do I know if it’s a show or bleeding?

A show is the mucus plug coming away, and it can have some blood in it. The NHS says it can mean labour is starting. If you’re not sure, call your midwife or maternity unit.

Can I wait until my next appointment?

No. Call your midwife or maternity unit straight away. Call 999 if the bleeding is heavy, or you have severe tummy pain or shoulder pain, or you feel sick, faint or dizzy.