does implantation bleeding have small clots

Signs & symptoms

When you see a miscarriage portrayed on television or a film, you often see a woman suddenly overcome with excruciating pain and then collapsing in a pool of blood. In fact, that’s not what happens to most women.  We talk below about pain, bleeding, spotting and other symptoms – and about having no symptoms at all.

Pain, bleeding or spotting

Pain in pregnancy doesn’t always mean that there is a problem.

Some women feel discomfort as ligaments stretch with the growing baby. Many women experience backache, especially as the pregnancy progresses. And abdominal pain may be due to a stomach upset or constipation.

But if you are worried, and especially if you have severe abdominal or one-sided pain or pain in your shoulders, it might be wise to contact your GP and explain what is happening. That’s especially important if you have previously had an ectopic pregnancy.

Similarly, if you have pain when you try to move your bowels (pass a motion), you might also want to ask if you might be referred for an ultrasound scan to rule out the possibility of ectopic pregnancy.

Bleeding in pregnancy may be light or heavy, dark or bright red.  You may pass clots or “stringy bits”.  You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks.  It doesn’t necessarily mean that you are miscarrying or that you will miscarry: one study [1] of women attending an Early Pregnancy Unit because of bleeding in pregnancy showed that about half of them had continuing pregnancies.  So if you have bleeding or spotting, you may still go on to have a healthy pregnancy.

How can I know what’s happening?

If you have vaginal bleeding or spotting at any time during your pregnancy, it is worth talking first to your GP. S/he may refer you to hospital for an ultrasound scan to try to see whether the pregnancy is developing as it should.

Many hospitals now have a specialist Early Pregnancy Unit or Emergency Gynaecology Unit (EPU, EPAU, EPAC or EGU).  They usually require a GP referral. You can find information about your nearest Early Pregnancy Unit here or you could just contact the nearest hospital that has maternity facilities.

If you have acute, sharp abdominal pain, pain in your shoulders and/or pain on moving your bowels, contact your GP, EPU or midwife or if necessary, go to A&E (Casualty department). Tell them that you are pregnant and describe your symptoms so they can arrange an emergency scan.

If you have previously had an ectopic pregnancy, ask your GP or EPU for an early scan to make sure the baby is in the right place.

My GP won’t refer me for a scan…

If your GP won’t refer you for a scan, it might be because it is too early to be able to see even a healthy pregnancy on scan (see our section on ultrasound scans).  But it might be that s/he takes a “wait and see” approach and advises you to stay home and put your feet up, or to stay in bed – or just to go about your normal routine.

You might find this very frustrating and even frightening, especially if you are feeling very anxious:

• If it’s your first pregnancy, you may worry because you don’t know what is normal and what isn’t.
• If you have had a previous healthy pregnancy, you may worry because this pregnancy is not progressing in the same way.
• And if you have previously lost a baby, you are likely to be particularly anxious because of what happened last time.

But I really want a scan…

If you want a scan because of bleeding or spotting, and you can’t get an appointment at an Early Pregnancy or Emergency Gynaecology Unit, you could go to your nearest Accident & Emergency Department.  Bear in mind that you might have a long wait and that they may not be able to scan you there and then.

If you want a scan for reassurance, you might decide to go for a private scan (try putting “early pregnancy scan” and the name of the nearest town into your search engine).  It is best to ensure that they are registered with the Care Quality Commission (CQC) if in England, or adhere to the same standards if in other countries.

What should I do?

Whatever you do – have a scan, stay in bed or continue your usual routine – it’s very unlikely to make a difference to the outcome of your pregnancy.  Sadly, if the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to stop this. (The only exception might be if the bleeding occurs in the last few months of the pregnancy).

Resting in bed might slow down any bleeding, but when you get up, perhaps to go to the toilet, it’s likely to start again.  That’s not your fault – it’s just because of gravity. (Again, the only exception might be in the later months of pregnancy.)

Some people prefer to rest, others to continue their usual routine. It makes sense to do what feels right for you.

Other symptoms – or lack of…

It’s common for women to have certain symptoms in early pregnancy: feeling or being sick, tiredness, breast tenderness, a need to go to the toilet more often etc.  But if you don’t have any of those symptoms – or if you do and then they suddenly disappear – it doesn’t necessarily mean that you are likely to miscarry.

On the other hand – and this is confusing – having all of those symptoms doesn’t guarantee that all is or will be well. It can be very difficult to make sense of symptoms or their absence.

[1] Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s, Unpublished dissertation