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

Over 12 weeks pregnant or in severe pain

Less than 6 weeks pregnant

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?

Should I use tampons or pads?

Can I still have sex?

Can I still go to work?

Can I have a bath?

If you need any further advice or information 

Useful organisations and websites

© North Bristol NHS Trust.  This edition published June 2024. Review due June 2027. NBT003376.

This information is for patients who have attended the Emergency Department following an episode of self-harm. 

Thank you for attending the Emergency Department. We understand that this must be a difficult and distressing time for you.

Our team would like to be able to offer you an assessment of your current needs in order for us to identify any help that may be beneficial to you. 

It is also important that you have any physical healthcare needs addressed. We would therefore like you to wait to be seen by the triage nurse and the admitting doctor. 

Whatever your reason is for attending the Emergency Department, we aim to treat you with respect, dignity, and in confidence.

What is self-injury and self-harm and who does it affect?

Self-injury or self-harm can be many things that people do to themselves in a deliberate and often hidden way like cutting, burning, overdosing, scratching, biting, hair pulling and breaking bones. 

Sometimes people think they are the only ones doing it but research shows that it is very common. 

In the UK at least one in every 15 young people has experience of self-injury. That is two young people in every classroom. 

Why do people self-injure or self-harm?

People self-injure and self-harm for all sorts of reasons, but often it is because feelings like anger, sadness, and fear have got too painful to deal with. 

Sometimes people self-injure or self-harm because of the pressure and stress from things like relationships, family problems, school, work, finances, debt and sexual worries. It may be way of dealing with horrible situations like abuse or the death of someone close. 

You may not know why you self-injure or self-harm. If you think back to the first time, then you may understand what made you start. 

Notice what is going on for you when you get the urge to self-injure and you may get clues as to what your self-injury or self-harm is about.   

Wound care: 

If you require any advice or instructions around wound care please ask a nurse before you leave or attend your GP surgery as soon as possible for assistance. 

Please visit Wound care advice | North Bristol NHS Trust (nbt.nhs.uk) for advice about wound care. 

Sources of Support and information. 

Self Injury Self Help Group (SISH)
www.sishbristol.org.uk/support-groups

Self injury helpline 
Available Tuesday and Wednesday 7pm-9 pm
Thursday 3pm-5pm
Phone: 0117 230 8230     
Email: sishbristol@gmail.com 

Self injury support 
www.selfinjurysupport.org.uk

National Self Harm Network
Online peer support forums
www.nshn.co.uk

NHS direct 
Phone: 111

Bristol Mindline
Wednesday to Sunday, 8pm – midnight
Phone: 0808 808 0330

Kinergy-Sexual Abuse Counselling
www.kinergy.org.uk
Phone: 0117 908 7712

Next Link – Domestic Abuse services – Bristol
Phone: 0800 4700 280

Survive – Domestic Violence Support Service – South Gloucestershire
Phone: 0117 961 2999

DHI – Developing health and independence, drug and alcohol service 
Bristol Phone: 0117 440 0540    
South Gloucestershire Phone: 01454 868750
Email: info@dhi-online.org.uk 

ARA, Bristol Alcohol Misuse Service 
Phone: 0330 1340 286 

Your GP maybe able to offer you more information and support services

Samaritans 24hr helpline 
Phone: 116 123

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002890.

​This information will help with any questions you may have after sustaining a burn or scald.

First aid

• Run the burn or scald under cool water for 20 minutes or until the burning feeling begins to settle.
• We may continue to cool the burn under water when you arrive to the Emergency Department (ED).
• Immediate cooling is vital to stop further damage to the skin.
• Cover the burn with a damp, clean cloth or clothing, you can also use loosely applied cling film, ensuring it is not too tight.
• Do not pop any blisters this will be done by someone trained and in a clean environment.
• Do not apply any creams as this can make the burn worse.

The healing process

In the ED we will apply a suitable dressing and advise you if any further dressing changes are required.

Further dressing changes can be done by your treatment room nurse based at your GP surgery; you will need to call them to arrange an appointment.

Healing can take 14-21 days. Smaller and very superficial burns may take less.

We may feel it necessary to refer you to the Burns Specialist team (Adults: Southmead Hospital, Children: Bristol Children's Hospital). If so, you will be given a follow up appointment before your discharge from the ED.

Staying hydrated by drinking well and having a healthy diet will help with healing.

Once the burn is healed it is important to protect that area from the sun, it will be more susceptible to burning. Use a high factor sun cream or keep covered with clothing when in the sun.

How to look after your dressing

• Keep your dressing dry and clean at all times and cover the dressing when bathing or showering.
• Ensure you have your dressing changed as advised by a health care professional.
• If your dressing becomes dirty or falls off apply a temporary covering such as loose cling film or damp clean cloth and seek medical advice for a new dressing.
• When a dressing is no longer needed you will be advised of this. The area can appear dry, you can apply a non-perfumed moisturiser to the affected area.

Monitor for signs of infection

If you notice any of these signs you must seek medical advice as you might have an infection.

• Redness surrounding the dressing.
• Feeling feverish or unwell.
• Severe pain at the sight of the burn.
• Unusual colour leaking through the dressing.
• Offensive smelling odour.

Pain relief  

• You will be given appropriate pain relief while you are in the ED undergoing treatment for your burn.
• You can take regular paracetamol and/or ibuprofen for your burn.
• You can take pain relief such as paracetamol and/or ibuprofen an hour before your next scheduled dressing change.

Reference

British Burns Association (2021) www.britishburnassociation.org/patient-advice

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002439.

This page is for parents whose child has sustained a head injury. Following a thorough examination we are satisfied that the injury is not serious.

• Do expect your child to feel generally miserable and “off colour”. These feelings may include feeling sick (without vomiting), dizziness, irritability or bad temper, problems concentrating, problems sleeping or lack of appetite. Do not force them to eat but make sure that they have enough to drink.
• Do expect your child to be more tired than usual. Allow them to sleep if they want to. See them every hour or so. Do not be confused between normal sleep and unconsciousness - someone who is unconscious cannot be woken up. You need to be satisfied that they are reacting normally to you.
• Do expect your child to have a moderate headache. Children’s Paracetamol (sugar free) will suffice for this. A young child may only show a headache as fretfulness.

These symptoms should improve rapidly.

If you are concerned about any of these symptoms in the first few days, you should take your child to their doctor.

If these problems do not go away after two weeks, take your child to see their doctor.

Babies:

• Encourage your child to have plenty of rest and avoid stressful situations. Your baby should be alert and be easily arousable from sleep.
• Offer your baby milk feeds as normal. Avoid rich puddings etc. for the first two days.

Toddlers:

• Avoid vigorous play.
• Offer a light diet avoiding sweets/chocolates and fizzy drinks.
• Do make sure that there is a nearby telephone and that the child stays within easy reach of medical help.

Children:

• Do encourage your child to have plenty of rest and avoid stressful situations.
• Do not give them sleeping pills, sedatives or tranquilisers unless they are prescribed for your child by a doctor.
• Do not let them play any contact sport (for example, football) for at least three weeks without talking to their doctor first.
• Do not allow them to return to school until you feel that they have completely recovered.
• Do not leave your child alone in the home for the first 48 hours after leaving hospital.
• Do make sure that there is a nearby telephone and that the child stays within easy reach of medical help.

Even after an apparently minor head injury, complications may occur, but these are rare.

If you notice any of the following signs

• Unconsciousness, continuing drowsiness or difficulty in waking from sleep.
• Appears confused or not understanding what is said.
• Vomiting.
• Complaining of severe headache or trouble with their eyesight.
• Any loss of balance or problems walking.
• Becomes irritable.
• Has any kind of attack, which you think is a fit.
• Any weakness in one or both arms or legs.
• Clear fluid coming out of their ears or nose.
• Bleeding from one or both ears.
• New deafness in one or both ears.
• Cries more than usual or is more difficult to settle than usual.
• Fails to grasp objects.
• Any abnormal behaviour.

Then you are advised to contact your own doctor or contact the Emergency Department without delay.

If you are unsure of anything, please do not hesitate to telephone us. A nurse is always available to give advice and will be happy to help.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002266.

The results of the last three years of Pathology User Surveys are displayed below. We use a standard survey report available from the Royal College of Pathologists. This is fed into by a large number of laboratories and allows for some benchmarking and comparison to be carried out.

The survey undertaken in 2022 had a very poor response rate. We created a separate survey off the back of this to look at ways we could improve things. Your feedback was invaluable and increased the responses in 2023 as a result.

We have combined the 2022 and 2023 comment section to help us define our action plans. 

A new survey will be sent out towards the end of 2024. If you have any feedback in the meantime, please email BloodSciencesAdmin@nbt.nhs.uk.

​This page provides information for patients with any of the following:

• Fractured (broken) ribs
• Fractured sternum (breastbone)
• Chest wall bruising

Injuries of the chest wall can be very painful. Due to movement of the chest wall, deep breathing and coughing will be painful, but it is important to breathe and cough normally. Chest wall injuries often take several weeks to get better. As a rough guide, a patient with one broken/bruised rib can expect to be in pain for three weeks and to be in discomfort for several more weeks and even longer if more than one rib is involved. It may be helpful to sleep sitting upright for the first few nights.

There is no specific treatment for broken ribs and it is not always necessary to X-ray the chest, as the treatment for a broken rib is the same as that for a bruised chest. This is to take painkillers and follow the guidelines below.

The main complication is stagnation of the normal chest secretions leading to chest infection. The risk is greater in smokers and people with chest disease.

To prevent infection, you must:

• Do regular deep breathing exercises: 10 very deep breaths every hour.
• If you feel the need to cough, it is vital that you do cough to remove phlegm. You should not suppress it, despite the pain. It will be more comfortable to cough if you support the painful area with a pillow or, after a few days, your hand.
• Do take regular painkilling tablets, either as prescribed or as bought over the counter (e.g. aspirin or paracetamol). This will make it easier to cough and breathe deeply. Do not take cough linctus.

See your General Practitioner (GP) if:

• You become short of breath.
• You start to cough up green, yellow or blood-stained sputum (phlegm).
• You become unwell with a temperature.

This page gives guidance only. If you have any queries or your symptoms worsen, please contact your GP surgery or the Emergency Department.

If you are unsure of anything, please do not hesitate to phone us. A nurse is always available to give advice and will be happy to help.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002256.

How to care for your wound to aid wound healing

Glue

• A special wound glue has been used. It is designed to hold the wound edges together until it has healed.
• The glue will need to stay on long enough for this to take place (at least five days).
• The glue will come off on its own. Do not pick or encourage the glue off. Too early a removal will increase the risk of scarring and may introduce infection.
• Avoid washing the area. However, water splashing onto the wound after treatment will not affect the glue.
• Do not put any dressing on the wound. Never use an Elastoplast on the glue as this will make it sweat and the edges will not hold together.
• Do not use any antiseptic creams over the glue.

Staples

• Your wound has been closed using special steel wound staples. They are designed to hold the wound together until the wound has healed.
• You will need to make an appointment with the practice nurse at your GP’s surgery to have the staples removed in 5-7 days or as advised by the health care practitioner who put them in for you.
• We will provide you with a staple remover that you will need to take with you. It is a painless procedure.
• You may both shower and wash your hair with staples in. If using a hair dryer it is advised to have it on a cool setting.
• The staples are designed to stand up proud from the skin and this may, if you are not careful, catch in a comb or brush.

Suture (stitches)

• If your wound has been closed using stitches, you will need to make an appointment with the practice nurse at your GP’s surgery for them to be removed. Your clinician in ED will advise you on the number of stitches to be removed and how many days before they need to be taken out.
• Stitches on the face may not be dressed. Apply clean Vaseline to the wound twice a day, but not last thing at night as it will rub off on your bedclothes.
• If Steristrips have been used you can remove these yourself after seven days by gently moistening the wound and paper strips with warm water.
• Avoid touching the wound or getting it wet as this will encourage infections.
• If a plastic finger stall is needed for hygiene purposes, only use for short periods due to them increasing moisture around the wound site.

General wound care advice

Wound infections are always a possibility after an accident.

Please contact your GP if your wound develops any of the following:

• Increased redness, pain, swelling or heat around the wound.
• An offensive smell.
• A thick creamy discharge. However, it is normal for there to be a clear straw coloured fluid weeping from the wound in the first 36 hours.
• Fever.

If you get any of the above, please go and see your GP or return to the Emergency Department.

Tetanus

We will only give you a tetanus injection if you have the type of wound that is shown to be likely to be infected by tetanus or you have not had the full recommended course of immunisation during your lifetime.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002253.

Nutrition

Under this section, you can find out more information around how a dietitian can help with Nutrition and about Dietetic clinics

How can a dietitian help me?

Dietitians are ‘qualified and regulated health professionals that assess, diagnose, and treat dietary and nutritional problems at an individual and wider public health level’.

‘Dietitian’ is a protected title and they are the only legally recognised health professionals who advise on nutrition and dietary intake.

Dietitians translate nutritional science into understandable and practical information tailored to each patient.

We provide personalised and tailored advice for patients with and after a cancer diagnosis which might include

• Concerns about weight loss.
• Issues with your gastrointestinal system e.g. bowel habits.
• Eating well for the future.

Dietetic clinics

Dietetic clinics are run throughout the week to support individuals with nutritional concerns following a cancer diagnosis. This service offers the opportunity for people to self-refer, or to be referred by a professional for 1:1 nutritional advice from a HCPC registered Oncology (Cancer) Specialist Dietitian.

Referrals are accepted at any time following a cancer diagnosis, however, if we are unable to support your nutritional needs, in some cases, your GP may be able to direct you to another dietetic service in your area.

At present, we are able to support individuals with the following nutritional concerns:

• Coping with a poor appetite, or unintentional weight loss.
• Urgent nutritional support for cancer/treatment-related side-effects.
• Altered texture diets due to swallowing difficulty.
• Making dietary changes as a result of cancers affecting the digestive tract.
• Managing weight following completion of cancer treatment – acceptance criteria will apply.
• Eating well to support your health in the future.

We are not currently excepting patients with a diagnosis of upper gastrointestinal malignancy. Please contact your GP for referral to a local dietetic service. 

A variety of support options are available including; face-to-face appointments (if safe and appropriate to do so), video calls, and telephone support. Self-referral forms are available from the NGS Macmillan Wellbeing Centre or the self-referral is available online.

Exercise

A daily brisk walk can give your body a boost, lift your mood and make everyday activities easier. Try the NHS tools, tips and special offers to move more every day.

Penny Brohn Provides a range of resources. Ranging from exercise guides and lists of local charities to cookery demonstrations and relaxations. 

Online help and local community support to help manage your symptoms.

Get U Better App for musculoskeletal injuries

A free app containing advice, exercises and support to help manage common musculoskeletal injuries. Register for the service here and then download the app to your smartphone.

Local support services for musculoskeletal injuries

Download this Musculoskeletal (MSK) self-help information directory with information on local services that aim to support you to reduce pain and improve functionality.

Advice from the Chartered Society of Physiotherapy

The Chartered Society of Physiotherapy has advice, guidance and exercises to help manage your pain.

Living well with rheumatology conditions

This directory has useful information and resources for patients with rheumatology conditions.

Information on pelvic, obstetric & gynaecological physiotherapy

These webpages have health advice for patients who need pelvic, obstetric & gynaecological physiotherapy.

The Bladder & Bowel Community

The Bladder & Bowel Community help support the millions of people in the UK who are living with conditions that affect their bladder or bowel.

Mental Health resources

Looking after your mental health is just as important as your physical health. Here is a directory of local mental health services.