Bleeding in early pregnancy!

One of the scariest thing in pregnancy is when you find yourself bleeding. Even a small red or brown coloured spot on your undergarments can really make you fear for your pregnancy. Although I agree that bleeding from the vagina in pregnancy is not a good sign but many a times the bleeding will not really turn out to be very significant. So here is a little information and guidance on vaginal bleeding in pregnancy.

Vaginal bleeding in early pregnancy

So one out of every four women can have bleeding in early pregnancy (first three months of pregnancy). However most of them will go on to have an otherwise normal pregnancy. The bleeding could be something not so serious or it could be a symptom of miscarriage or other complications like ectopic or molar pregnancy.

Possible causes

Implantation bleeding:  In very early pregnancy as the sac of the baby attaches to the lining of the womb there may be some areas where the sac is not completely attached. There can be slight bleeding from these areas as the baby burrows deep into the womb to get attached and start growing. This is normal and will not cause any risk to your pregnancy.

Possible miscarriage or risk of miscarriage: Whenever the fetus is not growing properly in the womb or has passed away very early there can be some bleeding. In early pregnancy one out of every 5 pregnancies can result in a miscarriage. This can be confirmed by a scan done by your doctor.

Ectopic pregnancy: When the fetus implants outside the lining of the womb it is called an ectopic pregnancy. The uterus being empty can result in slight spotting and the growing pregnancy outside the womb can cause bleeding inside your tummy to result in risk to you. This is a condition that must be diagnosed at the earliest with scan and hcg tests for earliest treatment and best outcome. An ectopic pregnancy cannot result in a healthy baby, it has to terminated.

Molar pregnancy: This is a condition where the pregnancy does not have a live fetus. Instead it is only abnormal placental tissue that grows and fills the womb. This is not very common and will require immediate treatment.

Bleeding from the cervix : sometimes a polyp or cervical lesion can bleed in pregnancy specially after intercourse.

Unexplained bleeding: sometimes no cause can be identified.

What you should do

Contact your obstetrician or GP at the earliest. If you are having heavy bleeding visit the closest early pregnancy assessment unit or accident and emergency. Also report to the emergency ASAP if you have associated fainting, dizziness or severe tummy pain. Meanwhile try and rest, avoid intercourse and stay calm.

What tests you may be offered

Your doctor will ask you a few questions about your pregnancy and the bleeding. He or she will then most likely offer a scan to check the pregnancy and some blood and /or urine tests. It is absolutely fine to do a trans vaginal (from down below) scan if the doctor feels it is needed. It will not increase the risk to you or the baby. In fact it will make the diagnosis more clear to your doctor. Sometimes your doctor may want to put in a small tube like instrument called a speculum in the passage down below to see if the bleeding is from the cervix. Again that is safe for you.

You may be asked to give a sample of your urine to rule out infection. Blood tests may be done to check the level of the pregnancy hormone (hcg) or your hemoglobin and blood group. Sometimes the doctor may do a swab from down below for chlamydia.

What treatments you might be offered

Depending on what the doctor feels is the cause of your bleeding you may be asked to come back in after 48 hours for a blood test (suspected ectopic pregnancy), advised rest and observation at home and review scan after 1-2 weeks, offered admission in case of heavy bleeding or medications to complete the miscarriage if the miscarriage is confirmed. Pregnancy supplements can continue. The role of progesterone medications that “support” the pregnancy is controversial. Research has not shown any clear benefit but you may choose to take them after discussing them with your doctor.

 What precautions you need to take

Well, in the early months the most common cause of miscarriage is abnormality in the baby itself. So, in a way nature miscarries the babies which are not healthy. So you can rest assured that the miscarriage or any adverse outcome is not related to your activity level, what you ate or did etc. However being more careful if you are having bleeding will not do any harm. So avoid travelling if not necessary, may avoid intercourse for a few days, try and avoid constipation and straining at stools and rest as much as you can.

 Good luck and hope you never have to go through a period of uncertainty where you fear for your pregnancy and unborn child, but in case you do keep the faith and feel free to write to me at drnehagami(at)gmail.com

Author: drnehagami

M.B.,B.S
M.D. ( Obs and Gyne)
D.N.B. ( Obs and Gyne )
M.R.C.O.G ( United Kingdom )
F.C.L.S ( India )

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