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Bleeding in early pregnancy

First trimester vaginal bleeding or spotting occurs in up to 25% of pregnancies. It does not inevitably lead to miscarriage. In many cases the pregnancy proceeds without further problems and results in the birth of a normal baby. However, vaginal bleeding at any stage of pregnancy is not normal and as a precaution should be reported to your midwife, obstetrician or GP immediately.

Sometimes no obvious cause is found for first trimester bleeding but it is important that your condition is assessed by a doctor to rule out potentially serious problems such as an ectopic pregnancy, impending miscarriage and cervical or placenta problems. It will be helpful if you can give your doctor as much detail about the bleeding and any accompanying pains as possible. Note the colour of the bleeding, whether it is heavy or light, continual or intermittent.

If you have vaginal bleeding and are going to hospital do not eat or drink anything until you have been assessed by your healthcare professional.

What causes bleeding in early pregnancy?

'Spotting' is common in the very early stages of pregnancy, especially around the time the fertilised egg implants in the uterus. Many women confuse implantation bleeding and cramping with their normal period.

You may also experience spotting or light bleeding around the time that your menstrual period would have been due. This is known as 'breakthrough bleeding' and occurs as a result of increased levels of oestrogen, which can cause the cervix to become slightly reddened or eroded and bleed, especially after intercourse.

More serious causes of first trimester bleeding include ectopic pregnancy and miscarriage.

Ectopic pregnancy

Vaginal bleeding in early pregnancy may signal an ectopic pregnancy. An ectopic pregnancy, also called a tubal pregnancy, occurs when the fertilised egg is implanted outside the uterus. The most common site for implantation outside the uterus is the fallopian tube but, in rare cases, implantation can also occur in the ovary and cervix. As the fallopian tube cannot accommodate the growing foetus, the tube may expand and eventually rupture.

Vaginal bleeding associated with an ectopic pregnancy may be slight, brownish in colour and continuous. In women who do not yet know they are pregnant, it may be taken as a missed period. In some cases the bleeding is accompanied by lower abdominal cramp-type pain, usually on one side of the abdomen. This may be sudden and severe in onset or mild and intermittent. Pain may also be felt in the shoulder tip, on the same side as the abdominal pain, especially if there is internal bleeding irritating the diaphragm.

Some women may also feel faint or dizzy. As the condition becomes more acute because of rupture or internal bleeding the women may also have symptoms of shock, which includes a fall in blood pressure, weak pulse, sweating, weakness and dizziness.

An ectopic pregnancy is treated as a medical emergency due to the risk of tubal rupture and haemorrhage. If you experience any of the symptoms associated with an ectopic pregnancy you should contact your GP or obstetrician immediately.

Miscarriage

Threatened miscarriage. A threatened miscarriage occurs in approximately 30% of all pregnancies. Symptoms include slight vaginal bleeding and mild pelvic pain. In the majority of cases the cervix remains closed, the foetus stays alive and healthy and the pregnancy continues normally after the bleeding settles. Your doctor or midwife is usually able to predict whether your pregnancy will continue or miscarry based on an ultrasound examination. You may be advised rest, although research suggests that rest is of little benefit. Avoiding sexual intercourse may also be recommended.

Missed miscarriage. A missed miscarriage (when the foetus dies but remains in the uterus ) may be indicated by a brownish discharge. If the foetus and other products of conception are not expelled spontaneously then you may be offered the choice of medication or surgical intervention. Oral medication may be given to induce miscarriage. Alternatively, the foetus and placenta may be surgically removed from the uterus in a procedure called an ERPC (evacuation of retained products of conception) or D&C (dilation and curettage).

Inevitable miscarriage. Bright red vaginal bleeding accompanied by lower abdominal pain may signal a miscarriage. An inevitable miscarriage occurs when the cervix opens and the foetus is expelled from the uterus before it is capable of sustaining life, which is normally considered to be before 24 weeks.

Most miscarriages happen in the first 10 weeks of pregnancy. Possible reasons include abnormal development of the foetus, defective placenta, sperm or egg, or chromosomal problems. However, in many cases the cause remains unknown.

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