Worried about bleeding in early pregnancy? Learn about common causes, implantation bleeding, miscarriage signs, subchorionic hematomas, and when to contact your doctor. There are FAQs and additional references at the end of this article. Please scroll down to read them.
Case 1 – A 34 years old lady (let’s call her X) about 8 weeks into her second pregnancy woke up one morning with blood stains on her panty. Obviously, she was shocked. What followed was a myriad of other emotions naturally expected in such situations – worry, fear and uncertainty. She had been having some mild cramps in the lower belly for the last few days. What was wrong? Was the baby alright? Did she do something wrong? Should she have not eaten that spicy samosa two days back? She rushed to see her Gynaecologist who performed an examination, gave her some injections and asked her to get an Ultrasound scan. Fortunately, as per the Ultrasound report, the baby was alright and had a strong heartbeat. There was a small blood clot next to the pregnancy sac. Her Gynaecologist reassured her, prescribed some medication, adequate rest and asked her to return after a week for a repeat ultrasound scan.
Case 2 – A 28 year old lady (let’s call her Y) about 6 weeks into her 1st pregnancy, had similar complaints to our previous patient X. She instinctively knew that something was wrong. Unfortunately, the Ultrasound scan confirmed a miscarriage. She had followed her doctor’s instructions and taken her supplements properly. Then what could have gone wrong? Could she have done anything to prevent this?
Case 3 – A 30 year old lady (let’s call her Z) realized that her periods were overdue by 3 weeks. She took a home urine pregnancy test and the test line was faint pink. She was unsure about the test result. She decided to wait for periods to start since she was already feeling some pre period discomfort. But then 2 days later, she came to the Hospital Emergency Room in the middle of the night with complaints of vaginal spotting and severe pain on one side of the lower belly for 2-3 hours. She was feeling very dizzy and weak. She was diagnosed to have a ruptured ectopic pregnancy and was admitted for an emergency surgery to remove her Fallopian tube.
So what exactly happened in these 3 cases? How were they different? How do you know if bleeding in early pregnancy is due to a miscarriage or some other condition? And what should you do if you experience bleeding in early pregnancy?
Let me begin by telling you that bleeding in early pregnancy is a common occurrence. Almost 1 in 4 pregnant women experience first trimester bleeding – many of them go on to have healthy babies. About a third of women who experience early pregnancy bleeding, miscarry. So if you see blood on your panty, don’t panic. Keep calm and contact your Gynaecologist right away. Here’s a brief write up to help you understand the causes, treatment options, and if there are preventive measures you can take.
Need more information or support on this topic? Dr. Daksha Bakre can help you.
Causes of First Trimester Bleeding:
- Implantation Bleeding: This is a light spotting that happens when the fertilized egg implants itself in the lining of your uterus disrupting the blood vessels in the process. It usually occurs around the time you would expect your period and is a normal part of early pregnancy. It may be associated with mild cramps, breast tenderness and nausea. However it is difficult to distinguish these symptoms from premenstrual symptoms.
- Cervical Changes: Blood flow to the cervix increases during pregnancy. So light bleeding can occur if the cervix is touched during intercourse or a pelvic exam. Sometimes, use of tampons or menstrual cups can also trigger bleeding. Heavy exercise may irritate the already inflamed cervix and cause it to bleed.
- Subchorionic Haematoma: Blood can trickle between the pregnancy sac and uterine wall and form a clot. It typically goes away without causing complications. The cause for this phenomenon is unclear. However it is generally speculated that travel, trauma, intercourse, weight lifting, straining at motion, heavy exertion, etc can trigger it. Risk factors for SCH include recurrent pregnancy loss, structural abnormalities of the uterus, pelvic infection, and previous childbirth. This was the cause of bleeding in our patient X.
- Threatened Miscarriage: This refers to bleeding that may occur with cramping, but the pregnancy hasn’t necessarily ended. Early intervention can sometimes help continue a healthy pregnancy.
- Spontaneous Miscarriage: Bleeding with passage of clots and crampy pains could be a sign of a miscarriage. This was the case with patient Y.
- Ectopic Pregnancy: This is a serious condition where the fertilized egg implants outside the uterus, most commonly in the fallopian tubes. The fallopian tube does not have the capacity to expand to accommodate the growing pregnancy and eventually ruptures. This usually leads to profuse internal bleeding and severe pain. It is a life threatening medical emergency requiring prompt treatment as in patient Z.
- Molar pregnancy: This is a rare occurrence in which an abnormal fertilized egg develops into abnormal tissue instead of a baby.
- Cervical polyps: Cervical polyps are vascular fleshy growths in the cervix that can bleed due to friction.
- Infection: Vaginal or urinary infections can cause bleeding in early pregnancy.
What to Do if You Experience Bleeding:
- See Your Doctor Right Away: Regardless of the amount or color of bleeding, it’s crucial to consult your doctor to determine the cause and receive proper guidance.
- Provide Details: Be prepared to share information about your bleeding, including the amount, color, any cramps, and your pregnancy history.
Treatment:
Treatment depends on the underlying cause of bleeding. In some cases, no treatment is needed, like with implantation bleeding. With other causes, your doctor might recommend bed rest, medications, or even hospitalization for monitoring.
Prevention:
While there’s no guaranteed way to prevent bleeding, maintaining a healthy lifestyle can contribute to a healthy pregnancy. This includes taking prenatal vitamins with folic acid, eating on time, getting adequate rest, hydrating well and avoiding heavy exercise or travel in the first trimester.
Remember:
Bleeding during the first trimester can be frightening, but it doesn’t always signal a problem. Early diagnosis and proper management can lead to a healthy pregnancy. If you have any concerns or experience bleeding, don’t hesitate to contact your doctor immediately.
Frequently Asked Questions.
It can range from slight brown spotting to bright red bleeding, may last from a day to weeks and may be accompanied by mild cramping and low back pain. However, it may or may not be a sign of a problem.
Bleeding in early pregnancy is estimated to happen in almost one in our pregnancies – many of which will result in a healthy baby. About a third of all women who have bleeding will go on to miscarry.
Spotting is usually red or pink in colour. It can also look brown like old blood or like bleeding at the start or end of your period.
Implantation bleeding is usually much lighter than a period and usually not enough to fill a pad.
Miscarriage is usually associated with crampy pains and heavier bleeding than the bleeding due to other causes. However the best way to know is to see your Gynaecologist and get an Ultrasound scan done.
Bleeding due to a miscarriage may range from slight pink, bright red or brown discharge to profuse bleeding with passage of clots or a fleshy tissue.
Make an appointment with your doctor immediately if the spotting is worrying you or is associated with symptoms like pain in lower abdomen, fever, dizziness, symptoms that are worsening or happening more often.
Bleeding in early pregnancy is a common symptom and most women who experience it go on to have healthy babies. Bleeding in early pregnancy does not cause any birth defects.
If you’re pregnant with twins or triplets, you may have a greater chance of bleeding in early pregnancy due to factors like implantation bleeding.
1) Get plenty of rest – Your doctor may even recommend complete bed rest.
2) Use pads instead of tampons or menstrual cups.
3) Avoid travel, intercourse, weight lifting, squatting, straining at motion or heavy exertion.
4) Report any changes to your doctor.
Menstruation only occurs when a woman is not pregnant. Although women may experience some bleeding in early pregnancy, this is not due to their menstrual cycle.
References and further reading
https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/vaginal-bleeding
https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy
https://www.aafp.org/pubs/afp/issues/2019/0201/p166-s1.html
https://www.mayoclinic.org/symptoms/bleeding-during-pregnancy/basics/causes/sym-20050636
https://my.clevelandclinic.org/health/symptoms/22044-bleeding-during-pregnancy
Need more information or support on this topic? Dr. Daksha Bakre can help you.
Disclaimer
This article provides general information and is not a substitute for professional medical advice. Always consult your doctor to discuss your individual circumstances and the best course of action for you.