Vaginal bleeding during pregnancy, especially in the first half, can be scary – and is a common cause for pregnant women seeing their obstetrician. Studies show that anywhere from 20-30% of women experience some degree of bleeding in early pregnancy but, fortunately, the vast majority of these women go on to deliver healthy babies. It is still important to take vaginal bleeding during early pregnancy seriously, as it might indicate serious conditions that require urgent treatment.
Causes of vaginal bleeding in early pregnancy
There are many causes of vaginal bleeding in early pregnancy. Some might be benign while others are more serious. Causes include the following:
Miscarriage – Miscarriage is a common cause of vaginal bleeding in the first 12 weeks of pregnancy. Bleeding can be a sign of miscarriage, but does not mean that miscarriage is imminent. Approximately half of pregnant women who bleed do not have miscarriages. Approximately 15-20% of all pregnancies result in a miscarriage, and the majority occur during the first 12 weeks.
Despite what some health professionals might tell you, most miscarriages cannot be prevented. They are often the body’s way of dealing with an unhealthy pregnancy that was not developing.
Implantation bleeding – Implantation bleeding is often confused as a normal menstrual period. It occurs about 10 to 14 days after conception. Fortunately, it is often very light and goes away after a few days. There are no serious complications from this.
Problem with the cervix – Problems with the cervix, such as a cervical infection, inflamed cervix or growths on the cervix can cause bleeding. In most cases the pregnancy progresses normally after treatment.
After intercourse, some women may bleed because the cervix is very tender and sensitive. You should discontinue intercourse until you have been seen by your doctor. This is to prevent any further irritation. Having normal sexual intercourse does not cause a miscarriage. Your obstetrician would discuss further management with the pregnant woman and spouse.
Molar Pregnancies – Molar pregnancies are a rare cause of early bleeding. Often referred to as a “mole”, a molar pregnancy involves the growth of abnormal tissue instead of an embryo. It is also referred to as gestational trophoblastic disease (GTD).
Ectopic Pregnancy – Ectopic pregnancies are pregnancies that implant somewhere outside the uterus. The fallopian tube accounts for the majority of ectopic pregnancies. Ectopic pregnancies are less common than miscarriages, occurring in 1 of 60 pregnancies. Of all the causes of bleeding during pregnancy, this is the most serious and, if not diagnosed and treated correctly, can result in the death of the pregnant woman.
Other signs and symptoms of an ectopic pregnancy include the following:
• Cramping pain felt in the lower abdomen often referred to as pain in the stomach (usually stronger than menstrual cramps)
• Sharp pain in the abdominal area
• Shoulder tip pain
• Fainting/dizzy episodes
• Signs of shock
What to do if you have bleeding in early pregnancy?
Vaginal bleeding in early pregnancy is an important symptom. It can be a sign of a problem, therefore inform your healthcare provider doctor about it. You should use a pad so that you can keep track of how much you are bleeding, and record the type of blood (for example, pink, brown, or red; smooth or full of clots). Bring any tissue that passes through the vagina to your doctor for testing. Do not use a tampon or have sex while you are still bleeding. After taking a detailed history and carrying out a clinical examination, your doctor might then carry out an ultrasound scan for complete evaluation of the developing fetus.
You should call 911, or go immediately to the emergency room at the Princess Alexandra Hospital, if you are having the following signs and symptoms:
• Severe pain or intense cramps low in the abdomen
• Severe bleeding, whether or not there is pain
• Discharge from the vagina that contains tissue
• Dizziness or fainting
Treatment
Treatment of vaginal bleeding in early pregnancy will depend on the cause. In the vast majority of cases where there is vaginal bleeding in early pregnancy, the complications are not serious. Serious complications can occur in cases of ectopic pregnancy and molar pregnancies. In these conditions you will be admitted to hospital for further management. In most cases of bleeding in early pregnancy, hospitalization is not required. Studies have shown that prolonged bed rest is not appropriate for treating patients with bleeding in early pregnancy.
Conclusion
Vaginal bleeding in the first twelve weeks of pregnancy can be scary for pregnant women. Causes can vary from one woman to another. Although some of the causes can be very benign, it is important to take vaginal bleeding during early pregnancy seriously. Your healthcare provider should be made aware of this important symptom at all times.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).