Bleeding in Early Pregnancy

Vaginal bleeding in the first few months of pregnancy is common. As many as 20% of pregnant women experience it. The colour of the discharge varies from light pink to red and brownish in some women. While pink to red signify fresh bleeding, shades of brown are usually an old blood collection.

In most cases, bleeding settles and the pregnancy continues. However, there is increased risk of miscarriage in women with bleeding in early pregnancy. Almost 20% of women who have bleeding in the first 12 weeks, pregnancy is likely to end up in a miscarriage.

Causes of bleeding in early pregnancy

1. Implantation Bleeding – At the expected time of the first periods after conception, light bleeding or spotting may occur. It is a sign that the fertilised egg has attached itself to the lining of the uterus. Stay assured that this is normal.
2. Cervical Ectropion – During pregnancy, owing to the increased levels of estrogen hormone in the body, the cervix has increased blood supply and there is redness on the cervix, called ectropion. This is a common reason for vaginal bleeding.
3. Ectopic Pregnancy – This medical condition occurs when the fertilised egg (embryo) implants outside of the uterus, commonly in the fallopian tube. This can lead to slight vaginal bleeding in early pregnancy. Ectopic pregnancy can be life-threatening if the fallopian tube carrying the pregnancy ruptures, leading to significant bleeding into the abdomen. Extreme pain in the abdomen and shoulder tip pain are emergency signs and one should go to the hospital immediately.
4. Vaginal infection – An infection in the vagina (bacterial vaginosis) or cervix (chlamydia) lead to inflammation and can cause spotting or bleeding in the first few weeks of pregnancy.
5. Molar Pregnancy – It is an abnormal pregnancy where in a fertilised egg implants in the uterus and grows into a mass of cysts. Embryo may be absent.
6. Unknown – In a few cases, the reason for vaginal bleeding is not known and there is nothing to worry as most of these women deliver healthy babies in the end.

Diagnosis

After checking full details regarding bleeding, a vaginal examination and transvaginal scan are suggested.

1. Ultrasound Scan – The woman is generally advised a transvaginal or a transabdominal ultrasound scan depending on number of weeks of pregnancy. If the scan reports are normal, corresponding to the number of weeks and if the Fetal heart is good, the doctor will prescribe medications, inform about the precautions to take, and may require another scan in 7 to 10 days for a follow-up.
2. Vaginal examination – Using a small device called speculum is performed to check cervical ectropion or vaginal infection
3. Blood tests – Beta hCG values are checked in blood in cases of suspected ectopic.

Treatment

Treatment depends on the cause. Antibiotics help in case of infection. Sometimes supplementation with progesterone hormone may help. Sometimes slight bleeding may continue for few days. There are, however, a few things that should be done

1. Take antispasmodics pain killers in case of pain in the abdomen
2. Stay hydrated
3. Stay rested
4. Avoid lifting weights or long distance journeys
5. Avoid sexual intercourse until the bleeding halts
6. Follow appointments as advised