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Pregnancy Bliss | Reproductive Health Hub

How common is vaginal bleeding in pregnancy?

Very common. It is arguably the most common problem doctors have to deal with among pregnant women.



Is vaginal bleeding in early pregnancy significant?

Yes. No bleeding at any stage of pregnancy should be ignored. For the majority, it is of no consequence, but this fact has to be verified. About one in five pregnant women experience vaginal bleeding in the first 12 to 14 weeks of pregnancy.



What could cause bleeding at such an early stage of pregnancy?

The causes are many and we can only mention the most common. These are threatened miscarriage, ectopic pregnancy, intrauterine fetal demise and cervical problems.



What proportion of women with early pregnancy vaginal bleeding go on to miscarry?

The first thing that should be done if a pregnant woman has mild or moderate vaginal bleeding is for the doctor to examine her and then perform an ultrasound scan. This will establish where the pregnancy is located (in or outside the womb) and, if it is inside the womb, whether it is viable.


For those where the fetal heartbeat is identified, about 10 per cent will still go on to miscarry. For the remaining 90 per cent, the bleeding stops sooner or later and the pregnancy carries on normally.



How soon can an ultrasound detect the fetal heartbeat?

At five weeks of gestation (calculated from the last menstrual period) the fetal heartbeat is just visible. A clear heartbeat should be seen at six weeks of gestation, if the doctor is using a vaginal probe. If an abdominal probe is used, it may be difficult to detect a heartbeat at five weeks and even at six weeks if the mother is of big build or overweight.



How safe is an ultrasound scan, especially at this stage of the pregnancy?

These machines use sound waves and there is no radiation at all. They have been used extensively over many years now and no adverse effect has been demonstrated. They are considered to be safe. This is discussed in more detail here:



Does a pregnancy implanting outside the womb (ectopic pregnancy) cause vaginal bleeding?

Yes. This may be one of the warning signs usually (but not necessarily) accompanied by abdominal pain.

The symptoms of ectopic pregnancy may occur in all sorts of fashions and bleeding may well be absent. Ectopic pregnancy is discussed here:



If the diagnosis turns out to be threatened miscarriage, can anything be done to pre-empt miscarriage?

No. It has to be emphasized that about 90 per cent of threatened miscarriages resolve by themselves. There are no measures which the pregnant mother or the doctor can take to influence the outcome.



Surely bed rest is beneficial if miscarriage in threatening?

No. The standard advice is to try to avoid physical and mebed rest and miscarriagental stress. This may actually be achieved by trying to carry on as normally as possible. There is no evidence at all that bed rest actually improves chances of avoiding a miscarriage.


It may be important to focus on the positive, which is the fact that the possibility of a successful resolution is, on the balance of probabilities, really quite high.










How is fetal demise diagnosed?

Sometimes the fetus dies at an early stage of the pregnancy but actual miscarriage does not take place. This is termed missed abortion or missed miscarriage. The warning may come in the form of disappearance of the pregnancy symptoms and/or a light blood-stained or dark-brown vaginal discharge.  

                                            

Sometimes there is light vaginal bleeding which tends to be painless. An ultrasound will confirm presence of an intrauterine pregnancy and absence of fetal heartbeat.





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Bed rest is still advocated by some doctors in many parts of the world. In fact, it does not have any role to play in the management of threatened miscarriage as it does not make any difference

Bleeding in early pregnancy

Early pregnancy Late pregnancy Placenta praevia Placental abruption Cervical bleeding Vasa praevia