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Introduction
There are few more anxiety-provoking incidents in pregnancy than vaginal bleeding. In early pregnancy, this invokes panic of an impending miscarriage. In spite of the understandable fright, in the majority of cases, the bleeding will pass off unexplained and without any lasting effect on the pregnancy. The figures speak for themselves. In an average pregnant woman where a pregnancy has already been clinically recognised, there is only a 10 per cent chance of a miscarriage before the halfway (twenty weeks) mark. The possibility of late miscarriage or preterm labour is even less, in fact much less, than this.

There is a minority group of women who are more prone to miscarriage than others and where bleeding in early pregnancy will be a comparatively more ominous sign. We explain these facts in detail in this chapter.

Bleeding in early pregnancy may also be an early warning of something wrong with the pregnancy from the outset. Conditions such as ectopic pregnancy, missed miscarriage and molar pregnancy may have bleeding as the first symptom. It all boils down to one conclusion: Each and every case of early pregnancy vaginal bleeding should be investigated.

An ultrasound scan, which is a perfectly safe test, will in most cases establish the status of the pregnancy. In many cases, however, it does not settle the question of why there is bleeding.

Bleeding in the later part of the pregnancy is slightly different. It does not necessarily warn of impending labour or delivery. In most cases, the cause remains unknown and it may be a recurrent phenomenon throughout the remainder of the pregnancy. In some cases, it may be a sign of a serious underlying condition,: such as placenta praevia or placental abruption. These conditions and their management are fully explained here.
Bleeding at any stage of pregnancy is a cause for concern and should never be ignored. However, it is also true that, in most cases, it will pass without further problems.





Early Pregnancy Bleeding: Next Page

19. Bleeding in Pregnancy

By Joe Kabyemela, MD

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