A warning sign
Shanthi is frightened. She is two months pregnant. She woke up this morning to find a small amount of blood on her underclothes.
Bleeding in early pregnancy is a complication, but one that’s not always serious
One of the more frightening yet common experiences in pregnancy is vaginal bleeding. This may vary from a small amount of spotting to heavy bleeding with clots and cramps. In pregnancy, even a small amount of vaginal bleeding can be alarming. Though bleeding may be a warning sign of an abnormality, it is not always a serious complication. Many pregnant women experience light vaginal bleeding at some point during pregnancy, particularly during the first three months.
Bleeding in the first trimester (1-13 weeks)
Though it is not normal to bleed early in pregnancy, it certainly is a common occurrence. In most cases, women who experience slight bleeding in the first trimester go on to have a normal pregnancy. There are some signs and symptoms which may indicate that the bleeding is of serious concern.
Common causes of early pregnancy bleeding include:
Implantation bleeding. There might be a small amount of spotting or bleeding very early in pregnancy, about 10 to 14 days after fertilisation. Some women actually mistake this light bleeding for a period and may not realise they are pregnant.
Cervical changes. In pregnancy, the cervix becomes soft and congested. There may be light spotting or bleeding after contact to this area, such as after sexual intercourse or a pelvic exam.
Miscarriage. Bleeding in the first trimester can be a sign of miscarriage. Miscarriage occurs in 15 per cent to 20 per cent of pregnancies, most often during the first 12 weeks. Bleeding in the first trimester is always considered to indicate a possible miscarriage. It is called a threatened abortion. Once you are examined and an ultrasound scan shows a good heart beat in the foetus, it shows that the pregnancy will continue normally.
Ectopic pregnancy. In some women, the pregnancy will not implant inside the uterine cavity but will start growing in an abnormal place, most often the fallopian tube. This is called a tubal pregnancy. An ectopic pregnancy can cause serious internal bleeding and must be removed to save the life of the mother. Symptoms of ectopic pregnancy include vaginal spotting or bleeding, abdominal pain (which is usually worse on one side) and fainting.
Molar pregnancy. In this rare condition, the foetus does not form. Instead, the uterus is filled up with an abnormal cystic mass. Bleeding is the most common symptom of a molar pregnancy. A molar pregnancy may require treatment with suction curettage or with drugs.
Other reasons not related to pregnancy. Spotting or vaginal bleeding can be caused by small polyps on the cervix. Occasionally, the bleeding can be due to a small cut or tear in the vagina.
When should you seek immediate medical attention?
More than half of the women who have some bleeding in early pregnancy go on to carry the pregnancy to term. It is urgent to call your obstetrician if the bleeding is
heavier than a period.
accompanied by severe cramps.
accompanied by lower abdominal pain.
associated with fainting or giddiness.
associated with fever.
Management of bleeding in the first trimester
An ultrasound scan can immediately rule out an abnormal pregnancy like a molar pregnancy and will also tell us if the pregnancy is viable (healthy) or destined for loss. When a heart beat is identified, the chances are high that the pregnancy will continue normally.
If the bleeding is slight you may be advised bed rest and limited activity at home. If the bleeding is moderate or heavy, you might be admitted to the hospital for a few days till the bleeding stops. You will be asked to gradually increase you level of activity and if there is no further bleeding for 1-2 weeks, you will be asked to resume your routine activity. It is best to avoid intercourse for 2 weeks following any vaginal bleeding.
Hormones, not required
Over the years, medical research has clearly proven that there is no need for hormonal tablets or injections in case of a threatened abortion (miscarriage).
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)
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