Vaginal bleeding in early pregnancy is very common. Fortunately, in many instances it is not harmful, but in a few cases it might indicate a very serious problem requiring urgent medical intervention. As vaginal bleeding might be a serious sign, it is important that all pregnant women know the possible causes, and get checked out by their doctor to make sure that they and their developing fetus are healthy.
What are some causes of vaginal bleeding in early pregnancy?
About 20% of women have some bleeding during the first 12 weeks of pregnancy. Possible causes of first trimester bleeding include the following:
Implantation bleeding
In early pregnancy, you might get some harmless, light, bleeding called “spotting”. This is when the developing embryoplants itself in the wall of your uterus (womb). This type of bleeding often happens around the time your period would have been due. It is usually harmless.
Cervical changes
Pregnancy can cause changes to the cervix, and this may sometimes cause bleeding like after sex.
Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.
Miscarriage
During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage .However, if you bleed at this stage of pregnancy it is likely you will go on to have normal and successful pregnancies.
If a pregnancy ends before the 24th week, it is called a miscarriage. Around 1 in 5 pregnancies ends this way. Pregnant women should remember they are not the cause of a miscarriage. It is very little they can do to prevent a miscarriage happening.
Many early miscarriages (before 14 weeks) happen because there is something wrong with the fetus (baby). There can also be other causes of miscarriage such as hormone or blood clotting problems.
Most miscarriages occur during the first 12 weeks (3 months) of pregnancy and, sadly, most cannot be prevented. Other symptoms of miscarriage include:
• cramping and pain in your lower abdomen
• a discharge or fluid from your vagina
• a discharge of tissue from your vagina
• no longer experiencing the symptoms of pregnancy, such as feeling sick
If you have bleeding, or any of the symptoms above, contact your midwife or gynaecologist as soon as possible.
Ectopic pregnancy
An ectopic pregnancy is when a fertilised egg implants outside the womb – for example, in the fallopian tube.
It can cause bleeding and is dangerous because the fertilised egg cannot develop properly outside the womb. The egg has to be removed – which can be done through an operation or with medicines.
Symptoms of an ectopic pregnancy tend to develop in the 6th to 8th week of pregnancy but can happen later. Other signs of ectopic pregnancy can include:
• abdominal (tummy) pain which may be on one side
• vaginal bleeding or a brown, watery discharge
• pain in the tip of your shoulder
• discomfort when passing urine
Ectopic pregnancy is a very serious condition and can have serious complications including death.
Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a fetus. In rare cases, the tissue is cancerous and can spread to other parts of the body.
Other symptoms of molar pregnancy are severe nausea, and vomiting, and rapid enlargement of the uterus.
Unidentified causes
It is also possible to have vaginal bleeding for an unidentifiable reason. In early pregnancy, the pregnant woman is going through many bodily changes. Various hormonal changes might also cause bleeding. In a few cases, despite extensive investigations, the exact cause of vaginal bleed remains unknown.
Finding out the cause of bleeding in early pregnancy
A detailed clinical history and examination are often required. An ultrasound scan and other tests might be needed to confirm the diagnosis. It is also important to notify your doctor of vaginal bleeding during pregnancy because some people with certain blood types require medication if they experience this at any time during their pregnancy.
Do you need to be admitted to hospital?
Once the cause of the bleeding is confirmed a decision will be made on whether to admit you to a hospital. In the vast majority of cases hospital stay is not required, but close follow-up by an experienced obstetrian/gynaeclogist is required.
Conclusion
Let your doctor know if you notice bleeding at any time during pregnancy. Your doctor can determine whether you need to come in for monitoring or to be evaluated. Noticing spotting or light bleeding during pregnancy can feel terrifying, but it is not always a sign that something is wrong. Many women who have slight vaginal bleeding during pregnancy go on to deliver a healthy baby.
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 is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty eight years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
