Vaginal bleeding in early pregnancy

By Dr Joe Kabyemela, MD

Vaginal bleeding in early pregnancy is very common. It is arguably the most common problem doctors have to deal with among pregnant women.

Significance of early pregnancy bleeding

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 1 in 5 pregnant women experience vaginal bleeding in the first trimester.

Possible causes of early pregnancy bleeding

The causes are many and we can only mention the most common. These are:

· Threatened miscarriage,

· Ectopic pregnancy,

· Intrauterine fetal demise and

· Cervical problems.

Early pregnancy vaginal bleeding as a warning of impending miscarriage

The first thing that should be done if a pregnant woman has mild or moderate vaginal bleeding is an examination. An ultrasound scan should follow. A scan 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% will still go on to miscarry. For the remaining 90%, the bleeding stops sooner or later and the pregnancy carries on normally.

Detecting a fetal heartbeat

At five weeks of gestation (calculated from the last menstrual period) the fetal heartbeat is just visible using an ultrasound scan. A clear heartbeat should be seen at six weeks of gestation, especially if the doctor is using a vaginal probe.

If an abdominal probe is used, it might be difficult to detect a heartbeat at five weeks and even at six weeks especially if the mother is significantly overweight.

Safety of ultrasound scan in early 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.

Vaginal bleeding due to ectopic pregnancy

Vaginal bleeding may be one of the warning signs of ectopic pregnancy. This is usually (but not necessarily) accompanied by abdominal pain.

The symptoms of ectopic pregnancy tend to be variable and vaginal bleeding could be absent.

Action to take in threatened miscarriage

No action on the part of the mother or doctor can influence the course of events or outcome in threatened miscarriage. It has to be emphasized that about 90% of threatened miscarriages resolve by themselves.