Bleeding in Early Pregnancy

Am Fam Physician. 2019;99(3):online

See related article on first trimester bleeding

What causes bleeding during early pregnancy?

About one in every four pregnant women will have vaginal bleeding in the first few months. Mild cramping and light spotting can be normal in early pregnancy. But vaginal bleeding may be a sign of something more serious. Some of the most common causes are:

Threatened miscarriage. This is when there is bleeding from the uterus but the pregnancy is still healthy. Sometimes a blood clot forms in the uterus and increases the risk of miscarriage. But most women with threatened miscarriage will have a healthy baby.
Ectopic pregnancy. This is when the pregnancy grows outside the uterus, usually in the fallopian tubes. Symptoms include heavy bleeding, dizziness, sharp pain in the stomach or shoulder, and cramps. Ectopic pregnancy is a medical emergency and can be life threatening.
Early pregnancy loss (also called miscarriage). This is the unexpected loss of a pregnancy before 14 weeks. Most miscarriages happen because the pregnancy is not developing normally.

Other causes of bleeding in early pregnancy include infections, hemorrhoids (HEM-uh-roids, or swollen veins in your rectum or anus), cervical cancer, and rare pregnancy-related cancers.

What should I do if I am bleeding?

Call your doctor right away. If you have heavy bleeding or severe pain, go to the emergency room.

Your doctor can do tests to see why you are bleeding. You may need a pelvic exam, an ultrasound, blood tests, or urine tests. Sometimes an ultrasound is all that's needed to make sure your pregnancy is healthy. If it is still early in the pregnancy, you may need more tests to find the cause of the bleeding.

How is it treated?

It depends on the cause of the bleeding. No treatment is needed for a threatened miscarriage. Ectopic pregnancies need to be treated with medicine or surgery. After a miscarriage, the tissue may pass on its own. If not, you may need medicine or a procedure called aspiration to remove the tissue. Women with Rh-negative blood types may need a shot to help prevent problems in future pregnancies.

What can I do to prevent early pregnancy loss?

There is no way to prevent an early pregnancy loss after it has been diagnosed. There is often no way of knowing exactly why it happens. If you have an early pregnancy loss it is important to remember that you did not do anything to cause it. Most women who have had an early pregnancy loss can have healthy pregnancies in the future. If you have had two or more early pregnancy losses, talk to your doctor about whether you need other tests or treatment.

Keeping your body healthy is the best way to have a healthy pregnancy and baby. Talk to your doctor about any health problems before getting pregnant. Taking a prenatal vitamin with folic acid before you get pregnant can lower the risk of brain and spinal cord problems in your baby. Talk to your doctor before taking any over-the-counter or prescription medicines. Using cigarettes, drugs, alcohol, and large amounts of caffeine may increase your risk of early pregnancy loss.