Am Fam Physician. 2009;79(11):993-994
See related article on first trimester bleeding.
What causes bleeding during early pregnancy?
About one in every four women will have vaginal bleeding during the first few months of pregnancy. Many things can cause it. Some of the most common causes are threatened abortion, ectopic (eck-TAH-pick) pregnancy, and spontaneous abortion.
A threatened abortion is when there is bleeding from the uterus but the pregnancy is still normal. Sometimes a blood clot forms in the uterus, increasing the risk of miscarriage. However, most women who have a threatened miscarriage will deliver a healthy baby.
An ectopic pregnancy is when the fetus grows outside the uterus, usually in the fallopian tubes. If this happens, the area where the pregnancy is can bleed heavily. This can put the mother's life at risk.
A spontaneous abortion means there is a miscarriage. This happens when the pregnancy fails and there is no living tissue in the uterus. Sometimes the mother needs to take medicines or have a procedure done to remove tissue or to stop the bleeding.
Other causes of early pregnancy bleeding include infections, hemorrhoids (HEM-roids; 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, you should go to the emergency room.
Your doctor can do different tests to see why you are bleeding. You may need a pelvic exam, an ultrasound, or blood or urine tests. Sometimes an ultrasound is enough to make sure your pregnancy is healthy. However, if you are very early in your pregnancy, you may need more tests to help your doctor find the cause of the bleeding.
How is it treated?
The treatment depends on the cause of the bleeding. There is no way to stop a threatened miscarriage with medicines after the bleeding starts. If you have a miscarriage, your doctor will watch to see if the tissue passes on its own, or if you will need medicines or a procedure to help remove it. Tissue from an ectopic pregnancy needs to be removed with medicines or surgery. Some women with certain blood types may need a shot to help prevent problems in future pregnancies.
What can I do to prevent a miscarriage?
Keeping your body healthy is the best way to have a healthy pregnancy and baby. You should not smoke cigarettes, drink alcohol, or take street drugs. Taking a prenatal vitamin with folic acid before you get pregnant can lower the risk of brain and spinal cord problems in your baby. If you have medical problems like high blood pressure or diabetes, talk with your doctor about the care you will need during your pregnancy. It is best to talk about this before you get pregnant, if possible.
There is no way to prevent a miscarriage after bleeding has started. There is also no way of knowing exactly why a miscarriage happens. Usually it is not because the mother did anything wrong. Most women who have had a miscarriage can have healthy pregnancies in the future. If you have lost more than three pregnancies, talk to your doctor about other tests and treatments.
Where can I get more information?
American Academy of Family Physicians
Web site: https://familydoctor.org
National Institutes of Health: Medline Plus