Early pregnancy bleeding can have several implications. It is always important to get medical advice when it happens. One of the benefits of antenatal care (ANC) is to identify and prevent conditions that could cause bleeding in pregnancy. But sometimes they can occur well before you register for ANC. Generally, early pregnancy refers to the period within the first trimester, sometimes before you even realise you are pregnant. This could be as early as five weeks and up to week thirteen of your pregnancy. In this article, we look at some of the common conditions causing bleeding in this period and how to treat them.
Hello Mum (and Dad) to Be!
Here to learn about vaginal bleeding in early pregnancy?
First, Congratulations on your positive pregnancy test!
There is so much to talk about pregnancy - but vaginal bleeding in pregnancy is an important though very scary topic for expectant Mums.
Very likely, your pregnancy is going into your sixth week (depending on your cycle length) when pregnancy symptoms properly 'kick in'.
At this time (or even earlier), some women may experience 'spotting' (few drops of blood) which persists after a day or two and starts to get worse with heavier bleeding with or without clots.
Or they may experience heavy bleeding that begins suddenly - with or without pain in their 'tummy'.
The worry and anxiety are tremendous, but this piece will help explain some of the features and guide you in getting help when you need to.
What is Pregnancy Bleeding Like?
Early pregnancy bleeding is usually bleeding from the vagina.
In additional to vaginal bleeding, there could be bleeding into the abdomen as a result of the pregnancy.
Pregnancy bleeding could be light or heavy; it could be painful or painless.
It may be fresh, bright red blood, or darker, altered blood.
Light or Heavy Pregnancy Bleeding
With light pregnancy bleeding, you may have 'spotting', when a small amount of blood is lost, or very light bleeding like what happens at the start or end of your period.
Thus pregnancy bleeding and period bleeding could be similar.
Heay pregnancy bleeding can:
- soak sanitary towels or your underwear and outer clothing
- mean bleeding that soaks through to your bed sheets and mattress
- maybe in the form of blood clots.
- Clots are fleshy/solid dark red pieces of congealed or clotted blood.
- Their significance is that they indicate a lot of bleeding in a short time - especially if they are very large.
- be blood flowing like a trickle or gush from a tap.
Of course, the heavier the bleeding, the more severe the problem as losing a large quantity of blood could lead to shock.
'Shock' means the body has lost so much blood, there isn't enough to supply vital organs like the brain, kidneys and heart. Shock left untreated can lead to death.
Painful or Painless Bleeding in Early Pregnancy
Pain is often a useful symptom in pointing to the fact that something is wrong before any further signs develop.
When you are pregnant, problems like infections in the vagina and womb may cause pain; as could other causes of pregnancy bleeding like ectopic pregnancy.
During a miscarriage, there may be pain that is quite severe but in some cases miscarriage could be painless.
Fresh red bleeding or 'Altered' blood
Either of these could happen in early pregnancy bleeding.
In some cases of infection or a miscarriage, blood may appear darker or changed (altered) from usual, but otherwise, fresh, bright red blood occurs.
Bleeding with or without Discharge.
Is there a time when we could consider early pregnancy bleeding normal, though?
Actually yes. If you experience a very light, episode of bleeding - the odd or occasional spotting in very early pregnancy - this could be normal. But how is this possible?
What is Implantation Bleeding?
In fact, if you don't know you are pregnant, you might assume an episode of vaginal bleeding is your period coming a little early - until some other symptoms develop.
However, it may last a few days unlike your usual period, and appear lighter than usual.
This is known as Implantation bleeding and happens when the newly fertilised egg is settling within the muscle walls of the womb.
It settles after a few days and is nothing to worry about.
Many women experience it as a normal, shorter period without actually realising they are pregnant for another few weeks.
You may also feel you are experiencing 'pregnancy symptoms but bleeding like period'.
Vaginal Discharge in Pregnancy
Many women who are pregnant will experience a discharge which is different from their ‘usual type of discharge’.
The pregnancy hormones that your body is making cause changes to the tissues in the womb and vagina affecting your discharge.
If it is not heavy, smelly, itchy and discoloured or linked to other symptoms, then you shouldn't worry.
These are natural events getting your body ready for the baby.
However, if you have a vaginal discharge that is unusual - heavy, discoloured and smelly, a visit to the doctors' is advised.
Infections in Pregnancy
Sexually Transmitted Infections could still develop while you are pregnant.
Examples are HIV, Gonorrhoea, Herpes, or Chlamydia.
Some of them may cause a discharge that is bloody, smelly or associated with pain in your lower abdomen.
To avoid spreading these germs to the baby, getting yourself checked out as soon as possible is a priority.
Urinary Tract Infections, such as bladder and kidney infections are common in pregnancy.
A woman's urethra, the urinary tube which connects the bladder to the opening outside is much shorter than that for men.
It is very close location to the anus and is one of the reasons a woman may be more prone to an infection in the urinary tract than men.
Germs from the anus may be easily transferred to the bladder through the urethra.
(In men, their uretha runs inside the penis where it is relatively distant from the anus).
When a woman is pregnant, hormones also relax a lot of the muscle and other tissues in the body.
This could also affect the urethra in the woman meaning a bigger chance for a urine infection in pregnancy.
Infection in the bladder can cause bleeding - both from the bladder and the womb.
Thrush, a yeast or fungal infection that can affect the vulva and vagina is also common in pregnancy - but will not usually cause vaginal bleeding, although if the infection is severe you may have a bloody discharge.
It is also particularly important to detect and treat any infections that may or may not be sexually transmitted quickly to prevent any harm to both yourself and your growing baby.
(Heavy) Bleeding and Pain - Always a Sign of Miscarriage?
In cases of pregnancy bleeding, an ultrasound scan preferably done after six-seven weeks to identify the position and viability of pregnancy is important.
If a pelvic scan is performed earlier than five weeks, the embryo and the pregnancy sac may be too small to see clearly.
A transvaginal scan is an ultrasound scan performed by passing the probe into the vagina instead of over the surface of your tummy (as happens in a pelvic scan).
When bleeding happens, some women may have low abdominal pain that is described as cramp like - feeling like a period, while some have no pain.
It is important to discuss any form of bleeding with your clinician whether accompanied by pain or not.
What is a Miscarriage?
A miscarriage is the word we use when a pregnancy is no longer able to continue.
There are many reasons this could happen such as very serious illness in the mother.
It may also happen because there is a problem with the baby - like a genetic (chromosome) problem which prevents their survival.
Most of the time, however, we do not know why a miscarriage happens but the symptoms are mostly the same regardless:
- It might start with slight bleeding which gradually becomes heavy, like a period.
- You may develop a dull ache in your tummy which may get more intense, leading to pregnancy bleeding and cramping.
- The early signs of pregnancy like nausea or fullness and breast pain may disappear.
Doctors classify two types of miscarriage:
In a threatened miscarriage, the embryo, ('pregnancy') is still within the womb.
A complete miscarriage, on the other hand, means the embryo has completely come out of the womb.
An ultrasound scan of the womb can tell us whether or not a miscarriage is complete or threatened.
It can also tell us whether you need to have a 'D&C' (Dilatation and Curettage or evacuation of the embryo from the womb), if the embryo has died and still remains inside the womb.
If the retained embryo is not completely cleared from the womb, it may cause womb infection and lead to blood poisoning.
Or Could Early Pregnancy Bleeding suggest an Ectopic Pregnancy?
The presence of severe pain in your tummy in your early pregnancy increases suspicion of an Ectopic Pregnancy.
An ectopic pregnancy means the fertilised egg has implanted outside the womb and in a location where it is unlikely to survive - commonly within one of the fallopian tubes.
The bleeding may be deceptively light in an ectopic - but there will be persistent pain (sometimes you may feel pain going upwards to the back and right shoulder).
Bleeding from an ectopic pregnancy can be life-threatening unless quickly detected.
Usually, treatment with medication, monitoring blood tests or surgery to remove the pregnancy and (usually) the damaged fallopian tube can save the woman's life.
Presently we do not know the exact cause of ectopic pregnancy, though in a lady who has experienced it in the past; it is still possible to have healthy and successful pregnancy outcomes in the future.
Will a Pregnancy Test Work if bleeding?
Yes, a urine pregnancy test will be positive even if you are bleeding.
If bleeding has developed as a result of a miscarriage, the pregnancy test could remain positive for up to two weeks afterwards.
The urine pregnancy test measures the amount of the hormone betaHCG (Human Chorionic Gonadotrophin).
This hormone is produced by the placenta as the pregnancy develops and can be detected as early as the second to third weeks of pregnancy in some very sensitive pregnancy tests.
The blood pregnancy test provides us with even more information.
While we are testing for the same hormone, a blood test is able to measure the quantity of the hormone; and not simply indicate whether it is present or absent.
In early pregnancy, the rate at which the hormone bHCG increases can alert doctors to the health of the pregnancy - especially used to monitor the events in ectopic pregnancy.
Things to do if you experience Early Pregnancy Bleeding
If you experience bleeding in pregnancy, it's important you do the following if your bleeding is not heavy:
- Wear a sanitary towel (instead of a tampon) to help keep track of the amount of blood loss.
- Keep an eye on how often you change the towel or pad; and how heavy they are.
- Avoid sexual intercourse when you are bleeding
- For mild pain or cramps in your tummy, you may use a warm water bottle or simple paracetamol tablets.
- Speak to a health care professional as soon as possible for advice specific to your medical status
- If you are advised to remain at home, try to rest, and avoid strenuous activity.
- Try not to worry about your baby. It is still true that most of the cases for early pregnancy bleeding do stop and the pregnancy continues with a normal, healthy result for mum and baby.
If you have heavy bleeding (clots or heavy, soaked sanitary towel/clothing):
- Speak to a health professional as soon as possible
- If you start to feel faint, dizzy or light headed; experience a very fast pulse or develop severe pain, you must seek urgent medical attention
Bleeding in early pregnancy may happen for no obvious reason.
Majority of the times, it settles with no further occurrence and no harm to Mum or baby.
But every case should be discussed with your Midwife or Doctor.
Tell us in the comments below if this has been helpful, or any experience you have. And do have a happy, joyful pregnancy.
Editing by AskAwayHealth Team
All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence based guidance and to help promote quality health care. The advice in our material is not meant to replace management of your specific condition by a qualified health care practitioner.
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