Bleeding in Early Pregnancy : Causes

Any blood from the vagina can be categorised as vaginal bleeding (that is abnormal bleeding not associated with regular menstrual cycles).

The first trimester refers to the first three months of the pregnancy period, first trimester bleeding occurs during this period. Vaginal bleeding varies between light spotting and severe bleeding with clotting. Vaginal bleeding is common in early pregnancy, affecting 20-30% pregnancies.

Up to half of bleeding cases may go on to have a miscarriage. About 3% pregnancies are ectopic in location (the foetus is outside the uterus), which is life threatening for the mother.

NOTE: Light spotting is not considered as a major problem. If there is fresh bleeding, particularly if it is followed by cramping or abdominal pain, immediately care should be taken.

Early pregnancy bleeding is surprisingly common, and it is always worrying. Therefore, care must be taken, as it may be dangerous to the life of the woman.

Implantation bleeding

Implantation bleeding small amount of spotting because of implantation bleeding. While very minimal, it occurs on or around the same day as a period is due.

Threatened miscarriage 

The foetus is definitely still inside the uterus but the pregnancy outcome is not guaranteed. This can be because of infection, like infection of the urinary tract, dehydration, drugs or medications use, abnormal foetus development, or for no reason.

Incomplete miscarriage 

It may be incomplete miscarriage (or leading to miscarriage) if in the pelvic exam it shows the cervix is open and tissue, blood and clots are still passing. If the cervix remains open for too long, it might indicate the miscarriage isn’t complete. This may happen if there is an infection. This may also happen if the uterus is clamping down before all tissue passes.

Abnormalities of the cervix, such as erosion (ulceration), polyp (growth) and cancer of the cervix. In these conditions, there is a slight irregular bleeding with no pain. The woman should be referred to a doctor.

Completed miscarriage 

If bleeding and cramping slow down and the uterus appears empty. It may mean loss of pregnancy.

Intrauterine foetal demise An intrauterine foetal demise (IUFD) may also occur. It’s also referred to as a missed abortion. It’s when the developing baby dies while in the uterus. This can occur at anytime during the pregnancy course and is detectable by ultrasound. The reasons for a threatened miscarriage if occurring in the early stages can lead to this. This is very uncommon during pregnancy’s second, third trimesters. Separation of the placenta and uterine wall (placenta abruption) can however cause this to happen. Another possible cause is insufficient blood flow to the placenta.

Abortion

in this, the woman has abdominal pain and vaginal bleeding which may be mild or severe. If this occurs in the first two months of pregnancy and the symptoms are mild, advice the woman to stay in bed until three days after all bleeding has stopped. If bleeding stops, this was probably a threatened abortion and the fetus may go on to term. Advice the woman not to go on journeys nor to do any heavy work, and to avoid sexual intercourse until about the 24th week of pregnancy. If bleeding and abdominal pain get worse, the fetus cannot be saved. This is an inevitable abortion; if possible the woman should be taken to the health centre or hospital. If this is not possible give Ergot two tablets, watch the condition and what is passed from the vagina. If a woman having an abortion develops fever, this is likely to be a septic abortion and is dangerous. She should be taken to the health centre or hospital without delay. Antibiotics or triple sulphia should be started.

Ectopic gestation

Ectopic pregnancy Bleeding from an ectopic pregnancy is the most dangerous cause of first trimester bleeding. This happens when a fertilized egg implants outside of the uterus, mostly in the fallopian tube. The fertilized egg grows and can rupture the fallopian tube causing life-threatening bleeding. Symptoms may include pain, bleeding, or light-headedness. Most ectopic pregnancies result in pain by the tenth week of pregnancy.

This is a pregnancy outside the uterus, usually in one of the tubes. Signs and symptoms usually start 6 to 10 weeks after the last menstrual period. They include nausea and vomiting, fainting, pain on one side of the lower abdomen, and a slight brownish vaginal bleeding. The woman’s life is in danger.

Vesicular mole

This is an abnormal pregnancy, in which after absence of menstruation for 3 to 4 months, small cysts with watery blood stained discharge are passed through the vagina. The fundal height is big compared with her dates.

Blighted ovum 

This is an embryonic failure. Intrauterine pregnancy can be detected through ultrasound. The embryo fails to develop even though it is in the proper location. This occurs if the foetus is not normal. It cannot be attributed to some mistake on anyone’s part.