Spotting, Bleeding and/or pain in early pregnancy

  • Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem.
  • However, bleeding and/or pain can be a warning sign of a miscarriage or, less commonly, of other complications of early pregnancy.

  • If you have any bleeding and/or pain, you should consult your doctor and he/she will advice you for USG. Which is done routinely at our SAAVI women’s hospital.
  • You will be asked about your symptoms and the date of your last period. You will also be asked about previous pregnancies and your general health.
  • You may have:
    • A urine sample tested to confirm that you are pregnant
    • An ultrasound scan done, it may be either transvaginal scan (where a probe is gently inserted in your vagina) or a transabdominal scan (where the probe is placed on your abdomen) or occasionally both. A transvaginal scan may be recommended as it gives a clearer image. Neither of the scan increases the risk of having a miscarriage.
    • A speculum and/or a vaginal examination to check the neck of the womb for any apparent cause of bleeding and/or pain.
    • Blood test(s) to check your blood group and/or the level of your pregnancy hormone (βhCG).

Types of miscarriage

Types of miscarriage

A threatened miscarriage

  • If you have had bleeding and/or pain but your ultrasound scan confirms that your pregnancy is progressing normally, this is known as a threatened miscarriage. Many women who bleed at this stage of pregnancy go on to have a healthy baby. You may be offered a follow-up scan.

An early miscarriage

  • Unfortunately, bleeding and/or pain in early pregnancy can mean that you have had or are having a miscarriage. Sadly, early miscarriages are common. In the first 3 months, one in five women will have a miscarriage, for no apparent reason.
  • However, most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. For further information on miscarriage see the patient information Early miscarriage

An ectopic pregnancy

Ectopic pregnancy

Ectopic pregnancy

  • When a pregnancy starts to grow outside the womb, it is called an ectopic pregnancy. Your symptoms, scan findings and blood tests might lead to suspicion that you have an ectopic pregnancy.
  • An ectopic pregnancy can pose a risk to your health. If this is suspected or confirmed, you may be advised to stay in hospital. For further information, Ectopic pregnancy.

A molar pregnancy

Molar pregnancy

Molar pregnancy

  • A molar pregnancy is an uncommon condition where the placenta is abnormal and the pregnancy does not develop properly. It affects only 1 in 700 pregnancies. A molar pregnancy is usually diagnosed when you have an ultrasound scan.

A pregnancy of unknown location (PUL)

  • If you have a positive pregnancy test and your pregnancy cannot be seen clearly on ultrasound scan, it is known as a pregnancy of unknown location (PUL).

  • There can be following 3 possibilities.

    • Pregnancy is in the womb but it is too small or too early to be seen. Modern pregnancy testing kits are extremely sensitive and can detect the pregnancy hormone just a few days after conception. However, a pregnancy may not be seen on ultrasound until approximately 3 weeks after conception (at least 7 weeks from your last period). When βhCG level reaches 2000 iu/ml.

    • That an early miscarriage has occurred. Pregnancy tests can stay positive for a week or two after a miscarriage. For further information Early miscarriage

    • Ectopic pregnancy that is too small to be seen. As many as one in five women with a PUL may have an ectopic pregnancy.

  • It is important that you are followed up to get a diagnosis and to confirm the status of your pregnancy.
  • You are likely to be asked to come every 2–3 days for a blood test to check the level of your pregnancy hormone (βhCG). The results should help show where the pregnancy is developing. They will also help to guide your follow-up:
    • In a normal pregnancy, βhCG levels rise significantly ( doubles every 48-72 hrs. )
    • In an ectopic pregnancy, the level will usually rise slightly or stay the same
    • Once a miscarriage has occurred, the level will fall significantly.
  • You may also be adviced for another ultrasound scan, usually within 1–2 weeks to confirm the diagnosis.
  • This uncertainty will be difficult but it often takes time to come to the right diagnosis. Sometimes this is reached within a few days but it may take up to 2 weeks.

  • It is important that you are aware of the signs of an ectopic pregnancy (below) and that you seek urgent medical help if you have any of them. Fortunately, most women with a PUL do not have an ectopic pregnancy.
  • Contact your doctor immediately if you have any of the following:
    • Heavy bleeding
    • Severe pain in your abdomen
    • Pain in your shoulders
    • Dizziness
    • Fainting.

  • Bleeding and/or pain is common in early pregnancy and does not always mean that there is a problem.
  • Bleeding and/or pain in early pregnancy can sometimes be a warning sign of a miscarriage.
  • If you have bleeding and/or pain in the early stages of pregnancy, you should seek medical advice.
  • You may be advised to have tests including blood test, an ultrasound scan to check your pregnancy.
  • If you have heavy bleeding, severe pain in your abdomen, pain in your shoulder, dizziness or fainting, you should contact your doctor immediately.

  • This information aims to helps you make the best decision regarding your care. It is not meant to replace advice from a doctor about your own situation.