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

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.

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

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.

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.

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.