Pain and bleeding in early pregnancy

How common is pain and bleeding in pregnancy? Is it normal?

Pain and bleeding in early pregnancy is common. Two out of 10 women will have bleeding in early pregnancy.

Does bleeding in early pregnancy always mean there is a problem?

There are many reasons for pain or bleeding in early pregnancy; it does not always mean there is something wrong. A lot of women have light bleeding, 'spotting' or mild crampy pain in the first 3 months of pregnancy. This can be a very worrying time, but in most cases a scan will confirm the pregnancy is developing normally. However, it can sometimes be a warning sign of a miscarriage or other early pregnancy problems, therefore, it always needs to be checked. In most cases, we don't know the cause of the pain or bleeding, but if the scan looks normal, symptoms will likely settle.

What are the possible causes of pain and bleeding in early pregnancy?

Causes of pain and bleeding in pregnancy include:

• 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.
• An early miscarriage – bleeding and/or pain in early pregnancy can mean that you have had or are having a miscarriage. Sadly, early miscarriages are common. One in five women will have a miscarriage in their first 3 months of pregnancy for no apparent reason. However, most miscarriages occur as one-off events and there is a good chance of having a successful pregnancy in the future.

• Ectopic pregnancy – when a pregnancy starts to grow outside the womb, it is called an ectopic pregnancy. An ectopic pregnancy can pose a serious risk to your health. It is important that you are aware of the signs of an ectopic pregnancy. If you have heavy bleeding, severe pain in your abdomen, pain in the tip of your shoulder, dizziness or fainting, you should go to the nearest hospital or healthcare facility immediately. If this is suspected or confirmed, you will require further treatment and you may be advised to stay in hospital.

• Molar pregnancy – a molar pregnancy is an uncommon condition in which the placenta is abnormal and the pregnancy does not develop properly. It is usually diagnosed by ultrasound scan. The best treatment for a molar pregnancy is an operation to remove the pregnancy tissue from your womb as this is not a healthy pregnancy. This operation is usually done under general anesthetic and involves a small suction tube being passed through your vagina and your cervix (the neck of your womb) to remove the abnormal pregnancy tissue. This tissue will be sent to a laboratory to confirm the diagnosis of molar pregnancy.
• Pregnancy of unknown location – 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).

What should I do if I think I have miscarried?

If you think you have miscarried, do not diagnose and treat yourself; you still need to be seen by a healthcare worker to confirm this. This is because you may need a scan to confirm if it is a complete or incomplete miscarriage or if it is something else such as a molar or ectopic pregnancy. If it is an incomplete miscarriage, then you may need medication in the form of pills or a small operation to complete the miscarriage.

What do I do if I experience pain and bleeding in early pregnancy?

If you have bleeding or pain in the early stages of pregnancy, you should seek medical advice urgently. Your healthcare provider will ask you questions and carry out an examination often including a speculum or vaginal examination to look at the neck of the womb. You may be advised to have tests which may include blood tests and an ultrasound scan to check your pregnancy. This may be in the form of a transvaginal scan, if this is available.

Are there any treatment options available if I am having a threatened miscarriage?

Progesterone treatment may prevent a miscarriage if you are bleeding in early pregnancy (before 12 weeks) and have had a miscarriage before. You should ask your healthcare provider if this is a treatment option for you.