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Bleeding in the first trimester of pregnancy

Published 16th February 2021 | Dr Ujwala Parashar

Pregnancy is one of the most exciting times in a woman’s life, but it can also be very worrying – especially if you experience bleeding. Vaginal bleeding is quite common in the first 12 weeks (the first trimester) of pregnancy, in fact around 1 in 4 (or 25% ) of women experience bleeding or spotting in early pregnancy. It doesn’t necessarily mean that you have a problem, but it can sometimes be an indicator of a more serious issue.

Bleeding in the first trimester of pregnancy

Pregnancy is one of the most exciting times in a woman’s life, but it can also be very worrying – especially if you experience bleeding.

Vaginal bleeding is quite common in the first 12 weeks (the first trimester) of pregnancy, in fact around 1 in 4 (or 25% ) of women experience bleeding or spotting in early pregnancy. It  doesn’t necessarily mean that you have a problem, but it can sometimes be an indicator of a more serious issue.

What are the causes of bleeding in early pregnancy? 

Although bleeding is common in early pregnancy, it is not always possible to pinpoint the reason, but there are a number of possible causes. These are:

1.     Implantation bleeding - This occurs as a result of the fertilised egg implanting in the lining of the uterus, which can cause light bleeding or spotting and may also cause cramping pain. It often occurs around the time your first period would have been due. Implantation bleeding is not usually serious and should only last for a few days.

2.     Cervical bleeding - This can occur in early pregnancy due to the development of more blood vessels in the area and increased blood flow. If it is only light bleeding, it is often not serious and should resolve after a few days.

3.     Miscarriage - Sadly, approximately 1 in every 5 or 6 pregnancies miscarry, and they don’t always have a known cause. Miscarriage occurs most often in the first trimester and in most instances, are believed to be as result of chromosomal anomalies in the embryo which is incompatible with life. Vaginal bleeding is the most common sign of a miscarriage (this can be light or heavy), and some women will experience cramping pain. Having experienced one miscarriage does not mean that you will have another.

4.     Ectopic pregnancy - An ectopic pregnancy is a serious medical condition that occurs when the fetus doesn’t travel to the uterus properly and starts to grow outside of the uterus. Ectopic pregnancies occur most often in one of the fallopian tubes, and in rarer cases, in the ovary, abdominal cavity or the cervix. 

The symptoms for ectopic pregnancy include heavy bleeding or blood clots, cramping, and abdominal pain. If there is blood leaking from the fallopian tube it can cause nerves to be irritated, and some women experience shoulder pain, light headedness or faintness, or the urge to have a bowel movement. 

Ectopic pregnancies can’t proceed normally as the fertilised egg is unable to survive outside of the uterus and if left untreated, may result in life-threatening bleeding. If an ectopic pregnancy is diagnosed, an emergency medical treatment will be necessary. 

Unfortunately, if you have had one ectopic pregnancy, the risk of experiencing another one in future pregnancies is increased by 10-15 percent. Therefore, it is important if you have had an ectopic pregnancy previously to arrange for a consultation to your GP and your specialist for monitoring as early as possible in your pregnancy.

What tests are undertaken for bleeding in early pregnancy?

Depending upon your symptoms and their severity, there are several different tests that may be needed to find the cause of your bleeding. These include:

1.     A vaginal examination. This is to determine the size of the uterus as well as the amount of the bleeding. This examination does not take long (only a few minutes), but it can be uncomfortable.

2.     Blood tests. These are to test the levels of pregnancy hormones in your blood.

3.     An ultrasound. This takes around 15-20 minutes and it offers the best possible view of your pregnancy to check for any problems.

If your tests determine that your bleeding is not a serious problem, while there is not any specific treatment to prevent a miscarriage, there are some positive, preventative measures you can take. Perhaps the best thing you can do is:

Stay calm, relax, and get plenty of rest!  Your body is going through many hormone changes and if you have been feeling stressed and worried because of light bleeding or spotting, take the time out to chill out.

Other steps you can take if you have none-serious bleeding include:

·       Don’t use tampons if you are bleeding in early pregnancy – use sanitary pads.

·       Avoid sex. Once the bleeding has stopped, you can resume.

Ensure that you keep aware of any changes, or other signs and symptoms and be sure to advise your doctor.

Take home messages

·       Remember that bleeding is quite common in the first trimester of pregnancy and that 1 in 4 women will experience this. Light bleeding or spotting may not be serious.

·       If your bleeding is heavy, if there are clots and if you have other symptoms such as cramps and stomach pain, it could indicate a miscarriage or an ectopic pregnancy.

What is the best course of action if you experience bleeding in your first trimester?

If you experience bleeding in your first trimester, you should contact your GP or your obstetrician. Dr Parashar’s patients are provided with a 24/7 contact in the case of concerns with bleeding and pain, and our care team will be able to advise of what action to take based on your symptoms.  

Dr Ujwala Parashar, Obstetrician & Gynaecologist

Sam Samant

Dr Ujwala Parashar is a highly trained female obstetrician and gynaecologist with over 12 years of experience, practicing in Sydney's North Shore and Barangaroo. If you would like more information on conception, or if you are seeking obstetric options and advice, please contact us or call 1300 811 827 to arrange a consultation with her.