Vaginal bleeding is common in early pregnancy, occurring in 20-40% of pregnant women. The bleeding might be associated with pain.
The four major causes of bleeding in early pregnancy are:
- Miscarriage (threatened, inevitable, incomplete, complete) – prevalence 15-20%
- Ectopic pregnancy- prevalence 2%
- Implantation of the pregnancy
- Cervical, vaginal, or uterine pathology (eg, polyps, inflammation/infection, trophoblastic disease)
Because of the varied nature of early pregnancy complications, the symptoms can vary widely but may include the following:
- Vaginal bleeding
- Pelvic pain
- Shoulder pain
- Excessive vomiting
- Feeling dizzy or faint
- Fever or chills
Proper evaluation is required in early pregnancy to make a definitive diagnosis and exclude ectopic pregnancy which can be a life threatening.
Dr Farjo will obtain a detailed history and perform physical examination first. A blood test as well as a vaginal Ultrasound will be organised and performed to assess the nature and the location of the pregnancy. Follow up may be required with repeat a blood test or ultrasound if an intrauterine pregnancy was not confirmed on the first scan.
During the early stages of pregnancy, an ultrasound can be used to detect complications, particularly if you are presenting with symptoms that may indicate problems or you have had complications in the past. Some of the complications an ultrasound can be used to help diagnose in early pregnancy include:
- Miscarriage – The loss of a pregnancy in the early stages due to natural causes. A miscarriage can become apparent without an ultrasound with the body naturally expelling the contents of the uterus, however, where this doesn’t occur in the case of a ‘missed miscarriage’, the miscarriage will normally be detected through an ultrasound.
- Ectopic pregnancy – An ectopic pregnancy occurs when the fertilized egg implants itself outside of the uterus, often in the fallopian tubes. An ectopic pregnancy means the egg cannot develop and the ectopic tissue must be removed to stop damage to your organs.
- Molar pregnancy – A molar pregnancy occurs due to problems during fertilisation resulting in an abnormal mass of placental-like tissue in the uterus. A molar pregnancy cannot continue and the pregnancy tissue must be removed.
Where a pregnancy cannot continue, treatment is generally undertaken to remove the pregnancy tissue and prevent any further problems with your own health either through medication or surgery.
Management of Ectopic pregnancy:
- Surgical- Laparoscopy
- Medical treatment in certain cases with methotrexate
- Expectant management- only if the HCG level falling and proper counselling provided
A miscarriage is a very emotional time for any woman, and while most happen without any further problems, in some cases there can be complications with the miscarriage.
There are three types of early miscarriage, and to understand the problems that can arise, we’ll first explain what the types of miscarriage are:
- Complete miscarriage – once all of the contents of the uterus has been expelled, the miscarriage is complete.
- Missed miscarriage – this may not be picked up until a routine scan, as the baby has died or stopped growing but a miscarriage hasn’t occurred.
- Incomplete miscarriage – a miscarriage has started, but not all of the pregnancy tissue has been expelled from the uterus.
Infection is one of the complications that can arise with a miscarriage, particularly when all of the pregnancy tissue hasn’t been expelled from the uterus. Infection associated with a miscarriage can be dangerous if untreated.
Haemorrhaging or excessive bleeding is also another complication that can arise. While typically, bleeding heavier than a regular period occurs with a miscarriage, excessive bleeding can be dangerous and requires immediate medical attention.
The symptoms of problems associated with a miscarriage will vary depending on the complication and may include the following:
- Excessive or prolonged bleeding
- Severe abdominal pain
- Fever or chills
- Unpleasant smelling vaginal discharge
- Fainting or dizziness
Treatment may take place to prevent complications occurring, or to treat complications if they do arise and may include:
- Expectant management – letting nature take its course