Heavy bleeding during early pregnancy elicits anxiety and fear in the expecting mothers. Most mothers associate bleeding with miscarriage. This, however, is not always the case. Fact be told, about 20-25% of women will have vaginal bleeding during early pregnancy. Half of these women will carry the pregnancy to term and deliver healthy infants. Bleeding is more common during the first trimester. For some women, it is noted as spotting on the panty while others experience bleeding similar to that experienced during regular menstruation. The bleeding may be a one-off event or may continue intermittently throughout the pregnancy.

What to Do First

There should be no delay in seeking medical help. Contact your primary healthcare provider as soon as possible. Get ready to be asked very personal questions during your visit. It is essential for the mother to co-operate and give accurate information. This helps the doctor or midwife to make a right diagnosis and make the most appropriate decision with regards to the health of the mother and the unborn child.

What Causes Bleeding During Early Pregnancy?

1. Bleeding after Sex

Bleeding after sexual intercourse is a common occurrence. There is increased blood flow to the cervix. It also becomes softer and hence more prone to injury during sex. This cause of bleeding is non-consequential and does not harm the baby.

2. Implantation Bleeding

Fertilization takes place in the fallopian tube. The egg is then transported into the uterine cavity for implantation into the uterine wall. In the process of embedding in the wall, bleeding occurs. This bleeding is commonly mistaken for regular menstrual periods and is a common cause of error in dating the pregnancy. The blood lost is usually bright red in color unlike normal menstrual blood which is dark red and may contain clots. Sometimes, the implantation is marked by passage of a pink mucus stain. This is normal and should not be a cause of alarm.

3. Breakthrough Bleeding

The normal menstrual cycle is regulated by hormones. The ovaries continue producing these hormones even after pregnancy. This results in a woman experiencing menstrual related symptoms such as low back ache, bloating and abdominal fullness at the dates she would be expecting her normal menstrual period. Of course, the actual bleeding does not occur because of the pregnancy hormones. However, the hormones from the placenta can be overcome by those produced by the ovaries and menstruation ensues. It is prevalent in the first 3 months. After that, the placenta is solely responsible for production of hormones that maintain pregnancy and the bleeding ceases.

4. Threatened or Actual Miscarriage

Up to a third of pregnancies are terminated via spontaneous abortion. This occurs when the body rejects the fetus early in the course of pregnancy. For some women, they suffer a miscarriage so early that some do not realize they were pregnant in the first place. Fetal abnormalities that are incompatible with life are the most common causes of spontaneous abortions. This is common during the first trimester and a woman can feel safe once she transitions into the second trimester. Miscarriage is characterized by bleeding, back pain, cramping and regression of the signs of pregnancy such as nausea and bloating. In a missed miscarriage, the fetus dies and is retained in the uterus. This is marked by regression of the signs of pregnancy. No bleeding is experienced in a missed miscarriage.

5. Ectopic Pregnancy

An ectopic pregnancy occurs when the fertilized egg implants on the fallopian wall lining instead of the uterus. The fallopian cavity is small and can only accommodate the growing embryo for a short period. Once it is stretched to maximum, it can rupture. This is a medical emergency. An ectopic pregnancy is characterized by severe pain localized on one side of the abdomen, nausea and loss of consciousness.

The rupture of fallopian tube causes bleeding into the abdomen which if severe enough results in maternal collapse. During treatment, the damaged fallopian tube is removed.

What Tests Can I Take If I Experienced Heavy Bleeding During Early Pregnancy?

1. Basic Assessment

Onarrival to the hospital, a triage nurse will assess you based on the level of bleeding, the pain and discomfort and distress. She is mandated to provide you with information that expounds on various causes of bleeding during early pregnancy and the expected outcomes. Pain relief medications such as paracetamol may be administered. The triage nurse may also take blood samples for blood grouping and confirming the pregnancy. After this the mother may decide to go home and contact their personal healthcare provider for further management.

2. Blood Tests

If a mother’s blood group is rhesus negative and the father of the child has a rhesus positive blood group, she needs to receive anti-rhesus. This is a drug that prevents sensitization of the mother’s blood to the rhesus antigen. When a mother becomes sensitized to the rhesus antigen, she forms antibodies which may complicate all future pregnancies if the unborn child is rhesus positive. The severity of the complications varies and ranges from anemia to death of the unborn child.

3. Ultrasound Scan

In the first trimester, it is performed externally, but if the baby is too small, a probe may be inserted into the vagina for better visualization. An ultrasound can be performed at the local emergency department. It provides pertinent information such as the gestational age of the baby, the position of the placenta, and it can also pick any concealed bleeding.

4. A Vaginal Exam

In a miscarriage, the cervix opens, allowing the products of conception to be expelled. In a threatened abortion, the cervix is still closed and the pregnancy can be saved. In an inevitable abortion, the cervix is open and nothing can be done to conserve the pregnancy. A vaginal exam helps the doctor assess the state of the cervix and quantify the bleeding. The examination will last several minutes and you may feel mild discomfort during the process.

How to Handle Bleeding During Early Pregnancy

This is a period during which emotions run high. The high levels of hormones do not help the matter. Do not blame yourself for the bleeding or think you caused it. This is not true and you need the help and support of friends and family at this difficult period in your life. Meanwhile, you can try the measures below, which may help you reduce the risk and cope with the bleeding during early pregnancy.

• Getting plenty of rest goes a long way.
• During active bleeding, use pads instead of tampons. This reduces risk of introducing infection into the uterus.
• Avoid sexual intercourse during the bleeding period. It is safe to resume sex once the bleeding ceases.
• Pain relief medication such as paracetamol is allowed. Avoid non-steroidal inflammatory drugs such as ibuprofen. This is because they impair blood clotting and may make that bleeding worse.
• Report to your healthcare provider in the shortest time possible in case the bleeding or pain intensifies.
• Avoid smoking and cocaine during pregnancy.
• Control your blood pressure if you have high blood pressure; this will minimize the risk of bleeding.

In a nutshell, a good relationship with your healthcare provider during pregnancy is of immense benefit. Problems can be identified early and corrective measures will be taken within appropriate time by your doctor.

An emergency physician expounds more on how to take care of heavy bleeding during early pregnancy in this video. Check it out: