Bleeding in early pregnancy - When to worry??

About 1 in 5 pregnant women experience bleeding in early pregnancy and is a common cause of concern for the to-be-parents. Bleeding can be in the form of occasional spotting, brownish discharge, frank and fresh bleeding or bleeding associated with watery discharge. An ultrasound scan can be performed to detect the possible cause of bleeding. The scan may be performed on the abdomen (called the trans-abdominal scan) or by inserting a probe through the vagina (Trans-vaginal scan). Performing a trans-vaginal scan does not increase the risk of miscarriage in early pregnancy.

Some of the causes of bleeding in early pregnancy are:

· Threatened miscarriage- Vaginal bleeding in early pregnancy, with an ultrasound scan showing a live baby in the uterus, with a normal fetal heart rate (FHR), is called threatened miscarriage. The ultrasound scan may show collection of blood between placenta/ membranes and the uterus and is termed as subchorionic beelding. 

Majority of women (75-90%) with bleeding in early pregnancy go on to have a healthy baby in their pregnancy. The sub chorionic collection of blood, if present, gradually resolves. Vaginal progesterone is often prescribed to reduce the risk of miscarriage. However, if there are frequent episodes of heavy bleeding associated with pain, the risk of miscarriage increases. 

· Early miscarriage- Unfortunately, about 1 in 5 pregnancies end in miscarriage, which may present for the first time as spotting/ bleeding in pregnancy. The ultrasound scan shows either an empty pregnancy sac or no heart beat in the fetal pole. The cause is usually unknown and most women will have successful outcome in their future pregnancy.

· Ectopic pregnancy- When the pregnancy grows outside the womb, it is called an ectopic pregnancy. An ectopic pregnancy cannot grow into a health pregnancy as it is outside the womb. It poses risk to the pregnant woman’s health, as it can rupture- leading to excessive bleeding. Ectopic pregnancy can present as bleeding with or without pain abdomen. Ultrasound scan shows an empty uterus with the pregnancy sac located outside uterus- most commonly in the fallopian tubes and rarely in other locations like cervix or ovaries.

· Molar pregnancy- It is an uncommon condition where the placenta and pregnancy do not develop properly and the pregnancy cannot progress into healthy fetus. This happens due to abnormal set of chromosomes making the pregnancy. This can be diagnosed by the typical appearance on the ultrasound scan and increased levels of a pregnancy hormone- Beta HCG in the mother’s blood.

· Pregnancy of unknown location- When the pregnancy cannot be located on the ultrasound scan after a positive pregnancy test, the pregnancy is said to be of ‘Unknown location’. The possibilities are-

· Pregnancy is in the uterus but is too early and small to be seen on the scan.

· Ectopic pregnancy

· Complete miscarriage

A follow-up ultrasound scan and serial blood tests of Beta HCG Hormone in mother’s blood can help in the diagnosis.

Other causes of bleeding are- bleeding from the neck of the womb (Cervix) and infection in the vagina/ cervix which can be detected by performing an examination of the cervix and the vagina and can be treated accordingly