Symptoms of Miscarriage
Pain and bleeding are the most common symptoms of a miscarriage; however, they differ from woman to woman and can occur at any time after a missed period. The amount of pain and bleeding varies and is more likely to increase when the pregnancy is further along.
Some women may not experience any symptoms of miscarriage, and only discover that their pregnancy has ended during a routine ultrasound examination (a missed miscarriage).
Bleeding is often noticed when going to the toilet as a staining of pink, brown or red blood loss on the toilet paper. The bleeding can range from brown vaginal discharge or light pink spotting to bright red and heavy bleeding with or without clots. Some women experience very heavy bleeding which may require hospitalisation.
At home, there may be times when you notice increased bleeding. This may occur when you stand up or go to the toilet. This is due to pooling of blood in the vagina from lying down which then becomes noticeable upon standing due to the influence of gravity. If the bleeding is very heavy, i.e., you need to change a sanitary towel (pad) with blood clots every 15 minutes for more than an hour, you need to go to the Emergency Room in CUMH.
Some women will experience pain associated with their miscarriage. The level of pain can vary, ranging from a dull ache to strong abdominal cramping. Many women describe it as a strong period pain, but others experience much more severe pain. This pain may or may not be associated with vaginal bleeding. You might also experience dizziness due to this pain and/or the level of bleeding.
If the pain is very severe, and not responding to over-the-counter pain relief such as paracetamol or ibuprofen, you may need to go to the Emergency Room in CUMH.
Causes of Vaginal Bleeding in Early Pregnancy
Vaginal bleeding in early pregnancy is very common, affecting 20-40% percent of pregnant women.
It is not always possible to give an explanation as to why bleeding occurs in early pregnancy. If a baby’s heartbeat is seen on an ultrasound scan between 7 to 8 weeks there is an 85-97% chance of the pregnancy continuing as normal.
The most likely causes of bleeding in early pregnancy are:
The implantation site: As the pregnancy itself attaches to the womb, it may cause some blood vessels of the womb to bleed.
The neck of the womb (cervix): During pregnancy, tissues become rich in blood supply and soften. Any slight trauma to the cervix can provoke bleeding. Sometimes an unusual area of tissues on the cervix can also cause bleeding.
The vagina: Thrush or infection can cause the vagina to become inflamed and bleeding in the form of spotting may occur.
Miscarriage: This can be a threatened miscarriage, an incomplete miscarriage or a complete miscarriage. More information on each type of miscarriage can be found here.
What You Should Do If You Think You Are Having a Miscarriage
If you are concerned it is advisable to attend your GP (General Practitioner). It is not always possible to be certain of the diagnosis immediately. The GP might first ask you some detailed questions about your menstrual cycle and timing of your first positive pregnancy test. This may be followed by a physical examination. In some circumstances your GP may do a blood test.
Depending on how far along in the pregnancy you are, and on your symptoms, the GP may not be certain about a diagnosis and may refer you to the Early Pregnancy Unit (EPU) or the Emergency Room in CUMH. Depending on the stage of your pregnancy, and your symptoms, this referral may take days, or weeks.
It is possible that your GP might not be available to see you. If you are unable to contact your GP, you can always contact the Emergency Room in CUMH for advice.
You should attend the Emergency Room immediately if:
Your pain is severe
Your bleeding is especially heavy - if you need to change a sanitary towel (pad) with blood clots every 15 minutes for more than an hour
You are feeling weak or dizzy
You have severe abdominal pain, which is not relieved by painkillers
You have a high temperature
You feel very unwell.
It is advisable to bring someone with you to the hospital.