Symptoms of Miscarriage

Causes of Vaginal Bleeding and Pain in Early Pregnancy

Vaginal bleeding in early pregnancy is very common affecting 20-40% percent of pregnant women. If you are concerned it is advisable to attend your GP. It is not always possible to be certain of the diagnosis immediately. The first step may involve asking you some detailed questions about your menstrual cycle and timing of your first positive pregnancy test. This may be followed by a physical examination.

The most likely causes of bleeding in early pregnancy are:

The implantation site: As the placenta of your baby tries to attach itself into the lining of the womb, it may cause some blood vessels of the womb to bleed.
The cervix: During pregnancy, tissues become rich in blood supply and soften. Any slight trauma to the cervix can provoke 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.

Mild lower abdominal pain can occur in early pregnancy due to muscular and hormonal changes. Pain such as this can also occur with bleeding. If this persists or you are concerned please contact your GP.

Depending on your history and the findings at examination, you may need to be referred to the hospital through the Emergency Room or as a booked appointment at the CUMH early pregnancy clinic (EPC) in the Aislinn Suite.

CUMH Bleeding in Early Pregnancy Leaflet

Symptoms of Miscarriage

Pain and bleeding are the most common symptoms of a miscarriage, This can range from light spotting to heavy bleeding. However they differ from woman to woman. Some women will have pain, which can be a dull ache or strong cramping abdominal pain. Many women describe it as a strong period pain. This pain may or may not be associated with vaginal bleeding. The bleeding can range from brown vaginal discharge or spotting to bright red and heavy bleeding.

Some women may have no symptoms at all and only discover that their pregnancy has ended during a routine ultrasound examination.

What to expect

Bleeding and/or pain can occur at any time after a missed period. It is often noticed when going to the toilet as a staining of pink, brown or red loss on the toilet paper.

The amount of bleeding may vary from just spotting to heavier bleeding with or without clots. Unfortunately, there is nothing that can be done to prevent bleeding or stop a miscarriage from happening. Sadly, 25% of all pregnancies will result in a miscarriage.

If your pregnancy is less than 6 weeks gestation a blood test will be taken to check the pregnancy hormone in your body. This will be repeated 48 hours later. If you are sure of your dates and you are more than six weeks pregnant, you will be offered an ultrasound scan.

Ultrasound in early pregnancy is best performed within a designated early pregnancy clinic by a trained sonographer. In CUMH this is carried out in the Early Pregnancy Assessment Unit (EPAU) also known as the Aislinn Suite. To identify a pregnancy at this stage a trans-vaginal or trans-abdominal ultrasound scan may be necessary.

It is possible that you may not be given a definite diagnosis after one scan and a repeat ultrasound may be necessary approximately 7 to 10 days later. 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 that comes out on standing as a result of gravity. If the bleeding is very heavy i.e. you need to change a sanitary towel every 30-60 minutes, you need to go to the Emergency Room at CUMH.

You should also attend the hospital if you develop:

severe abdominal pain, which is not relieved by painkillers
a high temperature
if you feel very unwell

Although bed rest was routinely advised in the past for threatened miscarriage, it has been shown not to make any difference to the outcome of the pregnancy. However, if you have concerns you may need to rest and take time off work until the bleeding resolves. If you need a certificate for work your GP will be able to provide you with one.

Having sexual intercourse during pregnancy does not have any negative effect on the pregnancy. However, it is sensible to avoid sex until the bleeding has completely stopped due to the risk of infection.

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.