VARIABLE SYMPTOMS: Many women who have vaginal bleeding in early pregnancy have little or no cramping. Sometimes the bleeding stops and the pregnancy goes on. At other times the bleeding and cramping continue, become stronger, and miscarriage occurs. This pain is usually stronger than menstrual cramps. The stronger the cramping and the heavier the bleeding, the greater the risk of miscarriage.

MANAGEMENT: 
1. Take a careful history about how much bleeding or cramping is occurring.
2. Perform a pelvic examination to see if the cervix is dilated or tissue is passing.
3. Perform an ultrasound examination to see:
…..if a gestational sac is inside the uterus
…..if an embryo is inside the sac
…..if the embryo has a heartbeat
…..to look at the uterus, placenta and any evidence of bleeding
4. Check a blood test for your level of a pregnancy hormone called HCG
5. Recheck the HCG hormone level in 48 to 72 hours
6. Watch for worsening bleeding or cramping
7. Give Rhogam if the mother is Rh negative

WATCHFUL WAITING: We will discuss the findings and talk about what they mean.  We always approach the problem on the side of safety and the protection of the unborn child.  Well over half of the women who bleed do not end up losing the pregnancy. However, at least 20% of all pregnancies end in miscarriage (loss of the pregnancy).

SUCTION CURETTAGE: If you think you have had a miscarriage, bring any tissue you have passed to the doctor’s office so that it can be examined. If you have had a miscarriage but some tissue remains in the uterus, bleeding often continues. If this happens, the tissue may be removed by a surgical procedure called dilation and suction curettage (D&C). This may involve dilating, or widening the cervix (mouth of the uterus) and gently removing the tissue of miscarriage.

PREVENTION: Most miscarriages cannot be prevented. They are often the body’s way of dealing with a pregnancy that was not growing normally. Usually, having a miscarriage doesn’t mean that you can’t have more children or that anything is wrong with your health. There is no proof that physical activity or sex during pregnancy cause miscarriage. If you have two or three miscarriages in a row, however, your doctor may suggest that some tests be performed to look for a possible cause.

ECTOPIC PREGNANCY: Another problem that may cause bleeding in early pregnancy is ectopic pregnancy. This is when pregnancy occurs outside the uterus, usually in a fallopian tube. Pelvic pain and vaginal bleeding may result. The tube may burst, and there may be internal bleeding as well. Blood loss may cause weakness, fainting, or even shock. A ruptured ectopic pregnancy requires prompt treatment.  Ectopic pregnancies are much less common than miscarriages. They occur in about 1 in 60 pregnancies. Women who have had an infection in the tubes (such as pelvic inflammatory disease) have an increased risk. Women who have already had an ectopic pregnancy or have had previous tubal surgery are also at higher risk.

YOU SHOULD: Avoid intercourse until all bleeding has stopped for at least 2 weeks. “Take it easy” and avoid vigorous exercise or work activity. Call us is your symptoms of bleeding or cramping are new or if your ongoing symptoms (bleeding or cramping) are clearly worsening.