Bleeding in early pregnancy

If you bleed in early pregnancy it does not always mean that you are having a miscarriage; in fact it is quite common.

One in four women will bleed in early pregnancy, many of whom go on to have a healthy baby. However, if you have any bleeding at any time during your pregnancy, contact a health professional, so that appropriate investigation and treatment can be started.

Miscarriage and ectopic pregnancy (where the fetus is growing inside the fallopian tube) can both cause bleeding. It is also possible that you will have tests and investigations but the reason for your bleeding will not be found.  

Investigating early bleeding

Your doctor is likely to begin with an internal examination to feel the size of your uterus and to look for any obvious visible sign of bleeding.

Ultrasound

After about six weeks of pregnancy the baby’s heart beat can usually be seen on ultrasound. If you have been bleeding, you will likely be offered a vaginal ultrasound because it offers the best possible view of your pregnancy. A vaginal ultrasound is a narrow probe, which is put inside the vagina; it feels much like an internal examination and is quite safe.

Before six weeks, the embryo is so small that it can be very difficult to see its heartbeat. An ultrasound this early is not likely to give any definite answers about the future of the pregnancy. The benefit of an early ultrasound is that it may locate a pregnancy that is growing in the fallopian tubes (an ectopic pregnancy). An ectopic pregnancy is very serious and if found you will be treated immediately.   

If a heartbeat is found during an ultrasound it is likely that your pregnancy will continue with no further problems. Your chances of having a miscarriage in this scenario are less than one in twenty.

The ultrasound can also show if a pregnancy has stopped growing. Sometimes it is also possible to see that a miscarriage has begun and that some of the pregnancy tissue has been passed out of the uterus.

Blood tests

A blood test can measure the level of the pregnancy hormone hCG (human Chorionic Gonadotrophin), which changes depending on how pregnant you are.

• If the pregnancy hormone is lower than expected it might mean that you are not as pregnant as you thought or it could mean that the pregnancy is not growing normally. Usually a repeat blood test is needed after two days.
• If the pregnancy hormone is rising slower than is usual it might mean that you are miscarrying or the pregnancy is ectopic, sometimes though it is due to unusual hormonal patterns in an otherwise normal pregnancy.
• If the pregnancy hormone is falling this usually means that the pregnancy is ending and that you will miscarry. 

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