Bleeding in the First Trimester

The first three months of a pregnancy is referred to as the first trimester. Vaginal bleeding during pregnancy is a significant event and should always be reported to one’s healthcare provider. There are many reasons for vaginal bleeding during the first trimester. Bleeding in the first trimester is quite common and may be due to the following:

Implantation of the fertilized egg in the uterus
Hormonal changes
Undetermined factors that cause no harm to the mother or baby

Or, in more serious cases:

Bacterial vaginosis: (women with this reproductive tract infection are twice as likely to experience first-trimester bleeding than those without it)
Miscarriage: (almost all women who miscarry will have vaginal bleeding prior to the loss of the pregnancy)
Ectopic pregnancy: (when the fertilized egg develops outside of the uterus; usually in one of the fallopian tubes)
Molar pregnancy: (also know as a hydatidiform mole or trophoblastic disease, this is a condition in which the placenta does not form properly)
Luteal phase deficiency: (this is when the ovary does not produce enough progesterone)

If bleeding is present, the healthcare provider should be notified. If the bleeding is heavy, and the healthcare provider cannot be contacted, then one should go to the emergency room. Usually you will be asked very specific questions that could include the following:

How far along is the pregnancy?
Has bleeding occurred before or during this pregnancy?
Has the bleeding been constant since the beginning of the pregnancy?
When did the bleeding begin?
Is it intermittent or constant?
How much bleeding is present?
What is the color of the blood?
Is there an odor to the blood?
Is cramping present?
Is there other abdominal pain, weakness, or increased fatigue?
If there fainting, dizziness, nausea, vomiting, or diarrhea?
Is there a fever?
Are there changes in urination or bowel movements?
Has there been an injury, such as a fall?
Have there been changes in physical activity?
Has there been additional stress?
Did the bleeding occur during or after sexual intercourse?
Does rest reduce or stop the bleeding?

It is best to try and be as precise as possible since the variations in bleeding may signal different complications. The health-care provider will most likely perform a pelvic exam, with careful inspection of the cervix. The healthcare provider might also perform other diagnostic tests that could include:

Blood tests
Ultrasound of the abdomen or pregnancy ultrasound
Pap smear
Cervical cultures or tests for infections

Early term bleeding is generally treated with bed rest. The healthcare provider might also advise taking time off from work, staying off your feet, avoiding sexual intercourse. However, the bed rest is usually enough to stabilize the pregnancy.

While a small amount of “spotting” is common for pregnant women, there is a difference between “spotting” (which is a periodic drop of blood) and “bleeding” which can be a light to heavy flow of blood. In either case, the healthcare provider should be contacted; the same day the spotting or bleeding starts.

If there is any material passed that looks like tissue, place it in a clean jar, and bring it to the healthcare provider for analysis.

While one-third of pregnant women experience bleeding at some time during the first trimester, the majority goes on to have a completely normal and healthy pregnancy. However, of the women who experience vaginal bleeding in the first trimester, half will have a miscarriage. But the odds of other problems are lower: exotic pregnancy occurs in seven out of 1,000 pregnancies; molar pregnancy occurs in one out of 1,500 to 2,000 births; placenta previa happens in one of 200 births; and placenta abruptio happens in one of 150 births.

Some miscarriages are the result of a pregnancy stopping because there might have been an improper combination of genetic material in the fetus. There is also a possibility that the implantation site for the pregnancy was not a good one, or that there might be some type of problem with the uterus.

Often, the cause of the bleeding is due to an irritation of the cervix and/or vagina. Hormonal changes in early pregnancy make the vagina and cervix slightly more “delicate” and may produce some light bleeding which may be treated by vaginal creams, or not treated at all.

As many as 30 percent of all pregnancies end in miscarriages, half of them before the woman even realizes she is pregnant. Fortunately, most women who miscarry, even more than once, can become pregnant again and give birth to a healthy baby.

Exercising, a minor fall, or sexual intercourse does not typically cause a miscarriage. The fetus is well protected by the mother’s bones and muscle as well as by the amniotic fluid in which it floats. While there is no evidence that conceiving while taking birth control pills increases the risk of miscarriage, becoming pregnant while using an IUD does increase the chance of miscarriage or even of infection.

Miscarriage can leave a couple severely shaken as the anticipation of having a baby suddenly turns to grief over a loss. Many feel devastated and guilty even if the miscarriage occurs during the early weeks or months of the pregnancy. However, while it is normal to blame some specific act or situation, miscarriages are rarely triggered by factors under the couple’s control.

Whatever the cause of the spotting or bleeding, and whatever the severity, you healthcare provider should immediately be notified. As stated above, there is no insignificant bleeding during pregnancy.

Other resources: