May 12, 2018

Bleeding in Early Pregnancy

Bleeding in Early Pregnancy

Vaginal bleeding in early pregnancy is a frightening experience and in the past was assumed to represent a threatened miscarriage. However bleeding in early pregnancy is quite common affecting up to 20% of pregnancies, yet the majority of these women, over 80%, go on to have a successful delivery. There are many causes of vaginal bleeding in early pregnancy although often the etiology remains unexplained. Sometimes there is break-through bleeding when the pregnancy hormone masks the usual menstrual cycle that nevertheless may cause regular spotting that can occur during the first trimester of an otherwise normal pregnancy. Implantation bleeding may occur in the first weeks of pregnancy which is less common than break-through bleeding. Cervical erosion called ectropion can occur in response to the normal hormonal changes in early pregnancy leading to cervical softening to the point where a raw area develops on the cervix leading to spotting or light bleeding. Vaginal bleeding in early pregnancy can also occur in response to a vaginal or cervical infection or due to a harmless growth called a cervical polyp. These conditions could lead to bleeding especially if the cervix is touched, for example with sexual intercourse.

Bleeding inside the uterus is often seen on ultrasound monitoring. This bleed occurs adjacent or beneath the placenta and is called a subchorionic hematoma representing a collection of blood similar to a bruise. Sometimes a subchorionic hematoma may be associated with uterine cramping and in the presence of no fetal pole being seen on ultrasound does represent an ominous finding. The causes of subchorionic hematoma are not will understood but may result from trauma or related to the way the embryo implants into the uterus. A recent study presented at this year’s meeting of the International Society of Ultrasound in Obstetrics and Gynecology evaluated 1,115 women in early pregnancy experiencing vaginal bleeding and found a subchorionic hematoma in 142 or 13% of those scanned. No statistical significant association was found between the presence of subchorionic beeding and subsequent miscarriage especially in the presence of seeing the fetal heart beat. This study should provide reassurance and hopefully help alleviate some of the anxiety caused by experiencing vaginal bleeding in early pregnancy.

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More information on early bleeding during pregnancy or miscarriage:

Implantation Bleeding or Miscarriage

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Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility