Bleeding at any stage of pregnancy is not considered normal. If this happens to you then you should see your midwife or doctor. Bleeding from the birth canal before 20 weeks is called a threatened abortion or miscarriage. The bleeding may or may not have abdominal pain associated with it. The blood loss may be brown spotting, blood stained discharge or bright red bleeding. In fact, the amount of bleeding is proportional to the risk of miscarriage. Therefore, the greater the bleeding the greater the risk of miscarriage (Beischer & Mackay, 1998). Abdominal pain associated with the bleeding is sadly not a good sign. Around one in four women will experience vaginal bleeding in the first three months of pregnancy. Of these women 70-80% will continue their pregnancies to full term (Bennett & Brown, 1993).
Is there anything I can do to help prevent the threatened miscarriage becoming a miscarriage?
There is probably nothing that can prevent a threatened miscarriage becoming a miscarriage (Davis, 1997). However, certain strategies are certainly worth a try. If symptoms are acute, bed rest may be recommended. Research to date has not found bed rest to be helpful, although little research has been carried out. It is important that the woman’s preferences regarding bed rest are taken into consideration (Enkin, Keirse, Renfrew & Neilson, 1995). It is best to avoid sexual intercourse during any period of vaginal bleeding. Some recommend that sexual intercourse be avoided for two to three weeks after the bleeding has settled (Bennett & Brown, 1993).
What tests or treatments may I expect if I am experiencing bleeding in pregnancy?
If you are experiencing bleeding in pregnancy then the main test you will be offered is an ultrasound. An ultrasound can establish whether the baby is alive or dead. It can also help predict if the pregnancy will continue or end in miscarriage. There are a small number of pregnancies where the baby is alive but is destined to miscarry; ultrasound cannot predict this group with any certainty.
You may be offered blood tests to detect placental hormonal levels. Low levels of these hormones indicates that there is a high risk of miscarriage. Other blood tests that may be performed include testing for haemoglobin levels (if there has been heavy bleeding) and blood typing (to identify women who have a negative blood group).
Over a period of many years administering various hormones to pregnant women, in an attempt to prevent miscarriage, have been tried. The results of research found no benefit. The miscarriage rate stayed the same (Beischer & Mackay, 1988; Enkin, Keirse, Renfrew & Neilson, 1995).
What impact will bleeding have on my pregnancy?
Naturally most couples will worry about the long term implications of bleeding in early pregnancy. Unfortunately there can be no assurance that the pregnancy will continue normally. However ultrasound and hormonal levels can provide a fairly reliable picture of the potential outcome of the pregnancy. If the pregnancy continues past 20 weeks around 95% of babies will survive. Additionally, the incidence of any major abnormalities is increased by only 1.3% (Beischer & Mackay, 1988).
How will I cope with the uncertainty of bleeding during pregnancy?
It is very normal to feel agitated or upset at the possibility of losing your baby. Having a supportive environment with empathetic and understanding people around you is a big help. Everybody copes in a different way; there is no right or wrong way. A supportive health care professional is invaluable. The health care professional can guide you through any tests, provide you with factual information about what is happening and also they can provide ongoing support.
- Beischer, N. A., and Mackay, E. V. (1988). Obstetrics and the newborn (2nd ed.). Sydney: W B Saunders Company.
- Bennett, V. R., and Brown, L. K. (1993). Myles textbook for midwives (12thed.). London: Churchill Livingstone.
- Davis, E. (1997). Hearts and Hands: A midwife’s guide to pregnancy and birth (3rd ed.). California: Celestial arts.
- Enkin, M., Keirse, M. J. N. C., Renfrew, M. & Neilson, J. (1995). A guide to effective care in pregnancy and childbirth (2nd ed.). Oxford: Oxford University Press.
First Published 20th January 2000