Pain and bleeding in early pregnancy

Bleeding in early pregnancy can be very distressing but it does not always mean that you are having a miscarriage. Bleeding is very common in early pregnancy, affecting about one in four women, many of whom will go on to have a healthy baby.

If the bleeding is being caused by a miscarriage, there is no treatment or therapy that can stop the miscarriage from occurring. However, it is still very important to be seen by a health professional. If your bleeding is very heavy with large clots and accompanied by crampy pains you may need urgent care. Otherwise you can make an appointment with your General Practitioner or Early Pregnancy Assessment Service.

Ectopic pregnancy can also cause bleeding and pain. This is when the pregnancy is growing outside the uterus - usually in the fallopian tube. One to two percent of all pregnancies are ectopic and without treatment an ectopic pregnancy can seriously impact on your health and fertility. If you experience severe pain it is very important to see a health professional.

Other causes for early bleeding

Often, a cause will not be found and the pregnancy will continue normally. Sometimes a blood clot seen on ultrasound will suggest that there has been some bleeding around the pregnancy sac, this is sometimes referred to as implantation bleeding. Other causes, which have nothing to do with pregnancy, may also need to be considered; such as, benign polyps, infection or changes in the cervix. If bleeding continues or recurs after a normal pregnancy scan, it is important that you are examined for other possible causes. Early bleeding that does not lead to miscarriage will not have caused your baby any harm.

Tests for bleeding in early pregnancy

When you visit your GP or Early Pregnancy Assessment Service, you may be offered one or all of the following tests.

Internal examination

A doctor or nurse may do an internal examination to see if:

the uterus is the size we would expect given your stage of pregnancy there is any cause for pain there is any visible cause for bleeding such as infection or an open cervix (neck of womb).

Further tests may be needed to investigate infection.

Ultrasound

After about six weeks of pregnancy the baby’s heart beat can usually be seen on ultrasound. If you have been bleeding in pregnancy you will usually be offered a vaginal ultrasound because it will offer the best possible view of your pregnancy. The vaginal ultrasound is a narrow probe which is put inside the vagina. It will feel similar to an internal examination and is quite safe. Before six weeks, an ultrasound is unlikely to give a definite answer, but may be helpful if there is concern that your pregnancy is ectopic.

Blood tests

Blood tests are done to measure if the pregnancy hormone (HCG) level is appropriate for your stage of pregnancy (based on the time of your last period). Often the test has to be repeated to check whether the hormone levels are rising normally. You may also need a blood test to check your blood group.

What should I do while waiting for results?

Try, as much as possible, to rest and relax.

Continue, as much as you are able, to do your usual day to day activities, including work if you wish. Usual activity, that is not too strenuous, will not be harmful.

If you have pain you can take paracetamol (such as Panadol or Panadeine) according to instructions on the packet.

Many authorities advise avoiding tampon use during or after a miscarriage or threatened miscarriage. This is because of a possible risk of infection, although tampons have not been proven to cause infection in this situation.

Most people prefer to avoid sex if there is pain or bleeding. Once bleeding settles, it’s OK to have sex if you feel comfortable. People often feel anxious about having sex in these circumstances, but we do not believe that it will make any difference to the risk of miscarriage.

If the tests are inconclusive, it is possible that a miscarriage may occur while you are waiting for further tests. If you experience heavy bleeding with clots and crampy pain, it is likely that you are having a miscarriage. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed. Sometimes the bleeding will continue to be heavy and you may need further treatment. You should see a doctor or go to an emergency department for a check-up if you think you are having or have had a miscarriage.