Bleeding in pregnancy is common, but symptoms cannot show its cause. What threatened miscarriage means, and how it is assessed and followed up.
Bleeding in pregnancy is common, and not every bleed means there is a problem; however, its cause cannot be told apart by looking at the symptoms. For this reason, anyone who notices bleeding should be assessed, even if the amount is small. "Threatened miscarriage" describes the situation in which, despite the bleeding, the ultrasound shows that the pregnancy is continuing to develop; it does not mean the pregnancy will be lost.
Does every bleed in pregnancy mean miscarriage?
Bleeding and pain are common in early pregnancy; not all of it is necessarily a sign of a problem. At the same time, bleeding can also be a warning sign.
When is an assessment needed?
It is not possible to guess the cause of bleeding from its colour or amount. That the bleeding happened only once, lasted a short time or stopped by itself does not make an assessment unnecessary; do not wait on the basis of "I will go if it happens again". A recent normal smear or HPV result does not make an assessment of bleeding in pregnancy unnecessary either.
What is threatened miscarriage, and what does the word "threatened" mean?
Threatened miscarriage describes the situation in which, despite bleeding or pain, the ultrasound shows the pregnancy developing normally. The word "threatened" does not mean the pregnancy will be lost; it shows that the bleeding is being treated as a warning sign.
Can the pregnancy continue after a diagnosis of threatened miscarriage?
Many people given a diagnosis of threatened miscarriage give birth to a healthy baby. This does not mean the outcome can be known in advance; because monitoring and assessment are needed, it is important that you stay in contact with your doctor if you have bleeding.
What can cause bleeding in early pregnancy?
Bleeding in early pregnancy can arise from situations such as pregnancy loss, molar pregnancy and pregnancy of unknown location. Pregnancy of unknown location is when the pregnancy test is positive but the location of the pregnancy cannot yet be seen on ultrasound. Bleeding can also come from an ectopic pregnancy. This list gives examples only; your doctor determines the cause of the bleeding through assessment.
Could the bleeding come from the cervix?
At the examination, whether there is something at the cervix that could cause bleeding is also looked at. So the source of the bleeding may not be related only to the pregnancy inside the womb.
Why should bleeding in the second half of pregnancy be assessed?
Bleeding in the second half of pregnancy can arise from different causes, including conditions related to the placenta; for this reason every bleed needs assessment. This kind of bleeding is often not accompanied by pain, and the bleeding may appear after sex.
What is assessed in the consultation and examination?
The assessment begins with taking a history, which includes the date of your last period and your earlier pregnancies. A urine pregnancy test may be done, the cervix is assessed with a vaginal examination, and in some cases a chlamydia test may also be requested. You can ask to have a chaperone with you at the examination.
Which ultrasound and blood tests may be needed?
The ultrasound can be done through the abdomen or vaginally. Blood may be taken for your blood group and for the hormone hCG. Which of these tests are needed is determined by the doctor according to the timing of the bleeding and the symptoms.
What is done if the pregnancy cannot yet be seen?
If the pregnancy cannot yet be seen on ultrasound, a diagnosis may not be made straight away. In this case you are followed with repeated blood tests and ultrasound. The waiting period can be distressing.
How does your follow-up continue in threatened miscarriage?
If the pregnancy continues, your usual antenatal care carries on. If you have had a miscarriage before, progesterone may be recommended; your doctor decides whether it will be used, which medicine and how it will be used, and you should not start medicines or supplements on your own. Your doctor determines whether you need a recommendation specific to you on the level of daily activity, sex or exercise.
Tell your doctor your blood group. If your doctor has given you instructions on when to come back that are specific to you, follow them; if the bleeding or pain is increasing or a new symptom appears, you should be assessed again.
How can you get support if the bleeding ends in miscarriage?
Early pregnancy loss is very common and is most often caused by a chromosome problem in the baby; in many people no cause is found. Grief after a loss can be intense, and you can seek support to cope with these feelings. You can share the sadness you are experiencing with the health professional who is following you.
What information can you share when you go for the assessment?
- Briefly note when the bleeding started, whether pain accompanied it and how the bleeding has progressed.
- Say your blood group if you know it.
- Ask about the possible cause of the bleeding and which tests will be done.
- Ask when and how you will learn the results and how check-ups will be planned.
- Ask which symptoms mean you should come back straight away.
Frequently Asked Questions
Do stress, lifting heavy things or sex cause threatened miscarriage?
There is no evidence that stress or sex causes miscarriage. If you have lifted something heavy or had a fall, tell your doctor and ask what you should do in your own situation. You do not need to blame yourself for the bleeding.
Does a vaginal ultrasound harm the baby?
Vaginal and abdominal ultrasound are safe in pregnancy and do not increase the risk of pregnancy loss. Your doctor decides which route is chosen.
What does it mean if nothing is seen on ultrasound after a positive test?
The pregnancy may be very early. In repeated blood tests, the course of the hCG hormone gives a clue: if the pregnancy is progressing, hCG rises markedly; in an ectopic pregnancy it generally rises little or stays the same; in pregnancy loss it falls markedly. For this reason an interpretation is made not from a single result but from the course of the results.
Why does my blood group matter in bleeding if I am Rh negative?
In bleeding or pregnancy loss, knowing your blood group and Rh status is important for assessing whether a treatment called anti-D is needed. For people who are Rh D negative, anti-D is recommended after surgery in early pregnancy loss. Your doctor decides in which situation it is needed.
Does a small amount of bleeding also need assessment?
Yes. The colour or amount of bleeding does not show its cause. That it is small does not make an assessment unnecessary.
If the bleeding has stopped, should I just wait for it to come back?
No. That it happened once, lasted a short time or stopped by itself does not remove the need for assessment; do not wait on the basis of "I will go if it happens again".
If I have a normal smear or HPV result, is the bleeding still assessed?
Yes. Having had a normal result recently does not make an assessment of bleeding in pregnancy unnecessary.
Does threatened miscarriage mean the pregnancy will definitely be lost?
No. This diagnosis describes the situation in which, despite bleeding or pain, the ultrasound shows the pregnancy developing normally. Follow-up should continue.
Can I start progesterone medicine on my own?
No. If you have had a miscarriage before, progesterone may be recommended; your doctor decides whether it will be used, as well as the medicine and how it is used.
If bleeding or pain increases, is a new assessment needed?
Yes. If the bleeding or pain is increasing or a new symptom develops, you should be assessed again. Follow your doctor's instructions on when to come back that are specific to you.
Can I ask for a chaperone with me at the examination?
Yes. You can ask to have a chaperone with you at the examination.
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