When is vaginal bleeding a matter of concern in early pregnancy?

Around 20% of women observe vaginal bleeding in initial pregnancy phase. When this occurs, it may indicate miscarriage and if this type of pregnancy is followed by an infertility treatment, the fear becomes more prominent to an extent that borders on panic. However, in almost more than a half of such cases, vaginal bleeding does not indicate a miscarriage and is not harmful. So how does it become a cause for concern?

Usually, vaginal bleeding occurs in early stages of pregnancy and does not lead to pregnancy loss. However, you should be aware that specific events may result in miscarriage or pregnancy termination due to vaginal bleeding and occurrence of such a bleeding should not be ignored and evaluated carefully.

Why does vaginal bleeding happen?

This can happen due to a number of reasons. A few possible reasons are mentioned below:

Safe early pregnancy bleeding:

In this case, there is mild bleeding and does not increase in quantity and does not cause pains. This usually happens when the glandular lining of the cervical canal appears to move outwards caused by hormonal environment during pregnancy, ultimately leading to exposed vaginal secretions or introduction of vaginal suppositories or with sexual penetrations. This is not a matter of worry as it can be treated by staying away from sexual activity and terminating vaginal suppositories until the bleeding comes to an end.

Chemical Pregnancy:

In this case, painless and small quantity bleeding is observed. This usually happens prior to an ultrasound (the 6th week). A delayed menstruation with a positive pregnancy where the blood hCG levels tend to rise at first and eventually fail to rise and ultimately drops. When the beta hCG level falls to zero, menstruation is indicated in around 4-6 weeks, which can be the perfect time to restart a fertility treatment.

Miscarriage followed by a pregnancy failure:

At this point, bleeding repeats post a positive pregnancy after 2-6 weeks of delayed menstruation and before the ultrasound for determining a viable intrauterine pregnancy. At the initial stage, bleeding is less but quickly increases to blood with blood clots. This occurs in conjunction with severe abdominal pains which increase in severity extending to the passage of conception products. Some of the cases show continual bleeding post ultrasound to confirm a missed abortion. In this case, a surgical removal of the uterus should be performed to avoid possibilities of future endometriosis-induced implantation dysfunction.

Miscarriage risks:

This may arise if there is uterine bleeding associated with a possible pregnancy in the first 3 months. Mild and temporary bleeding is observed. While in some cases, there is abdominal discomfort or cramping but it does not increase as it is for a short term. After an ultrasound, a viable pregnancy is perceived but it may show mild bleeding outside the gestational sac, known as SCH (sub-chronic hemorrhage). Usually in such cases, SCH is not triggered and pregnancy proceeds normally. If the embryo surrenders itself, a surgical removal procedure of the uterus is recommended, unless followed by a miscarriage.

Ectopic Pregnancy:

This happens when implantation takes place outwards the uterine cavity. This is usually diagnosed in the fallopian tubes, which can be lethal and rarely occurs in the cervical canal. A fallopian tube rupture does not show any warning signs and you should never ignore indications like low-rising blood hCG levels, vaginal bleeding and abdominal pains along with dizziness or fainting conditions.

Molar Pregnancy:

This is a rare occurrence and is accountable in only 1 out of 2,000 pregnancies. This may happen when the placental tissue develops abnormally somewhere else and promotes excessive growth of trophoblastic tissue. The most common sign of this condition is rapid growth of uterus, faster rise in blood hCG levels, discomfort in lower abdomen and releasing of dark colored blood having tiny grape-like vesicles. A surgical removal of the uterus treatment involves extraction of the uterus, giving chemotherapy, regular ultrasounds and prevention of pregnancy until the blood hCG levels are stable at zero level.

I would advise every patient who experiences abnormal vaginal bleeding during the first trimester of pregnancy to report it to the concerned doctor and seek immediate treatment.

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