Early pregnancy bleeding | |
---|---|
Other names | First trimester bleeding, hemorrhage in early pregnancy |
Specialty | Obstetrics |
Complications | Hemorrhagic shock[1] |
Causes | Ectopic pregnancy, threatened miscarriage, pregnancy loss, implantation bleeding, gestational trophoblastic disease, polyps, cervical cancer[1][2] |
Diagnostic method | Typically includes speculum examination, ultrasound, hCG[1] |
Treatment | Depends on the underlying cause[1] |
Frequency | ~30% of pregnancies[1] |
Early pregnancy bleeding (also called first trimester bleeding) is vaginal bleeding before 14 weeks of gestational age.[1][2] If the bleeding is significant, hemorrhagic shock may occur.[1] Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.[1]
Common causes of early pregnancy bleeding include ectopic pregnancy, threatened miscarriage, and pregnancy loss.[1][2] Most miscarriages occur before 12 weeks gestation age.[2] Other causes include implantation bleeding, gestational trophoblastic disease, polyps, and cervical cancer.[1][2] Tests to determine the underlying cause usually include a speculum examination, ultrasound, and hCG.[1]
Treatment depends on the underlying cause.[1] If tissue is seen at the cervical opening it should be removed.[1] For those in whom the pregnancy is intrauterine and who have fetal heart sounds, watchful waiting is generally appropriate.[3] Anti-D immune globulin is usually recommended in those who are Rh-negative.[4] Occasionally, surgery is required.[1]
About 30% of women have bleeding in the first trimester (0 to 14 weeks gestational age).[1][5] Bleeding in the second trimester (12 to 24 weeks gestational age) is less common.[6] About 15% of those who realize they are pregnant have a miscarriage.[1] Ectopic pregnancy occurs in under 2% of pregnancies.[1]