Does Bleeding During the First Trimester of Pregnancy Mean I Am Having a Miscarriage?

July 1, 2023

15% to 30% of pregnant women experience light bleeding, or spotting, during the first trimester. But how much bleeding is too much?

Is spotting OK during pregnancy?

Two weeks after conception, light bleeding (spotting) can signal implantation. New blood vessels are developing and growing, so light bleeding can occur after a pelvic exam or sexual intercourse. Most patients go on to have healthy babies. Larger amounts of bleeding, especially with pain, can signal a threatened spontaneous abortion, or miscarriage.

How much blood is too much?

When there is as much blood as a menstrual period, particularly with pain, a clinician like an emergency medicine provider, gynecologist, or obstetrician must perform an examination.

What will the doctor look for?

If a spontaneous abortion can be seen, or the connection to the uterus is open, then the pregnancy cannot be saved. If inflammation, infection, or local bleeding is present, it can be treated. Blood levels of a hormone known as human chorionic gonadotropin (hCG) are measured and remeasured. This hormone goes up with pregnancy, so increasing levels indicate that the fetus is continuing to grow. Progesterone is another hormone that increases with pregnancy, and can be measured to judge how well the pregnancy is progressing. An ultrasound is usually done to find the fetus and discover its location. If it is located outside the uterus, it is called an ectopic pregnancy. If it is found in an inappropriate position such as the fallopian tubes, it must be removed, as it could lead to dangerous internal bleeding. Ectopic pregnancies cannot be implanted into the uterus and therefore do not lead to a successful pregnancy.

If the fetus is implanted correctly and continues to grow, then mother and doctor simply wait and watch. If bleeding continues, blood tests can be performed to check for anemia in the mom and treat if needed. Bed rest used to be recommended, but has not been shown to be effective, so continuing a normal healthy lifestyle with a healthy diet is the thing to do.

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