• Reference Number: HEY-025/2018
  • Departments: Gynaecology

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your nurse/doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team .

What is vaginal bleeding in early pregnancy?

Vaginal bleeding is common in early pregnancy and does not always mean there is a problem. However, bleeding can be a warning sign of a miscarriage.

What are the causes of early bleeding?

There are a number of causes of bleeding in early pregnancy which include:

Spotting or bleeding may occur shortly after conception, this is known as an implantation bleed. It is caused by the fertilised egg embedding itself in the lining of the womb. This bleeding is often mistaken for a period, and it may occur around the time your period is due.

Hormonal bleeding is when some women experience a light bleed at around four to eight weeks of pregnancy, or around the time their period would have been due. This can be very confusing for women who are pregnant and is the reason many women do not realise they are pregnant for a while. Again, it is totally normal. This usually settles around the 13th week of pregnancy as by this time the placenta is sufficiently developed to produce all of the hormones needed to sustain the pregnancy.

After the egg is fertilised, the fertilised egg then goes on to implant itself into the lining of the womb (uterus). Sometimes this results in a little bleeding that shows up on an early scan as a haematoma(collection of blood). This is not anything to worry about. When it happens the woman may notice a small amount of vaginal bleeding, but this is not necessarily the case.

The haematoma will gradually disappear and in most cases, the pregnancy remains safe.

Cervical Erosion (alternatively known as cervical ectropion) may be a source of spotting or bleeding. The blood supply to the womb and cervix is increased during pregnancy and the cervix may bleed harmlessly and painlessly. An erosion may cause bleeding following sexual intercourse; therefore this type of bleeding must always be reported to your doctor.

Can bleeding indicate a miscarriage?

Not all bleeding in pregnancy is harmless, and it can be the first sign of a miscarriage. As many as 1 in 5 pregnancies are thought to end in miscarriage. The cause of miscarriage is not always known, but researchers have shown that in some cases there is a problem with the developing pregnancy, which means it is unable to develop normally. For most women, miscarriage is a very sad and upsetting experience.

Experiences of miscarriage vary. In some cases there may be only very slight spotting, in other cases bleeding may stop and start or heavier bleeding with clots and cramping period type pains can occur. Sometimes there may be no bleeding at all.

For further information relating to miscarriage, please ask your nurse for further details.

What should I do if I experience bleeding during pregnancy?

If you experience bleeding, it is wise to have this checked out. If you have been seen in the Early Pregnancy Assessment Unit (EPAU) during your pregnancy, you may contact us directly, up to 15 weeks + 6 days of pregnancy. Your GP or midwife can also help you.

If you have been seen in the EPAU and you then experience more bleeding contact the EPAU. Depending on how much bleeding and for how long the nursing staff will decide if you need to be seen again. A rescan is not always necessary. Sometimes the nurse will advise that you monitor this bleeding at home.  A rescan will only be performed if bleeding heavy with clots. If there is a significant change in your symptoms then the nurse will make an appointment to come to EPAU and be either rescanned or to be assessed by the doctor. If bleeding unmanageable then the nurse may advise to be assessed on ward 30 or the Emergency department depending on your symptoms.

What if I experience pain in early pregnancy?

If you experience pain that does not go away, or which you feel is becoming more sever, you should seek advice from your doctor, nurse or midwife. It is important that any serious causes of pain are excluded. For example there is a need to rule out an ectopic pregnancy (this is where the pregnancy develops outside the womb).

What kind of pain may I feel?

Some women experience abdominal (tummy) pain in early pregnancy. This may be low cramping pain, similar to that felt during a period, or a stitch like or stabbing pain on one or both sides of the tummy. Aches and pains may come and go or be present continuously.

What are the causes of abdominal and back pain?

Some of the aches and pains experienced during pregnancy are thought to be due to hormonal changes. Large amounts of the hormone progesterone are produced, which are needed to sustain pregnancy. In addition to this, progesterone acts on the muscles, ligaments and joints causing them to become slacker and more flexible. This hormonal effect is thought to be responsible for some of the stitch like pains that some women experience in the lower part of the tummy and in some cases this can be quite severe. The same hormones can be responsible for constipation during pregnancy; this can also cause abdominal pain.

The enlarging womb is made up of layers of muscles and is held in place in the pelvis by supporting ligaments. As the womb expands to accommodate the developing baby, it can pull on the ligaments and muscles, to cause these "growing pains".

The backache that some women get in early pregnancy is also thought to be due to a hormonal effect, and the supporting muscles are softer.

Abdominal and/or backache can also be a sign of a urine infection. This may also cause burning or stinging when passing urine and the need to pass urine more frequently. You must inform your doctor of these symptoms, so that a urine test can be obtained and treatment given if needed.

Pain on its own does not mean that a miscarriage will occur. However if you experience bleeding as well as pain this could indicate a threatened miscarriage and you should always seek advice from your doctor, nurse or midwife.

Can I take pain relief medication during pregnancy?

If you find that you need to take pain relief medication to relieve any pain, it is safest to use something simple such as paracetamol. Drugs such as aspirin and ibuprofen should be avoided. If you find that you need a stronger pain relief medication, you must always check with your doctor, nurse or midwife first.

Scanning in early pregnancy

An ultrasound scan is used during pregnancy for a number of reasons. In the first three months of pregnancy it can be used to check the presence of the baby's heartbeat, which can be reassuring if you have experienced a problem, such as vaginal bleeding or pain. A scan will also be used to check to see if the pregnancy is in the correct place and to accurately predict the estimated date of delivery (the date the baby is due) by measuring the end points (size) of the embryo or fetus.

Will I have an ultrasound scan?

Yes, if the nurse/doctor thinks it is appropriate for you to have a scan.

What is an ultrasound scan?

Ultrasound uses high frequency sound waves that are sent out from a transducer or probe. These sound waves are received back and converted into an image on a screen.

Is it safe to have a scan in early pregnancy?

Yes it is safe, there is so far no evidence to suggest that an ultrasound scan is unsafe.

What type of scan will I have?

A vaginal scan is the best method in early pregnancy (under 8 weeks) as it gives us a more accurate result at an earlier stage in pregnancy than an abdominal scan. It may be a little uncomfortable but it is safe to be done, you do not need a full bladder when having a vaginal scan. If you have concerns about a vaginal scan, please let the nurse, midwife doctor know.

What will the scan tell us?

A scan can only tell us how your pregnancy is at that particular time. Unfortunately it is no guarantee that your pregnancy will continue successfully. If your symptoms persist or become worse, you must contact EPAU, midwife or your GP.

In later pregnancy ultrasound scanning is used to look more closely at the anatomy and organs of the developing baby. This is usually done between 18 – 21 weeks.

What if the scan confirms a miscarriage?

If the scan confirms that you have miscarried, the choices of how we can manage this will be discussed with you.

Occasionally, the scan may pick up an unexpected finding such as a cyst on the ovary. If this is the case, the staff will explain the findings and any necessary follow up.

Common abbreviations used on scans

LMP – Last menstrual period.

FH – Fetal heart-rate.

EDD – Estimated date of delivery.

FM – Fetal movement.

USS – Ultrasound scan.

YS – Yolk sac.

CRL – Crown to rump length (a measurement of the embryo/fetus used in early pregnancy).

BPD – Bi-Parietal Diameter.

HC – Head circumference. Both of these measurements of the fetus are used in later pregnancy, after 12-14 weeks.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the:

Early Pregnancy Assessment Unit/Emergency Gynaecology Unit
Women and Children's Hospital
01482 608767.

Gynaecology Ward
Women and Children's Hospital
01482 604387.

Useful information

Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust can be found at:

www.hey.nhs.uk/content/services/gynaecology.

Information on Maternity Services at Hull University Teaching Hospitals NHS Trust can be found at:

www.hey.nhs.uk/maternity.

www.womens-health.co.uk.

www.nhs.uk.

www.earlypregnancy.org.uk.

www.patient.org.uk.

www.screening.nhs.uk/annbpublications.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

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