One out of four pregnant women experiences first trimester bleeding during pregnancy. Fortunately, despite bleeding in the initial days, many women have a healthy pregnancy and a healthy baby. Vaginal bleeding is when there is a discharge of blood from the vagina at any time during the pregnancy. It may occur between conception and delivery. You should report vaginal bleeding during any stage of pregnancy to the OB/GYN. They would focus on identifying the underlying cause after running a few advanced tests. The following treatment or preventive measures depends on the diagnosis (1). Read on to know the causes and treatment for vaginal bleeding during pregnancy.
Spotting Vs. Vaginal Bleeding
Spotting is a light, bloody discharge that happens now and then and is not heavy enough to cover a panty liner. Bleeding is a heavier blood flow, and one might need a pad or liner to prevent the clothes from getting soaked (2) (3). While spotting or bleeding is not uncommon, it is not always normal and needs medical attention.
Causes Of First Trimester Bleeding
The following factors may lead to bleeding in the first trimester.
1. Implantation bleeding
Implantation occurs when the fertilized egg or embryo embeds itself in the uterine wall. It usually happens in the second half of your cycle. Some pregnant women experience implantation bleeding around the eighth week of pregnancy (4). Implantation bleeding is very light bleeding which is usually pink and at times brown. Some women know about it when they wipe themselves or on their underwear, and it is not enough to soak up a pad or your underwear. While it usually lasts only for a few days, for some women, it continues for a few more days.
2. Cervical polyp
A cervical polyp is a benign growth of connective tissue that may bleed when touched. Polyps are usually small and easy to see on examination and can be easily removed (3).
3. Intercourse or physical examination
Some pregnant women may have spotting after intercourse or physical examination as the cervix is very tender and sensitive during pregnancy. Therefore, you should discontinue intercourse until the doctor permits you for the same to prevent any further irritation. However, it is important to note that intercourse does not cause miscarriage (5).
4. Multiple babies
Women carrying twins, triplets, or multiple babies may be at a higher risk of having vaginal bleeding in pregnancy. However, according to the American Society for Reproductive Medicine study, bleeding in the first trimester does not affect the live birth rate. However, it may be associated with an increased risk of low birth weight (6).
5. Ectopic pregnancy
An ectopic pregnancy is when the fertilized egg attaches itself to the outside of the uterus. It most often gets implanted somewhere in the fallopian tube. Apart from bleeding, unilateral abdominal pain, pain in the tip of the shoulder, low levels of hCG, and discomfort while peeing or pooping are other common symptoms of an ectopic pregnancy (4).
6. Molar pregnancy
A molar pregnancy is characterized by the growth of an abnormal tissue instead of an embryo. It is also known as a gestational trophoblastic disease (GTD). Abnormal heart tones, unusually high hCG levels, and the visibility of grape-like clusters on abdominal ultrasounds are other signs of molar pregnancy (5).
7. Subchorionic hemorrhage and subchorionic hematoma
It is the most common cause of vaginal bleeding in the first trimester. It happens when there is some bleeding under the chorion membranes that enclose the developing embryo in the uterus (7).
8. Infections
Infections of the pelvic cavity or urinary tract may also lead to vaginal bleeding (5).
9. Miscarriage
Bleeding could be a sign of miscarriage, but not every pregnancy with bleeding in the first trimester end up in a miscarriage. Approximately half of the women who bleed have a healthy pregnancy (5)
Treatment For First Trimester Vaginal Bleeding
For most women, the recommended treatment for vaginal bleeding is rest. However, your healthcare provider will decide the exact treatment plan after a thorough examination. Depending on the underlying cause, the doctor may advise you one or more of the following (2).
Take time off work Stay off your feet Abstinence (No sexual intercourse)
No douching (cleaning the insides of the vagina with a heavy flow of water) Not to use tampons For very heavy bleeding, hospitalization or surgical intervention might be advised
When To Seek Medical Care
You must call or reach an emergency medical center in the following scenarios (2).
Heavy bleeding Bleeding accompanied by abdominal pain or cramping Dizziness accompanying bleeding Pain in the pelvis or abdomen
It is best to bring any episode of vaginal bleeding in pregnancy to your healthcare provider’s notice, even if the bleeding is mild and stops in some time.
Recent research has proven that progesterone therapy can be an effective therapy in preventing miscarriage. Progesterone helps in thickening the womb lining and supports the mother’s body to accept the growing baby. Progesterone may be given orally or vaginally (4).
