Many women experience bleeding early in pregnancy. If you are in your first trimester and notice bleeding, you should contact your physician. There are several possible causes of bleeding in pregnancy. Of utmost importance is determining whether you have an ectopic pregnancy, are having a miscarriage, or have a normally developing pregnancy.

An ectopic pregnancy is life-threatening. By definition, an ectopic pregnancy is a pregnancy that develops outside the uterus. Although the pregnancy can occur in many locations, ectopic pregnancies often develop in the fallopian tubes. As they grow in the fallopian tube, they will eventually outgrow the available space and will burst through the tube. This causes bleeding within the abdominal cavity–an extreme emergency. If you have bleeding and cramping in early pregnancy, your physician may order blood hormone levels (quantitative HCG levels) to determine if you have an ectopic pregnancy. Additionally, a vaginal ultrasound can determine the location of the pregnancy. Treatment for ectopic pregnancy includes medical management or surgery.

Bleeding in the first trimester of pregnancy may also be caused by a miscarriage (also known as spontaneous abortion). Miscarriages often present with heavy vaginal bleeding and cramping. To diagnose a miscarriage your physician may order blood hormone levels or a vaginal ultrasound. If you appear to be having a miscarriage, your physician may recommend a D and C to remove the contents of the uterus, or may let you deliver the products of the pregnancy at home.

Finally, many causes of early pregnancy bleeding remain unexplained. If your blood counts are rising normally, and your physician sees a pregnancy in your uterus on ultrasound, your chance of the pregnancy continuing normally is greater than 90%.

Indu S. Anand, MD
Dr. Anand is a former Assistant Professor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center, in Memphis, Tennessee. She now is in private practice in Atlanta, GA.