Bleeding in early pregnancy is a very disturbing and sometimes life threatening condition in women who desire the pregnancy. Once a pregnant lady sees a bit of blood with or without pain she tends to panic. Let us see if all bleeding is something to worry about.We will be dealing with the different causes one by one.

• Implantation bleeding

  when the fetus is making space for itself in the uterus and burying itself in the uterine lining, it may cause some spotting. This does not happen in everyone and it occurs a few days before the period is missed. This is normal and does not require any treatment.

• Menstrual bleeding

  the baby occupies a very little space in the uterus in early weeks and fills the whole uterus only at 12 weeks. Up to 10% women may have menstrual like bleeding in the first two months of pregnancy from the lower part of the unoccupied uterus. Except for confirmation that the pregnancy is healthy, no treatment is required.

• Threatened Abortion

  Sometimes the fetus is healthy but due to some other problems there is bleeding which if not diagnosed and treatment started early, the fetus may be aborted.This may be due to hormonal problems, structural problems of the uterus are even generalized problems like diabetes or hypertension.

• Missed abortion or Blighted Ovum

  Here the pregnancy is present, the sac is present which holds the fetus, but the fetus is missing or dead.Sometimes the baby is seen, a heartbeat is seen for some time, but then it is lost. Sometimes the fetus is seen, but no heartbeat can be seen even after a repeat sonography after 10 days. The basic cause is that the fetus is not normal and is unable to survive. This accounts for more than half of first trimester abortions.

• Ectopic Pregnancy

  This could be a life threatening emergency or just a chance finding. Ectopic pregnancy is a pregnancy that is placed outside the uterus and therefore unable to grow to full term and because no other part of the body is structured to stretch to accommodate a growing baby, wherever it grows, the part ultimately gives way and the lady may bleed a little or profusely accompanied by a little vaginal bleeding.There may be other features of pain abdomen and generalized features of shock due to blood loss- giddiness, fainting attack, turning pale. Then it is a catastrophe and requires immediate emergency surgery.If diagnosed by chance it may be managed with medicine.

• Complete, Incomplete or Inevitable abortion

  This is decided by sonography- empty uterus which had shown a pregnancy earlier is complete, partial retained pregnancy products is incomplete and an open cervix with products in the uterus or in the cervical canal is Inevitable abortion. Here the pregnancy cannot be retained and the doctors just have to ensure that the uterus is finally empty after the event.

• Vesicular Mole or Hydatidiform Mole

  Here there is pregnancy, the part of the conceptus that forms the placenta is there, overgrown like a bunch of grapes, and the baby may or may not be present when it is an incomplete or complete mole. This has to be surgically evacuated. A small percentage of moles turn into cancer- Choriocarcinoma. So all women with moles have to be followed for an year without allowing them to get pregnant in that year.

As you can see, the causes are diverse, but the diagnosis is only made best by a transvaginal sonography. Once diagnosed, treatment can be started according to the condition diagnosed.

As 25% women who get pregnant bleed in the first three months, it is not something to panic about. Half of these pregnancies will be lost. Half can be saved if correct treatment is given on time. So in case of bleed, visit your Gynecologist as soon as possible.

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