bleeding is scary

There are few things as terrifying as bleeding in pregnancy.  Even a spot, or a pink tinge on the paper after you wipe, will make most women panic. I've been there - several times.  It's scary as hell as you don't know: is this the start of a miscarriage? will it stop? what can I do to make it stop? is the baby ok? what am I supposed to do?  

We get many calls every day from women who are bleeding in the first trimester of pregnancy.  They are scared and we get it.  Indeed more than 50% of our patients will bleed in the first trimester.  IVF pregnancies bleed more than spontaneous pregnancies.  Why does bleeding happen in the first trimester of pregnancy?  

  • bleeding from the medications or the medication applicator touching the cervix
  • spilling of blood from vessels in the uterus that are being invaded by the growing pregnancy
  • polyps, fibroid, or other growths on or in the uterus or cervix
  • infections of the cervix
  • ectopic pregnancy
  • miscarriage

 

What should you do if you bleed in the first trimester?  First try not to panic. Remember this happens to most women who conceive from fertility treatment and most of the time it means nothing bad.  Most of the time everything is fine. Most of the time it will stop in a few hours and not come back.  It is important to know that there is nothing we can do (Olive doctors and nurses or emergency room staff) to prevent a miscarriage or stop the bleeding or truly help in any way make it better, EXCEPT we hopefully can reassure you with blood work or, if you are beyond 6 weeks of pregnancy, an ultrasound to assess whether the pregnancy is ongoing or a miscariage.

 

So, if you have bleeding stop what you are doing, rest/lie down and then call us in the morning.  Do not stop any medications we have prescribed for the pregnancy.  When you talk to us we will plan the next steps: if you are between 4-6 weeks of pregnancy (gestational age) we will do a blood test, if you are beyond 6 weeks of pregnancy we will do a transvaginal ultrasound to look for the fetus' location, heart beat, and size.  We review your blood type and if you are a Rh negative blood type then we will arrange for you to get RhoGam to prevent your body from making antibodies to fetus' positive blood type.  Most people are Rh positive and do not need RhoGam.

 

If the bleeding is heavy you should go to your nearest emergency room.  Now, as gynecologists say "one woman's spot is another woman's clot."  So what is heavy?  Heavy is soaking a thick menstrual pad every hour for more than 2 hours straight.

 

Please remember that most of the time the bleeding is ok - the baby is fine and the pregnancy will work out as you dreamed it would.  Sometimes it doesn't though, and that's the heartbreak of miscarriage.  Blood, ultrasounds, time and a good medical team will guide you through whichever outcome you face.  This is all part of the journey to family.

 

Dr. Beth Taylor MD, FRCSC
Reproductive Endocrinology & Infertility