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You're finally there. Just about through your first trimester of pregnancy, you are anxiously looking forward to telling all your family and friends (Facebook world, that means you) about your upcoming bundle of joy. You are nervous, excited, and still a little bit nauseous, but you're so ready to spill the beans on baby.
And then, one morning, you wake up to blood in your underwear. Your first thought is simple--and scary--does this bleeding mean you are having a miscarriage?
What you need to know
The first thing you need to do if you are experiencing bleeding during early pregnancy is, don't panic! Bleeding during a pregnancy does not always mean that a miscarriage is imminent. "Bleeding can occur in a completely healthy pregnancy," explains Dr. Zev Williams, MD, PhD, Director of the Program for Early and Recurrent Pregnancy Loss (PEARL) at Montefiore Medical Center/Albert Einstein College of Medicine. In fact, many women experience some form of bleeding, especially in the early weeks, during their pregnancies.
According to an article published by the American Academy of Family Physicians, almost 1 in 4 pregnant women will experience bleeding during their first trimesters, but only about half of those cases will result in a miscarriage.
Causes of bleeding during pregnancy
Instead, as many women discover after visiting with their pregnancy care providers, vaginal bleeding during pregnancy can be normal and not an immediate cause for concern. Some types of bleeding can be caused by implantation, (most commonly occurring the day your period is due) an infection of some sort in the body, or irritation (like from intercourse).
Dr. Elizabeth Nowacki, an OB/GYN at St. Vincent Fishers Hospital Indianapolis explains that one of the most common causes of bleeding is "lag time" before the placenta is fully formed. Before the placenta starts forming around 12 weeks, the ovary that released the egg provides the main source of hormonal support to the pregnancy, which can cause some time to pass before the placenta is ready to go, and thus, bleeding. "It always seems to happen at 2 o'clock in the morning!" says Dr. Nowacki. "If it's just light spotting or spotting with wiping, it's not a big deal and you can wait to call your doctor in the morning."
Bleeding that occurs later on during a pregnancy, in the second and third trimesters, can also have different causes that won't result in a miscarriage, such as cervical irritation (again, which can occur after intercourse) or even cervical changes (a growth or polyp on the cervix may cause slight bleeding).
"Sometimes, the outside of the cervix (which connects the uterus to the vagina) can bleed or an area of bleeding can occur in the space between the placenta and the uterus, which will usually resolve on its own," says Dr. Williams. Slight bleeding, especially if it is tinged with a mucus-like discharge, could also be a sign of early labor.
Some bleeding during pregnancy is simply unexplained; one patient I cared for in my work as a labor and delivery nurse experienced moderate bleeding, almost as heavy as her regular period flow, throughout each of her three pregnancies--with no known cause and no need for any further treatment. She delivered three, full-term and healthy infants. And who among us hasn't heard the stories of women who didn't know they were pregnant because they continued to have monthly bleeding? Bleeding that is not a direct indication of a miscarriage can definitely occur during pregnancy.
What should I do if I experience bleeding?
Although bleeding during pregnancy may not necessarily mean a miscarriage is inevitable, consistent bleeding at any point during a pregnancy always needs to be evaluated by a healthcare provider. If you are experiencing bleeding, take the following steps:
- Note the time the bleeding started and any activities that may have contributed to the bleeding (for instance, did you have intercourse in the last 24 hours or have a vaginal exam performed recently?).
- Place a pad or panty-liner (never use a tampon!) for absorption and as a means to gauge the amount of bleeding. Your healthcare provider may ask you how quickly you are filling up a typical overnight pad as a way to determine how much bleeding you are experiencing. Also be sure to note the color of the blood--your doctor may need to know if it is bright red or brown in color.
- While waiting to be seen by your doctor, try to sit down, put your feet up, and drink a large glass of water.
- Ask yourself if you are experiencing any other symptoms such as contractions, back pain, nausea, vision changes, or decreased activity of the baby.
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