Bleeding and Pain In Pregnancy

Bleeding and/or pain is common in early pregnancy and does not always mean that there is a problem.

• Bleeding and/or pain in early pregnancy can sometimes be a warning sign of a miscarriage.
• If you have bleeding and/or pain in the early stages of pregnancy, you should seek medical advice.
• You may be advised to have tests including an ultrasound scan to check your pregnancy.
• If you have heavy bleeding, severe pain in your abdomen, pain in your shoulder, dizziness or fainting, you should contact your Early Pregnancy Assessment Service or nearest A&E department immediately

A threatened miscarriage

If you have had bleeding and/or pain but your ultrasound scan confirms that your pregnancy is progressing normally, this is known as a threatened miscarriage. Many women who bleed at this stage of pregnancy go on to have a healthy baby. You may be offered a follow-up scan. 

An early miscarriage

Unfortunately, bleeding and/or pain in early pregnancy can mean that you have had or are having a miscarriage. Sadly, early miscarriages are common. In the first 3 months, one in five women will have a miscarriage, for no apparent reason, following a positive pregnancy test. However, most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. 

An ectopic pregnancy

When a pregnancy starts to grow outside the womb, it is called an ectopic pregnancy. In the UK, one in 90 pregnancies is ectopic. Your symptoms, scan findings and blood tests might lead to suspicion that you have an ectopic pregnancy.

An ectopic pregnancy can pose a risk to your health. If this is suspected or confirmed, you may be advised to stay in hospital. 

A molar pregnancy

A molar pregnancy is an uncommon condition where the placenta is abnormal and the pregnancy does not develop properly. It affects only one in 700 pregnancies. A molar pregnancy is usually diagnosed when you have an ultrasound scan. 

A pregnancy of unknown location (PUL)

If you have a positive pregnancy test and your pregnancy cannot be seen clearly on ultrasound scan, it is known as a pregnancy of unknown location (PUL).

Reasons for this may be:

• that your pregnancy is in the womb but it is too small or too early to be seen. Modern pregnancy testing kits are extremely sensitive and can detect the pregnancy hormone just a few days after conception. However, a pregnancy may not be seen on ultrasound until approximately 3 weeks after conception (at least 5 weeks from your last period).
• that an early miscarriage has occurred, particularly if you have had bleeding that has now settled.

Pregnancy tests can stay positive for a week or two after a miscarriage.

• an ectopic pregnancy that is too small to be seen. As many as one in five women with a PUL may have an ectopic pregnancy. 

If you are diagnosed with PUL, it is important that you are followed up to get a diagnosis and to confirm whether your pregnancy is continuing or not. You will be given an appointment to attend your early pregnancy unit for follow-up.

You are likely to be asked to come every 2–3 days for a blood test to check the level of your pregnancy hormone (βhCG). The results should help show where the pregnancy is developing. They will also help to guide your follow-up: 

• in a normal pregnancy, βhCG levels rise significantly
• in an ectopic pregnancy, the level will usually rise slightly or stay the same
• once a miscarriage has occurred, the level will fall significantly 

You may also be booked for another ultrasound scan, usually within 1–2 weeks. If an ectopic pregnancy is suspected, a member of staff may contact you with your results and give you advice. This uncertainty will be difficult but it often takes time to come to the right diagnosis. Sometimes this is reached within a few days but it may take up to 2 weeks. The team looking after you will discuss your options at each step. 

Hope you found this information helpful.