Bleeding In Early Pregnancy

Bleeding in early pregnancy is a relatively common problem.

Invariably, it is not normal.  However, it certainly does not mean that the pregnancy is lost.  In fact, especially in patients who have undergone treatment with ART ( Assisted Reproductive Technology – including IVF, Egg Donation, Gestational Surrogacy or Frozen Embryo Transfer or IUI) some bleeding can occur is upwards of 20% of cases.  The amount and color of blood flow is very important.  The less bleeding there is the better.  The darker the blood, the less ominous.  Dark blood means the blood is older, which in turn means the rate of fresh bleeding from the uterus, is slower.

If bleeding starts, it is important to try to get to bed as soon as possible.  This serves to take the pressure off the uterus and allows the organs to be in a quiescent state.  There should be no heavy lifting and no intercourse or other sexual stimulation.   You should remain on all supplemental medications (estrogen, progesterone and so forth) until instructed otherwise by the doctor.  If you are taking any anticoagulation medications (e.g. Lovenox, heparin or aspirin), they should be withheld until you have discussed the situation with the doctor.  It is likely that the doctor will want to see you for an evaluation on the next business day.  If the bleeding occurs during the weekend, you will likely not be seen until the following Monday, unless the bleeding is heavy and/or there is associated pain.

The presence of pain associated with the bleeding is important.  It may imply that a miscarriage is inevitable.   The thing to be concerned about would be an ectopic pregnancy (a pregnancy which is situated in a location other than the uterus).  These definitive diagnoses are usually made with exam and ultrasound in the office.  Accordingly, the presence of pain should be discussed with the medical team as soon as possible.

Sometimes, a large partial separation of the pregnancy sac can be noted on the ultrasound.  This is called an abruption.  The size of the abruption is very important.  If you consider the gestational sac to be a sphere (much like an orange), if the blood clot (abruption) covers half of the sphere, this would be called a 50% abruption, a quarter is 25% abruption and so forth.  The larger the abruption, the more threatening it is to the survivability of the pregnancy.  The risk of this partial separation is that it acts as a “wedge”, separating the pregnancy away from the lining of the uterus — the life line of the pregnancy.  The ability of the pregnancy to survive an abruption depends on the size, rate of progression and the stage of the pregnancy.

If you are diagnosed with an abruption, it is critical to try to rest as much as possible.  This in fact is the only treatment which has been shown to be beneficial.  If the bleeding stops, the abruption will become organized and the expanding pregnancy sac will once again adhere to the walls of the uterus.  Therefore, complete survival of the pregnancy is possible, although studies have indicated that there is a slightly higher risk of premature delivery in those cases where there has been a bleed in the early part of the pregnancy.  Therefore, it would be important to discuss this with your Obstetrician.