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Early pregnancy bleeding refers to vaginal bleeding before 24 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.
Common causes of early pregnancy bleeding include ectopic pregnancy, threatened miscarriage, and pregnancy loss. Most miscarriages occur before 12 weeks gestation age. Other causes include implantation bleeding, gestational trophoblastic disease, polyps, and cervical cancer. Tests to determine the underlying cause usually include a speculum examination, ultrasound, and hCG.
Treatment depends on the underlying cause. If tissue is seen at the cervical opening it should be removed. In those in who the pregnancy is in the uterus and who have fetal heart sounds, watchful waiting is generally appropriate. Anti-D immune globulin is usually recommended in those who are Rh-negative. Occasionally surgery is required.
About 30% of women have bleeding in the first trimester. Bleeding in the second trimester is less common. About 15% of women who realize they are pregnant have a miscarriage. Ectopic pregnancy occurs in under 2% of pregnancies.