Many patients who have bleeding or cramping in early pregnancy can still have a normal pregnancy. However, perhaps half the time a miscarriage, or unexpected loss of the pregnancy, can occur.
Thus bleeding is a sign that that should be observed diligently.
In the past, before the mechanisms of pregnancy loss were understood, it was traditional to put patients on bedrest when they had bleeding. This is not necessary. For pregnant patients in danger of a miscarriage, our typical advice is to avoid heavy activity, get some rest and maintain a reasonably quiet schedule. Athletics, intercourse and douching should be avoided until the bleeding has stopped for at least a week.
What we’ve learned about the causes of miscarriages, particularly with infertility patients, has made life a little easier for women in jeopardy of having one. These women should be aware of serious symptoms. Onset of any of the following would be a danger sign and your doctor should be contacted:
- Heavy bleeding such as soaking 3 pads or tampons in 3 hours.
- Onset of fever over 100 degrees.
- Worsening cramping or sudden severe abdominal pain.
There is one other diagnosis which must be considered with these symptoms – it may be a “tubal” or ectopic pregnancy. This is a dangerous condition which is another issue. Usually, this possibility is not part of the picture, but can sometimes be confused with threatened miscarriage.
Mild bleeding is less worrisome; heavy bleeding, particularly with cramping, is much more of a concern. Since infertility patients are aware they are pregnant very early, using hormone evaluation can be helpful for them. In the very early phase of pregnancy, the rate of rise of the human chorionic gonadotropin (HCG) hormone in the blood can be measured. If the rate of increase is slow, the pregnancy may not develop. Once the HCG level is over 3,000, it may be possible to see the early pregnancy sac by ultrasound. However, findings can be inconsistent.
It is not actually considered a miscarriage when there is a “biochemical pregnancy.” This is when the sensitive pregnancy tests show a low “positive,” but nothing can be seen on ultrasound. The test results that follow decline and eventually become negative.
The level of progesterone is an indicator of the condition of pregnancy as well. If progesterone levels are extremely low, it is a sign that the pregnancy may not be healthy. The outcome of bleeding in early pregnancy is not dependent on anything that you or your physicians can control. If you are on hormone treatment for intrauterine insemination (IUI) or IVF treatment, typically you would be continuing this treatment. Increasing the progesterone treatment is not helpful. The hormone treatment cannot rescue a pregnancy which has stopped developing.
For women who are struggling after a miscarriage, Resolve’s helpline will connect with a trained volunteer who has experience with infertility and can help you navigate the resources available to you.
