First Trimester: Bleeding

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It is early in your pregnancy, and you have already taken the opportunity to share the exciting news with all of your family members, friends, and co-workers.  One morning you wake up to discover that there is a small spot of blood on the underwear that you have on.  You are now frozen in fear that something has gone terribly wrong with your pregnancy.  First, take a moment to calm down and breathe!  Bleeding during a pregnancy is never considered “normal,” however, it is very common for bleeding to occur during the first trimester.  Statistics support that approximately 25% of all of the women who have delivered healthy babies will have experienced some degree of bleeding during the course of the first trimester of their pregnancies.

You should definitely bear in mind that bleeding can also be a sign of an impending miscarriage, so it is highly important that you discuss the bleeding with your obstetrician or midwife.  It is likely that he or she will choose to conduct some degree of examination, however, this will not necessarily require any type of emergency intervention.  Typically, an ultrasound may be required to best evaluate your health and the progression of your pregnancy. 

Two major questions to take into consideration are “What type of bleeding is likely to be an indicator of a miscarriage?” and “What are the common causes of bleeding during the first trimester of a pregnancy?”  In taking the question of possible causes into consideration, one of the most common is the aggressive growth of the placenta, which can contribute to light bleeding.  Typically, as contact is established by the maternal blood circulation and the formation of the placenta, some resultant bleeding from the uterine wall can occur.  Sometimes a small amount of blood will collect behind the placenta, which is referred to as retro-placental bleeding, and this collection of blood can escape the placental region and cause vaginal bleeding.

Amongst the typical symptoms associated with bleeding that can be an indicator of impending miscarriage, the most common, and the one that will most likely be addressed by your health care provider, is abdominal pain.  More often than not, an impending miscarriage will manifest itself through a combination of vaginal bleeding combined with lower abdominal cramping.  It has also been noted that the severity of the bleeding that occurs prior to miscarriage is a bit heavier than what is commonly associated with normal pregnancy.

One of the most common causes of a miscarriage is a blighted ovum.  On the surface, this term can be very misleading, because the abnormality is not specific to the ovum, but results, instead, from a combination of the sperm and the ovum.  This abnormal combination results in a chromosomal defect that is so severe that the development of the pregnancy cannot advance beyond the earliest stages.  Typically, with a case of a blighted ovum, there is no evidence of embryonic development, but merely the development of the placental tissue. 

Please bear in mind that the occurrence of a blighted ovum does not support that a chromosomal defect exists within either parent, as the abnormality is specifically related to only the fertilized ovum in question.  No evidence exists to support a recurrence of a blighted ovum during a future pregnancy.  This has very important implications for handling miscarriage, on both a psychological level and a medical one.  As the blighted ovum occurs at the moment of conception, there is absolutely nothing that can be done to prevent a miscarriage.  This being the case, you should never blame yourself for a miscarriage, if it is meant to happen it will happen!  Essentially, nothing can be done to save an abnormal pregnancy!  At the same time, however, typically nothing that you commonly do will disrupt a normal pregnancy!

Lastly, bleeding during the first trimester of a pregnancy may also be an indicator of a far less common condition referred to as ectopic pregnancy.  An ectopic pregnancy, which is also referred to as a tubal pregnancy, results from the implantation of the fertilized egg in the lining of one of the woman’s fallopian tubes instead of in the lining of her uterus.  This type of pregnancy can never be successful, and clearly represents a risk to the health and wellbeing of the mother.  An ultrasound can be a good tool for helping to effectively diagnose an ectopic pregnancy.


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By Jack Rambadt of Expecting Parents Alliance of America

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