Early pregnancy Pain/Bleeding

Vaginal bleeding and/or cramping pain during the first 3 months of pregnancy (early stages of pregnancy) is common and occurs in 20% of women. This does not always indicate there is a problem or that you are having a miscarriage. Sometimes it can be a sign of the following conditions: 

Threatened miscarriage

This is when you have had pain and/or bleeding but in most cases the pregnancy progresses normally. 

Early miscarriage

Unfortunately, bleeding and/or pain can mean you have had or are having a miscarriage. This will be confirmed after blood tests and/or ultrasound scans. Sadly, miscarriages are common, with 1 in 5 women having a miscarriage in the first 3 months for no apparent reason. Most occur as a one-off event and many women have successful future pregnancies. 

Ectopic pregnancy 

This is a situation where the pregnancy starts to grow outside the womb. This can pose a risk to your health. 

If your symptoms or observations lead us to believe you may have an ectopic pregnancy you will be assessed in hospital where you will have a series of tests. These tests will help identify the most appropriate management plan for you. The team will discus these options with you. Occasionally women become very unwell requiring emergency surgery. If this is the situation the treating team will discuss this with you. 

A pregnancy of unknown location 

If you have a positive pregnancy test and the team are unable to see the pregnancy on ultrasound scan, the reasons for this could 

be:

1. The pregnancy is still too early to be seen. 

2. An early miscarriage has occurred. 

3. You have an ectopic pregnancy that is too small to be seen. 

You will have follow-up organised by the early pregnancy team to decide which of these it is. 

This can understandably be a very worrying and stressful time. Many women express a wish to know what is happening and for scanning to be performed immediately. However, this also does not give extra information and can cause increased anxiety levels. Unfortunately unless your observations are abnormal or we have concerns about an ectopic pregnancy patients are followed up by the early pregnancy team. This is because there is nothing you or we can do to stop miscarriages or other problems in early pregnancy from happening. 

Discharge 

If you are fit to be discharged home, your triage nurse will contact the early pregnancy team. The nurse will discuss your symptoms with The Early Pregnancy Team, they will decide if a review is to take place. Occasionally we are able to confirm a day and time when you will be seen in the Early Pregnancy Unit. More often we pass on your details to be contacted the following day when a telephone assessment will take place and a decision will be made as to whether you require an appointment. 

First meeting with Early Pregnancy team. 

When you first meet with the team they will discuss in detail your pregnancy so far and will assess for further investigations. You may not necessarily require an ultrasound scan initially.: 

This information will be used to discuss with you what they think is happening with your pregnancy and the management options that are available. 

Sometimes they may not be able to give you a definite answer about what is happening with your pregnancy, you may need to return for further investigations. 

If you have been told the early pregnancy team will contact you please make sure you leave an up to date mobile number and address. Be aware that the hospital number is withheld or starts in 0800- so please still answer your phone. No message will be left. 

If you think you are becoming more unwell or develop any of the following symptoms: 

• Pain that is not controlled by regular paracetamol 

• Light headedness/ dizziness/faints/collapse 

• New shoulder pain 

• Excessive bleeding requiring pads to be changed more often than every 30 minutes 

Please contact the early pregnancy team for advice on: 

01592 729706 

(9-7pm weekdays and 9-12pm weekends) 

01592 729590 or 729591 

(After 7pm weekday or 12pm at weekends) 

Urgent medical help is always available by calling 999 for an ambulance if you believe you are seriously ill and your life is at risk. 

Further information about problems in early pregnancy available from: 

Royal College Obstetricians and Gynaecologists 

https://rcog.org.uk/en/patients/patient-leaflets/ bleeding-and-pain-in-early-pregnancy/ 

Association of Early Pregnancy Units www.earlypregnancy.org.uk 

National Institute for Health Care Excellence (NICE): Ectopic pregnancy and miscarriage 

www.nice.org.uk/guideance/cg154/ifp/ chapter/about-this-information 

Miscarriage association 

www.miscarriageassociation.org.uk