While bleeding can occur with or without pain, and pain can occur with or without bleeding, either symptom is significant in pregnancy. Bleeding is especially alarming for a pregnant woman and her family.

Some women go straight to hospital, but many consult their GP so it is important to know how to manage these common symptoms.

Bleeding in Early Pregnancy

This means before 22 weeks, the time at which the fetus is considered viable.

Any blood comes from the woman, not her fetus, and not every cause is related to her pregnancy (see Figure 30). However, in many cases bleeding is indeed pregnancy-related and can lead to fetal or even maternal death, so always take it seriously.

Miscarriage

This is often a woman’s greatest fear. It’s said that 20% of all pregnancies end in miscarriage, but ultrasound studies show that the real proportion is much higher because many occur early on, before the woman even knows she is expecting.

Miscarriage can be:

• Threatened: bleeding can be light, and pain minimal. The cervical os is shut.
  
• Inevitable: pain may or may not be severe. The os is open and there may be products of conception in the cervical canal.
  
• Incomplete: the woman continues to bleed after passing some products of conception. There may be also be products of conception visible in the canal.
  
• Complete: bleeding and pain stop, and the os closes.
  
• Recurrent: this is defined as three or more miscarriages.

History

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