Threatened pregnancy loss
(also called a threatened miscarriage)
Roughly 50% of pregnancies will have bleeding, most often occurring in the first trimester. When bleeding occurs in first trimester, and the ultrasound and beta-hCG does not show any indication of pregnancy abnormality, this is called a threatened miscarriage.
Quite often a reason for bleeding can not be identified on the ultrasound, even if the bleeding persists. If bleeding persists, it is important to have follow-up with your family physician, obstetrical care provider or early pregnancy clinic.
While seeing a normally developing pregnancy is very reassuring, it is still possible an early pregnancy loss can occur. Unfortunately, there is nothing that you can do to decrease this risk. There is no medication that can be taken to prevent a loss from occurring, and if a pregnancy loss occurs, it is not your fault.
After your visit to the Emergency Department, your family doctor, or an obstetrical care provider, you may be told, based on an ultrasound and/or blood work, that the pregnancy is not developing normally inside the uterus.
There are several possibilities of what could be happening.
If there is uncertainty regarding dates of your last menstrual period or if you have irregular periods, the dates used to compare the results of the measurements of the pregnancy during the ultrasound may not be accurate. It may look as though the pregnancy is smaller than it should be. In this case, repeat blood work and/or ultrasound will be done in follow-up with your family doctor, obstetrical care provider, or early pregnancy clinic.
It is also possible that the pregnancy is not developing normally, and the pregnancy will end in a pregnancy loss. In this case, repeat blood work and/or ultrasound will be done in follow-up with your family doctor, obstetrical care provider, or early pregnancy clinic.
Unfortunately, this waiting period can be very difficult, as there is so much uncertainty during this time. Typically, an ultrasound or blood work completed 7 to 10 days after the initial ultrasound is the recommended time frame to assess the status of your pregnancy. Completing an ultrasound earlier is often not able to provide any more information than what was received at the earlier visit.
Unfortunately, there is nothing that you can do to decrease the chances of a loss happening. There is no medication that can be taken to prevent a loss from occurring, and if a pregnancy loss occurs, it is not your fault.
Signs that may indicate a loss is happening are heavy bleeding from the vagina, passing large clots from the vagina, and intermittent, cramping and pain.
If a pregnancy loss is occurring at home, monitor for ‘red flags,’ which are indications that you need to go to the Emergency Department.
RED FLAGS
Go to the nearest emergency department if you:
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Suddenly have severe pain in your abdomen that is not going away or helped with acetaminophen (Tylenol)
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Suddenly feel faint or like you are passing out
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Have very heavy bleeding (soaking more than three pads in three hours)
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Have chills or a fever higher than 38°C (100.4°F)
Subchorionic Hemorrhage
Sometimes the cause of bleeding will be identified as a subchorionic hemorrhage. A subchorionic hemorrhage is a spontaneous accumulation of blood between the lining of the uterus and the chorion (the sac that surrounds the fetus) or under the placenta itself.
Bleeding from a subchorionic hemorrhage can be light to heavy spotting or bleeding.
In the vast majority of cases, these resolve on their own, and people go on to have perfectly healthy pregnancies. Because these bleeds or clots can rarely cause problems, they should be monitored by your family physician, your obstetrical care provider or an early pregnancy clinic.
It is usually recommended that you refrain from vigorous exercise (ie. running) or sexual intercourse until after the bleeding has resolved.