Early pregnancy bleeding can be an alarming incident, occurring in 15 percent of pregnancies, sometimes heralding a miscarriage or an ectopic pregnancy.

In the large majority, this bleeding is due to implantation bleeding as the embryo tries to embed itself in the lining of the womb.  When mild, it usually resolves, and the foetus continues to grow. An ultrasound scan confirms the viability of the pregnancy. In 1 in 8 pregnancies, the bleeding becomes heavier, leading to loss of the pregnancy, (miscarriage). This is commonly due to the conceptus being unhealthy, 70% of times due to a genetic defect. A miscarriage is thus nature's way of selection of the fittest. At times the womb needs to be cleared through a medical or surgical evacuation. Pregnancy can be attempted again from the very next cycle in most cases.

If accompanied by pain, early pregnancy bleeding could be a sign of a tubal ectopic, a pregnancy inside the tube (prevalence 2%) This is a potentially life-threatening condition as the ectopic could rupture due to lack of space to grow, causing torrential bleeding inside the abdomen and leading to loss of life. Treatment involves the replacement of blood and simultaneous laparoscopic surgery to remove the ectopic and damaged tube. Recovery is quick and dramatic if correctly diagnosed and tackled immediately without delay. Ectopics are caused due to tubal damage following an infection that might have gone undetected, making it incapable of transporting the embryo into the uterus. An ectopic increases the risk of a future ectopic tenfold and so an early scan in the following pregnancy is essential to check the location of the pregnancy. In conclusion, early pregnancy bleeding may be a sign of an impending medical emergency and an immediate visit to a doctor or hospital emergency is advisable.

By: Dr. Sujata Datta, Consultant - Obstetrics and Gynaecology