This website presents the facts concerning pregnancy and is intended to make pregnant women aware of what is happening to them. It is also intended to inform them about the many changes associated with pregnancy so that they are aware of some of the warning signs of dangers which may be involved. Pregnant women are highly susceptible to suggestion and it is very difficult to warn them about complications without creating doubts or making them afraid. Antenatal care today prevents many complications and can deal satisfactorily with most of those that do arise, and as long as pregnant women attend the antenatal clinic regularly and heed any warning symptoms they need not worry about their progress.
A normal pregnancy requires very little more than a certain amount of homage, and it is reasonable to expect a woman to take more care of herself when she is pregnant. She should have more rest; she should not take drugs and should not expose herself to undue dangers or to the risk of infections which might possibly harm her unborn infant. The pregnant woman can behave almost normally in the early part of pregnancy apart from these cautions since the fetus is extremely well protected within the uterus. She need not restrict her activities in any way unless she usually undertakes a lot of physical activity, in which case she should ask her doctor about continuing. The ability of a pregnancy to continue quite normally despite the most outrageous insults is shown by the number of women who attempt to get rid of unwanted pregnancies and find that all their efforts are completely unsuccessful.
Bleeding in early pregnancy
When a pregnancy occurs the first period that should come after the implantation of the ovum is normally suppressed so that there is no bleeding. Subsequently, all the periods that would normally occur are likewise suppressed throughout the pregnancy. This is because a greater amount of the hormone progesterone is being produced. It occasionally happens, however, that the level of progesterone is not sufficiently high and a certain amount of bleeding occurs when the period would be expected. This usually goes under the heading of a ‘partially suppressed period’. Bleeding at this time is usually comparatively slight and may last for only a few minutes, a few hours or perhaps for one or two days. The loss is much less than usual and the color is darker. There is no pain.
It is not generally recognized that a woman can have partially suppressed periods while she is pregnant and it is, therefore, understandable that although she may feel some of the symptoms of pregnancy she may not realize that she is pregnant, and it is only in retrospect that she will appreciate that the period was both shorter in duration and less in quantity than normal.
Occasionally a small amount of bleeding may occur at the time of the second or even the third period and there are instances in which women have continued to have virtually normal periods for six or more months of what was an otherwise normal pregnancy.
Bleeding at the time of an expected period in early pregnancy may cause some confusion concerning the exact date of conception and therefore the expected date of delivery. If during your first visit to the doctor or the antenatal clinic, your uterus is found to be slightly more advanced in size than the dates suggest, you may be asked for exact details of your last period in case this was partially suppressed. An ultrasound scan will clarify the duration of the pregnancy.
The true significance of bleeding at the time of a suppressed period in early pregnancy is not clear, for while in the majority of instances it does not seem to affect the pregnancy it does indicate that the pregnancy is unstable and it is certainly true that miscarriage is more likely in a woman who has had a partially suppressed period than in one who has not. Caution, therefore, being the watchword, doctors consider it wise for a woman who has bled at the time of her first period to avoid intercourse and rest quietly in bed for a few days when her next period would be expected.
The bleeding at the time of a suppressed period is bleeding from the mother’s uterus, not from the pregnancy or the baby. The baby is not adversely affected by it and if the pregnancy continues to progress satisfactorily the baby will develop normally.
Internal sanitary tampons should never be used during pregnancy.
Bleeding in the early stages of pregnancy may also come from abnormalities or diseases of the cervix.
Cervical erosion is a particular type of very superficial ulceration that occurs on the neck of the womb either before or very often during early pregnancy. It may occasionally become infected and give rise to a rather profuse yellowish, and sometimes irritating, vaginal discharge. A cervical erosion may bleed but this is usually very slight and may only be a stain. Bleeding may sometimes be provoked by intercourse at any stage of pregnancy. However, a cervical erosion does not usually bleed, even after intercourse, unless it has become infected. It is not treated during pregnancy although when it becomes infected local treatment with cream or pessaries is usual. A normal cancer smear test will confirm that this is nothing to worry about.
Bleeding from the vagina is abnormal at any stage of pregnancy and may be due to many causes. Some are of little or no significance while others are potentially more dangerous. There is no way a pregnant woman can know if any bleeding from which she is suffering during pregnancy is significant or not, and she must, therefore, report it immediately to her doctor. Similarly, she must report an excessive vaginal discharge or any acute abdominal pain.
An abortion by definition is the discarding by the uterus of the products of conception before the 28th week of pregnancy. There is no difference between an abortion and a miscarriage despite the frequently held view that an abortion is something that is induced and a miscarriage is something which occurs spontaneously. The two terms are synonymous and are so used here.
A threatened abortion is bleeding from the vagina during the first 28 weeks of pregnancy and is not accompanied by any pain.
Inevitable abortion. A threatened abortion becomes an inevitable abortion when the woman experiences pain due to uterine contractions or when, on examination, the cervix, or neck of the uterus, is found to be opening so that abortion must inevitably occur sooner or later.
A complete abortion has occurred when all the products of conception have been passed from the uterus.
An incomplete abortion is a condition in which part of the products of conception has been passed but some remain within the uterus.
A missed abortion is said to occur when the pregnancy has died within the uterus but the uterus has failed to expel it. The dead pregnancy will be aborted sooner or later.
Recurrent abortion is miscarriage on three or more occasions. The cause may vary on each occasion so the abortion may occur at different stages during different pregnancies.
Habitual abortion is the term usually reserved for miscarriage on three or more occasions at approximately the same stage of pregnancy and therefore assumed to be for the same reason each time.
Any bleeding which occurs at any stage during the first 28 weeks of pregnancy must be considered a threatened abortion until proved otherwise. If a woman notices any such bleeding she should go to bed immediately and stay there until she has been seen or advised by her doctor. The bleeding may be very slight in amount and may or may not be mixed with mucus. On the other hand, it may be comparatively severe and even as heavy as a normal period. Occasionally there may be a dull aching discomfort in the lower abdomen. A small amount of a backache, especially in the lower part of the back, may occur both before and with the bleeding. The abdominal discomfort and the backache usually pass with rest in bed. It frequently happens that a woman is first conscious of the bleeding when she passes urine. This does not mean that micturition has made the uterus bleed, but that the uterus has been bleeding slowly into the vagina for some time before micturition and on straining slightly blood appears from the vagina as urine is passed.
There are many causes of threatened abortion, some of which are known and many of which are not. Possibly the commonest cause is hormone imbalance so that the bleeding occurs at the time when the woman would be having a period and is called a ‘partially suppressed period’. If the amount of circulating hormone is insufficient to maintain a pregnancy this will first become apparent when it fails to suppress completely the next menstrual period. Such bleeding may be slight in amount or, if the hormone levels are really low, it may become much more severe and may end in actual abortion.
A threatened abortion most commonly occurs at the time of the first, second or third suppressed period, that is at 4, 8 or 12 weeks of pregnancy. It also occurs at about the 14th week of pregnancy because it is at this stage that the placenta, which may be inefficient, takes over the production of hormone from the corpus luteum of the ovary.
The correct treatment for threatened abortion is immediate bed-rest. This means complete rest: going to bed, staying there and resting as quietly as possible. The woman may be allowed up for toilet purposes but for no other reason.
When a threatened abortion first begins the loss is usually bright red or pink which means that the blood is coming almost directly from the uterus. When it stops bleeding the color of the loss from the vagina changes from bright to dark red and then brown. Normally bed-rest is continued until three days after the brown discharge has ceased.
Internal sanitary protection must not be used at any time during pregnancy unless specifically requested by your doctor. Sanitary towels must be used and changed frequently. They should be saved for your doctor to examine.
Complete bed rest may, of course, be impracticable for someone who has no help in the house or for someone who has to look after small children, but it is nevertheless the ideal and the maximum rest possible must be taken. A mild amount of sedation or tranquilizer is frequently administered to women when they threaten to miscarry because not only are they upset but it also helps them to rest quietly. Threatened abortion used to be treated by giving some sort of progesterone tablets or injections but this treatment has many disadvantages and no advantages so it is no longer recommended.
It is impossible to know how many threatened abortions settle down and how many proceed to actual miscarriage. A threatened abortion does indicate a certain instability of the pregnancy and care should be taken to rest quietly at the time when the next period would normally be. The pregnant woman’s activities should also be appropriately restricted for at least the first 14 weeks of her pregnancy. Sexual intercourse should not occur until the baby has been felt moving and in any event not until her doctor advises. An ultrasound scan may be performed in cases of threatened abortion. Provided this shows a viable fetus, miscarriage is unlikely. It will distinguish a threatened from a ‘missed’ abortion (see above).
Inevitable abortion is associated with pain in the lower abdomen which feels rather like the cramp of a period pain. The initial bleeding usually increases in amount and becomes brighter in color. The woman should go to bed immediately and notify her doctor who will decide if admission to hospital is advisable. The amount of discomfort or pain depends on the stage of the pregnancy. The pain is caused by the uterus contracting so that it will eventually expel the pregnancy. The only constructive treatment is usually bed-rest, a sedative drug and if necessary something to relieve the discomfort.
An abortion begins as a threatened abortion and proceeds to become inevitable after which the contents of the uterus will be completely expelled or only partially expelled (incomplete abortion). Complete abortion is said to occur when all the products of conception have been passed so that the uterus no longer contains any of the products of conception. A complete abortion may take only one hour from the onset of bleeding and may be accompanied by comparatively little pain. Alternatively, the process may take many hours and be associated with severe lower abdominal pain and profuse bleeding. If abortion is rapid it may be completed before the doctor arrives, or if slow, admission to hospital may have been arranged while the abortion was either threatened or inevitable.
When the abortion is complete all discomfort and pain cease and the amount of bleeding rapidly diminishes. The abortion itself is passed as a clot of liver-like. material which should if possible be saved for the doctor to examine and confirm that all the products of conception have been passed. The main treatment is rest in bed for one or two days and then a gradual return to normal activity over the next four or five days. An abortion is often complete in the early stages of pregnancy (less than 8 weeks).