Vaginal bleeding in early pregnancy

This is one of the commoner presentations from my clinic besides the general antenatal workload.

The euphoria of early pregnancy (first trimester) is sometimes interrupted by symptom of vaginal bleeding. There is usually high anxiety level, which is only natural. This bleeding varies from brownish discharge to fresh red bleeding. This symptom can be associated with lower abdominal cramps. Most couple comes early for consultation. My assessment during this consultation is to attempt to ascertain the cause of vaginal bleeding and demonstrate pregnancy viability.

It is understandable that couple would want to know if ‘the pregnancy or fetus is alright’. However, there is no single clinical assessment, blood test or ultrasound feature that provides a reliable prediction of the pregnancy outcome following such event. The current treatment this condition remains empirical. Most doctors advocate bed rest and hormonal support, although the evidence is lacking.

On the contrary, it is not uncommon to find a cervical polyp as the source of vaginal bleeding. This condition can be treated with removal of the polyp to relieve the symptom. The pregnancy is usually left undisturbed.

Our clinical experience has shown that about half of the early pregnancies with complication of vaginal bleeding is associated with good prognosis. In these cases, the vaginal bleeding stop gradually over time and the pregnancy continues to term.

Early pregnancy vaginal bleeding is common and requires immediate medical attention

The joy of knowing that one is pregnant is often interrupted by feeling of bloatedness, poor appetite and nausea. Most women (50-90%) will have these symptoms during their early stage of pregnancy but gradually subside by the 14-16th weeks. Morning sickness, another name for this condition is coined due to the belief that these symptoms are commonly experience by pregnant mothers in the morning.

Hyperemesis gravidarum is associated with the rising pregnancy hormone (HCG, human chorionic gonadotrophin). Once the placenta is fully functional, the HCG hormone declines and hyperemesis improved. It does not affect the fetus but can be a challenging experience for most pregnant mothers. Besides the discomfort of nausea and bloated, medication is usually not necessary for most cases. Very rarely, severe hyperemesis is associated with liver (Wernicke’s encephalopathy) or kidneys (acute renal failure) complications. Looking at the bright side, hyperemesis indirectly indicates a healthy ongoing pregnancy. Only in a normal pregnancy, the HCG hormone will rise accordingly. On the contrary, women with missed abortion or failed pregnancy will not have a decline in the serum HCG level, which clinically manifest as regression of symptom.

I do not often prescribe anti-emetic drugs for my patients except if the hyperemesis is severe. I generally advise them to choose their food carefully, identify symptom triggers to avoid them, and take frequent but small snacks. There are also other alternative methods such as acupressure, acupuncture, taking ginger drinks and hypnosis but their effectiveness remains to be proven.

Embrace and welcome your pregnancy symptoms. They are challenging but mostly transient