Bleeding during pregnancy: When to raise the alarm

Dear doctor,

I am in my ninth week of pregnancy and have been experiencing light bleeding. I have been told this is normal, but I am worried. Is this a bad sign?

Grace,

Dear Grace,

Any bleeding, at whatever stage in pregnancy, is never normal. True, minimal bleeding or spotting tends to be innocent, and majority of pregnancies in such situations never come into any harm. Bleeding in amounts equivalent to a period, or heavier, usually signifies a more serious situation. But regardless of the amount of bleeding, a medical assessment is usually required.

The ninth week falls into the first trimester of pregnancy, generally categorised as early pregnancy. This tends to be a very sensitive period, as any bleeding may be an early indicator of a pregnancy that may fail. Thus the immediate worry is the likelihood of ending up with a miscarriage. Pain associated with light bleeding additionally raises suspicion about an ectopic pregnancy (a pregnancy located outside the womb, usually in the fallopian tubes). Rarely, other conditions in the genital tract may be responsible for the bleeding.

Once you notice any bleeding in early pregnancy, your immediate course of action should be to visit your gynaecologist. Better still, you could arrange a review in specialised early pregnancy clinics, commonly incorporated in well-structured gynecological units. The aim is to get a one-stop comprehensive assessment. Your general status will be assessed. This may be followed by an internal check to gauge the amount of bleeding, and see where it’s coming from. You will almost inevitably get an ultrasound scan ordered to further assess the status of the developing fetus. Depending on the initial findings, some blood tests may be necessary.

Those found to have minimal bleeding, and a live developing fetus don’t usually require any specific treatment. Reassurance is all that is required, and a subsequent review should this become necessary. The extreme category is those with heavy bleeding, with a fetus who is already dead. There’s only one way out in this scenario, just to allow or enhance the pregnancy to be expelled as a miscarriage. Some will fall in between, with some significant bleeding but a fetus who is still alive. Such scenarios are categorised as threatened miscarriages. Majority of the pregnancies will still progress normally, while some may still end up with a miscarriage. There are unresolved controversies on how to treat such pregnancies, but a small proportion may be given empirical hormonal treatment.

Bleeding in early pregnancy is pretty common, its occurrence should prompt you to seek immediate medical review. Don’t agree with those who say it’s normal, but don’t go into panic either. A comprehensive assessment immediately provides you with an indicator of the status of your pregnancy. Luckily for the majority, no harm will come to the pregnancy despite the bleeding. 

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. [email protected]