Early pregnancy bleeding

Early pregnancy bleeding (also called first trimester bleeding) is vaginal bleeding before 13 weeks of gestational age. Early pregnancy bleeding is common and can occur in up to 25% of pregnancies. Many individuals with first trimester bleeding experience no additional complications. However, 50% of pregnancies with first trimester bleeding end in miscarriage.

Common causes of early pregnancy bleeding include miscarriage, ectopic pregnancy, and subchorionic hematomas. Other causes include implantation bleeding, gestational trophoblastic disease, cervical changes, or infections. Assessment of first trimester bleeding includes history and physical exam (including speculum examination), imaging using ultrasound, and lab work such as beta-hCG and ABO/Rh blood tests.

Treatment depends on the underlying cause. Emergent management is indicated for patients with significant blood loss or hemodynamic instability. Anti-D immune globulin is usually recommended in those who are Rh-negative. Early pregnancy loss can be treated with expectant management, medication, or surgical intervention. Ectopic pregnancy can be treated with medication or surgical management, although emergent intervention is needed if the pregnancy has ruptured.