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Vaginal bleeding during the first trimester of pregnancy will cause any pregnant woman to worry about miscarriage — and rightfully so. While around a quarter of pregnant women will experience vaginal bleeding during their first trimester, only half of those miscarry, however. 

How do you recognize a miscarriage, what are the other possible causes of first trimester vaginal bleeding, and when should you see a doctor?

What Are The Symptoms Of A Miscarriage?

Vaginal bleeding is, of course, one of the main symptoms of a miscarriage. The length of this bleeding varies from woman to woman and depends on how advanced the pregnancy is, but the bleeding associated with first-trimester miscarriages is generally over within two weeks. It tends to be quite a bit heavier than the bleeding you experience during a period, and is brighter in color.

Other symptoms of a first-trimester miscarriage include:

  • Cramping and pain in the lower abdomen. This cramping and pain is likely to resemble premenstrual cramps at first, and may become more rhythmic, coming and going in a pattern, later on. 
  • Noticing the expulsion of discharge and tissues along with your vaginal bleeding. The "clots" you notice during a miscarriage are made up of a combination of tissues from the products of conception and uterine lining tissues.
  • A sudden loss of pregnancy symptoms you previously experienced, such as morning sickness, fatigue, and frequent urination. 
  • No fetal heartbeat during an ultrasound scan, if one was previously detected. (Fetal heartbeats cannot be detected very early on.)

Some women wonder whether it is absolutely necessary to see a doctor if they are sure they are experiencing a miscarriage. Many will actively seek medical attention because they want to know what is going on, but if you are uninsured, in a place where it is difficult to get to a doctor, or scared of doctors, you may be looking for reassurance that you will be fine even without medical attention. In most cases, you will be. (And in practice, doctors in many countries will simply send you home once they have established you are having a miscarriage.) However, always seek immediate medical attention if you are bleeding very heavily, soaking more than one menstrual pad within the space of 60 minutes.

Women who experience very sharp abdominal pain, nausea and vomiting, shoulder pain, diarrhea, and dizziness or fainting also need emergency medical services, as they may be suffering from an ectopic pregnancy. 

Women who have suffered recurrent miscarriages — usually defined as three or more pregnancy losses, but sometimes defined as two or more pregnancy losses — will want to seek medical attention. Most miscarriages are caused by random factors such as chromosomal or genetic abnormalities that are incompatible with life, and do not, as such, have any bearing on future pregnancies. Some miscarriages are, jowever, caused by factors that can be treated, like hormonal imbalances (including those related to PCOS, thyroid problems, or diabetes) and uterine abnormalities. Finding the cause of your recurrent miscarriages may prevent future miscarriage.

Causes Of Early Pregnancy Bleeding And Spotting Other Than Miscarriage

Vaginal bleeding or spotting during the first trimester of pregnancy can be caused by sexual intercourse; the bleeding can come from your cervix, which is more sensitive during pregnancy. Early pregnancy bleeding can also be the result of an infection or hormonal changes associated with pregnancy. Very early on in the pregnancy, you may even be dealing with a so-called implantation bleeding, which some women experience after the fertilized egg nestles into the lining of the uterus. 

What Should I Do When I Notice Bleeding During Early Pregnancy? 

Refrain from sex or inserting anything into your vagina, and take it easy if you can — stay in bed or on the couch until you can see your doctor. Call your doctor as soon as you can, and head to the emergency room or call emergency medical services if you have symptoms that may indicate an ectopic pregnancy, which can become life-threatening. 

Keep any tissues you pass if you can; this will help your doctor make sense of what is going on with you. 

If you have already been to the doctor and you were told that your bleeding indicates a threatened miscarriage, follow your doctor's instructions. These will usually include (bed) rest and relaxation. Do not lift heavy objects, stay home from work, and refrain from having sexual intercourse. 

Try not to stress out too much if you have had an ultrasound during which a fetal heartbeat was detected or your doctor otherwise suggests that your bleeding may well be caused by something other than a miscarriage. Your doctor will tell you to be cautiously optimistic under these circumstances, and you should attempt to follow that advice.

Get back in touch with your doctor immediately if you are experiencing heavy bleeding, severe pain, fever, or dizziness. 

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