Bleeding during the first months of pregnancy is usually innocent, and there are various possible causes. In case of bleeding during the start of a pregnancy, in over half the cases it is not a miscarriage. The bleeding will stop automatically.
Bleeding during the start of your pregnancy
A common and innocent cause of bleeding during the early stages of your pregnancy is the implantation of the fertilised egg into the uterus. Increased circulation of your uterus (cervix) can also cause bleeding, this usually happens after intercourse or after (hard) bowel movement, and is not harmful for the pregnancy. More rare causes are a polyp, a uterus infection (such as chlamydia), or an ectopic pregnancy. In the latter case, bleeding often occurs in combination with intense stomach pains. Bleeding indicates a miscarriage in no more than half the cases.
A miscarriage is the loss of an (early) pregnancy. There are different kinds of miscarriages, depending on the phase of the pregnancy during which the miscarriage occurs. In case of a very early miscarriage, the growth has already stopped early in the pregnancy, and no embryo has developed. During this stage, the ultrasound will only show the amniotic sac. If the miscarriage occurs a little later, the growth will have continued, and the embryo will be visible. However, the embryo will not have any heart activity, and it is usually smaller than indicated by the pregnancy duration. These forms of miscarriage can go unnoticed.
In case of fierce cramps, which can be compared to contractions, and bright red bleeding with clots, the chance that the pregnancy will end in a miscarriage is significant. Once the foetal tissue has left the uterus, the pain and the bleeding will stop.
A miscarriage cannot be stopped or prevented. The cause of a miscarriage is almost always a deviation in chromosomes that usually originates when the egg is fertilised. This will disrupt the development of the embryo, so that it cannot keep growing and will be disposed.
Vaginal bleeding and menstruation-like cramps can be the first signs of an impending miscarriage. Fortunately, about half the women who experience bleeding do not have serious problems, and the pregnancy will continue without complications. Pregnancy symptoms, such as tight breasts and morning sickness, will usually decrease right before a miscarriage.
Chance of a miscarriage
A miscarriage is relatively common. It occurs in 1 in 10 pregnancies. The chance of a miscarriage increases with age. If you have a miscarriage once, it does not mean that you will have a higher risk of a miscarriage during your next pregnancy
Once a miscarriage has been determined and you have not started bleeding yet, you can wait for things to take their natural course, or you can be referred to the gynaecologist.
Waiting for things to take their natural course is not dangerous, after a while your body will get the miscarriage started and you will start bleeding. However, it is not possible to predict how fast or when this will happen. This can be emotionally taxing. That is why it is also possible to be referred to a gynaecologist to remove the pregnancy. There are two possible methods: with tablets (misoprostol) to trigger the miscarriage, or with a curettage, which is a small procedure to remove the tissue from the cervix. We will discuss the advantages and disadvantages of the options with you, and decide on the best option.
After the miscarriage
The physical recovery after a spontaneous miscarriage or a curettage is usually fast. For 1 or 2 weeks there can be some bleeding and/or brown discharge. The next menstruation cycle will start after about 4-6 weeks. For a lot of women (and their partners too), this is an emotionally taxing time. Feelings of guilt, grief, disbelief, anger, and a sense of emptiness are common feelings after a miscarriage. Everyone deals with a miscarriage in their own way, including the time it takes to emotionally process a miscarriage. When you and your partner are ready for a new pregnancy and you get pregnant, we will plan an early ultrasound with you, around 6-8 weeks in. It is not dangerous to get pregnant again right after your miscarriage.