First Trimester Bleeding: A common issue

By Dr Rick Robbins

At least 50% of women will have some bleeding in the first trimester, not even including so-called implantation bleeding/spotting around the time you miss your full period.

You should call us if you have 1st trimester bleeding and you’ll be evaluated for sure – although the type of evaluation varies depending on how far along you are.

At < 6 weeks pregnant, we typically draw blood work, including HCG and progesterone, to determine how far along you are in the pregnancy. Once the HCG is proven to be above 2000, we can order an ultrasound. These early ultrasounds are done primarily to rule out an ectopic pregnancy. In these early ultrasounds, we only expect to see a gestational sac to confirm the pregnancy has implanted in the uterus. We will not see a fetus with a heartbeat until just before 6 weeks.

At > 6 weeks, we often do an exam and ultrasound (U/S).

Ultimately, we use U/S to determine if there is a “bad” cause of the bleeding (ectopic or miscarriage) or not. Women who have bleeding, BUT have an U/S that looks normal should continue to be optimistic and follow our advice about activity restrictions. And, we should mention that the prognosis for a good outcome depends more on the gestational age at which you have your U/S than the you might think.

Studies have shown this:

At 6-7 weeks, a good U/S (with or without bleeding) means you have a roughly 85% chance of a successful pregnancy.

At 8-9 weeks, a good U/S (with or without bleeding) means you have a 90-95% chance of a good outcome.

And at 10-12 weeks? A good U/S OR + FHT’s with a fetal doppler provides a 98-99% chance of
a successful pregnancy.

Lastly, if you “read between the lines” you’ll notice very little here about intervention. Why? Most miscarriages occur as a result of problems that we humans cannot control. If you are destined to miscarry, we unfortunately might have to give you bad news about the findings. If you are not destined to miscarry, we get to give that good news.

A patient recently told me our job must be bad because people have miscarriages and we often have to give the bad news. I countered that here on Earth we have plenty of good things – and some bad things – as is true in most phases of life.

Here’s hoping you have no 1st trimester bleeding, but if you do – let us know!