Pain and bleeding in early pregnancy

Introduction

Who this leaflet is for?

Women who have experienced abdominal pain and/or bleeding from the vagina with:

• a pregnancy confirmed on a urine or blood test
• last menstrual period within the last 14 weeks.

What could the problem be?

Many women experience some pain and/or vaginal bleeding during early pregnancy. In many cases they will continue to have a healthy pregnancy. However, sometimes these symptoms can be a sign that something is wrong. The two main concerning causes for pain and bleeding in early pregnancy are:

• miscarriage 
• ectopic pregnancy.

Miscarriage is the loss of a pregnancy that is up to 24 weeks old. It is, unfortunately, very common; roughly one in five pregnancies will end in miscarriage. 

Ectopic pregnancy is when a pregnancy settles and begins to grow outside of the uterus (womb). The most common site for this is along the fallopian tube (between the ovary and uterus). This is less common (one in 100 pregnancies). It can be dangerous if not recognised. 

Non-pregnancy related causes of abdominal pain are still common during pregnancy. These include: urine infections, constipation, diarrhoea and muscular aches and pains.

What treatments are available to me?

You may need to be seen in A&E if you are bleeding very heavily or in severe pain. Otherwise, you can attend the Early Pregnancy Unit (EPU) on weekdays from 09:00 -12:30 and 14:00-15:00 for an ultrasound scan. This is an emergency service and no appointment is necessary. The wait you experience will depend on how many patients attend that day, but can be up to six hours. 

We have a limited service on the weekend between 09:00 - 12:30, for women who have attended A&E for initial review first. 

There are two types of ultrasound scans, known to be safe in pregnancy: 

• Transvaginal ultrasound (where a small probe is inserted inside the vagina). This scan is more accurate in early pregnancy.
• Transabdominal ultrasound (where the probe is placed on the abdomen).

A scan aims to tell us two things:

• the location of the pregnancy (i.e. to check that it’s not ectopic)
• whether it is healthy.

Frequently, it takes more than one scan to answer these questions. This will be explained after your first scan.

Progesterone hormone-containing vaginal pessaries will be offered to you if a pregnancy that could potentially be healthy is seen on scan, you are bleeding, and you have a history of miscarriage. This will be discussed further if relevant to you. 

What should I expect when I go home?

It is likely you will continue to experience some pain and/or bleeding. You can take paracetamol for pain relief, but avoid ibuprofen in pregnancy. 

In which situations should I come back to A&E?

You need to come back to A&E if:

• your pain becomes severe 
• you develop pain in the tip of your shoulder (this can be a sign that there is bleeding inside the tummy)
• your bleeding becomes very heavy, and unmanageable
• you feel weak, breathless or faint.

If your bleeding gets heavier, but it is still manageable at home, you do not necessarily need to return to A&E, as unfortunately we cannot prevent a miscarriage from happening. You could instead can call the EPU for advice +/- a scan on the next working day, if it is safe to wait.

Where can I get more information?

The Miscarriage Association: www.miscarriageassociation.org.uk
The Ectopic Pregnancy Trust: https://ectopic.org.uk

Contact details

On weekdays you can contact the EPU on 020 344 76515 (09:00-17:00). You should leave a message so we can return your call. Outside of these times for urgent advice you can contact NHS 111 or go to A&E if you have concerns. 

How to find our department

The EPU at UCLH is based on the Lower Ground floor in the Elizabeth Garrett Anderson Wing. Follow signs to Clinic 3.