Early pregnancy support

At Monash Women’s, we recognise that pregnancy does not begin at your first antenatal visit at the end of the first trimester. Many women need care for tentative and early pregnancy and Monash Women’s has several channels for support available.

Early pregnancy bleeding

Bleeding is a common event in early pregnancy, but fortunately most pregnancies continue healthily especially if the bleeding is not heavy or painful.

If this happens to you in your first trimester of pregnancy, see your GP in the first instance if the bleeding is mild.

Your GP will confirm the first day of your last period to assess how pregnant you are, confirm your blood group, perform a urine and/or a blood pregnancy test and request an ultrasound to determine if your pregnancy is healthy and if a cause for the bleeding can be identified.

Many women will have a healthy ongoing pregnancy and no further bleeding and can continue on as normal. All women who have a ‘negative’ blood group will need an injection of a medicine called anti-d to reduce the risk of future pregnancy complications.

If there are problems, or the situation is not clear, ask your GP to refer you to the nearest Monash Women’s Early Pregnancy Bleeding clinic. This runs daily at Clayton and Casey hospitals and combines ultrasound examination, blood tests and review by a doctor – this may include a speculum (internal) examination to assess the opening of your womb and amount of ongoing bleeding.

This clinic also takes referrals for women who are not bleeding but have unclear pregnancy diagnoses requiring expert follow up including where the location or health of the pregnancy is not clear (see below – ectopic and uncertain viability).

Once all the information is available, you will be informed regarding the health of your pregnancy and options for care going forwards.

If you have bleeding which is heavy (soaking more than one pad an hour) or painful (with severe cramps) you should attend your nearest Monash Health Emergency Department as emergency care can be provided including rapid miscarriage diagnosis and care if required.

Causes and care of early pregnancy bleeding

In most cases, the cause is not identified and the pregnancy continues without problems.

Threatened miscarriage

In many cases, a small amount of bleeding occurs with the early placenta formation. This is termed a subchorionic haemorrhage and also generally resolves naturally without harm (unless very large).

These types of bleeding are called a ‘threatened miscarriage’. It is important to remember that most threatened miscarriages have a healthy outcome.

Inevitable and missed miscarriage

If the cervix (the opening of the womb) is open when you are examined or ultrasound shows the pregnancy has failed/there is no fetal heartbeat when one would otherwise be expected, miscarriage will occur. If the womb is opening, this is termed an inevitable miscarriage and one diagnosed on ultrasound with no or minimal symptoms is termed a missed miscarriage.

It can take some weeks when the diagnosis is made on ultrasound, your cervix is closed and there is no or minimal bleeding for the miscarriage to occur naturally. Miscarriage is generally relatively quick to happen when the cervix is open and bleeding is heavier.

Waiting is safe as long as you are comfortable and your bleeding is not too heavy and you can usually go home to decide what further care you would like with the support of your family.

Miscarriage treatments

If you are otherwise well there is no urgency in making a decision on how you would like to proceed. Your doctor will talk to you about your options which include waiting for the pregnancy to pass naturally, taking tablets to help the pregnancy pass naturally or having a surgical procedure to empty your uterus (called a suction curette). They all have individual risks and benefits.

It is normal and ok to feel grief for some time at the loss of your pregnancy and it is also important to know that miscarriages are generally caused by ‘bad luck’ where the early pregnancy did not contain the correct genetic information to form a healthy baby and nothing you or your partner have done caused this to occur.

One miscarriage does not place you at increased change of this happening in your next pregnancy and you are safe to get pregnant as soon as you feel ready to do so.

For more information about the causes, care and follow up after a miscarriage:

Ectopic pregnancy

Ectopic pregnancy is an uncommon but important cause of bleeding in early pregnancy. This is where the pregnancy begins to grow outside the womb, most commonly in the fallopian tube which connects the womb to the ovary. This can occur due to damage to the tube from previous infection such as chlamydia or appendicitis or endometriosis but half of the time no cause is readily apparent.

The bleeding is generally light but it is important to have an ultrasound, and make the diagnosis, as an ectopic pregnancy can lead to life threatening bleeding inside the abdomen if it is not treated.

Ectopic pregnancies that are identified before major bleeding occurs have more treatment options and can generally be handled safely by either a one-off injection of medication or a keyhole operation to remove the affected fallopian tube and ectopic.

It is important to remember that in your next pregnancy you should have an ultrasound at six weeks to ensure the next pregnancy is in the womb as there is a ten percent chance of another ectopic.

Pregnancy of uncertain location or viability

In many cases it may not be initially clear if the pregnancy is inside the uterus or outside (ectopic), or if the pregnancy is healthy/ongoing or not ongoing/non-viable.

In these cases your doctor will generally advise regular blood tests and follow up scans to track your pregnancy until the situation is clear and you receive a diagnosis and the care you require.

While this can be stressful for many women, it generally cannot be sped up and it is important to attend your tests so your Monash Women’s early pregnancy team can ensure you are healthy.

Nausea and vomiting

This is a very common early pregnancy symptom and while upsetting, is a reassuring sign your pregnancy is healthy. It occurs at any time of the day and ‘morning sickness’ is a misnomer.

Most women find this symptom starts at around six weeks and begins to ease at the end of the first trimester (14 weeks). It does not affect your baby’s wellbeing except in severe cases.

Most pregnant women will have nausea and vomiting (up to 90 percent), only a minority will have nausea and vomiting that requires hospital admission for intravenous fluids and anti-nausea medication and a smaller minority, around five percent or one in twenty women, will have nausea and vomiting that is severe throughout the entire pregnancy (hyperemesis).

Simple measures to help your symptoms include eating small meals regularly, keeping hydrated, eating crackers before getting out of bed and avoiding strong smells/cooking. Medication is safe if required and your family doctor (GP) is well positioned to be able to help you with this. If you are unable to tolerate food or fluid or your vomiting does not settle with medication, you should attend your nearest Monash Health Emergency Department in the first trimester, or pregnancy assessment unit after 16 weeks for further care.

Constipation and frequent urination

These symptoms are also very common and caused by normal healthy pregnancy changes.

You can safely take most medications to keep your bowels regular, ask your family doctor (GP) or pharmacist for advice.

Frequent urination is not concerning if you have had a urine infection excluded by your family doctor.

Fatigue and food aversions

The hormonal changes of pregnancy also commonly cause easy tiredness (fatigue) and an aversion to particular foods or smells that is often different between women and pregnancies. Take reassurance that these symptoms do pass and they are not harmful, take regular rest and avoid foods and smells that trigger your symptoms.

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