Bleeding during pregnancy (aka threatened miscarriage), is bleeding in the first 2 trimesters (weeks 0-28), specifically, 24 weeks (i.e seen during pregnancy prior to viability), and has yet to be assessed further.

• Physiological, including:
  • Implantation bleeding, which is spotting within the first 6-12 days after you conceive, as the fertilized egg implants itself in the lining of the uterus
  • Rupture of a small vein on the outer rim of the placenta
• Spotting
• Miscarriage → strong cramps. It has a risk of 24% with heavy 1st trimester bleeding, compared to 12% in pregnancies without any 1st trimester bleeding
• Ectopic pregnancy → pain in the lower abdomen. Commonly in the tube, and may lead to bleeding, internally, that could be fatal if untreated. It is found in 6% with heavy bleeding and an obstetric U/S of pregnancy of unknown location (no visible intrauterine pregnancy)
• Molar pregnancy → rapid enlargement of the uterus
• Vaginal bleeding (see page) for non-pregnant reasons (e.g. STI, sexual intercourse, pap test)
• Gestational trophoblastic neoplasia
• Chorionic hematoma
• Lower genitourinary tract causes, including:
  • Vaginal bleed
  • Cervical bleed

• Hx, including:
  • ABC's/vitals → bleeding
  • Amount of bleeding → spotting may be physiological
  • Pain → less likely to be physiological
• Pelvic exam → cervical dilation → inevitable miscarriage
• U/S → ectopic will show an absence of intrauterine pregnancy

• As a preventative measure, women who are rhesus negative are given prophylactic anti-D, if they are >12 weeks (1st trimester)

• On further Ix, it may be found that the fetus remains viable, and pregnancy continues without further issue
• 50% of those who have a threatened miscarriage, go on to miscarry, and 50% will bring the fetus to term

• Bleeding is common particularly in the 1st trimester, occurring in 20% of women

• APH (>24 weeks)
• PPH (>birth)
• Postmenopausal bleeding (>menopause)
• Vaginal bleeding (category)