When you see a miscarriage portrayed on television or a film, you often see a woman suddenly overcome with excruciating pain and then collapsing in a pool of blood. In fact, that’s not what happens to most women. Some will have pain, which may be a dull ache or strong abdominal cramps (like bad period pain) or sharp or severe pain (especially if it is an ectopic pregnancy). Some will have very heavy bleeding, while others may have spotting or a brown vaginal discharge. Some will have no symptoms at all and may discover that their pregnancy has ended only when they have a routine ultrasound scan.

Bleeding in pregnancy

Even though bleeding in pregnancy (especially during the first 12 weeks) is often called “threatened miscarriage”, it does not necessarily mean that you will miscarry. Many women will go on to have a healthy pregnancy and a healthy baby.

If you have vaginal bleeding at any time during your pregnancy, it is worth talking first to your GP. S/he may refer you to hospital for an ultrasound scan to try to see whether there is a problem with the pregnancy. Some doctors are less keen to refer for scans in the early weeks of pregnancy – either because it is too early to be able to see even a healthy pregnancy on scan, or because they take a “wait and see” approach.

You may be advised to stay home and put your feet up or stay in bed, or just to go about your normal routine. Whatever you choose to do, it is unlikely to make any difference to the outcome of the pregnancy, so you might just want to do what feels right for you.

You might find this very frustrating and even frightening, especially if you are feeling very anxious as many women (and their partners) do. If it’s your first pregnancy, you may worry because you don’t know what is normal and what isn’t. If you have had a previous healthy pregnancy, you may worry because this pregnancy is not progressing in the same way. And if you have previously lost a baby, you are likely to be particularly anxious because of what happened last time.

We write about ultrasound scans below, but there are three important things for you to know if you bleed in pregnancy:

1. It doesn’t necessarily mean you will miscarry. In a study‡ of women attending an early pregnancy unit because of bleeding, around half of them had on-going viable pregnancies – i.e. they didn’t miscarry.
2. If the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to change this. The only exception might be if the bleeding occurs in the last few months of the pregnancy. So a scan may tell you what is happening, but it won’t change the outcome.
3. If as well as bleeding you have sharp pain in your abdomen (lower tummy) or in your shoulders, then having an early scan may help to detect whether you have an ectopic pregnancy. This is important, as although early treatment won’t save your baby, it can prevent your becoming seriously ill.
   

Pain in pregnancy

As with bleeding, pain in pregnancy doesn’t always mean that there is a problem. Some women feel discomfort as ligaments stretch with the growing baby. Many women experience backache, especially as the pregnancy progresses. And abdominal pain may be due to a stomach upset or constipation. But if you are worried, and especially if you have severe abdominal or one-sided pain or pain in your shoulders, it might be wise to contact your GP and explain what is happening. Similarly, if you have pain when you try to move your bowels (pass a motion), you might also want to ask if you might be referred for an ultrasound scan to rule out the possibility of ectopic pregnancy.

Other symptoms – or lack of…

Most pregnant women have an idea of certain physical changes that are likely to happen in the first few months of pregnancy, for example: nausea, a metallic taste in the mouth, food cravings, fatigue, breast tenderness and changes, a need to go the toilet more frequently.

If you don’t have any of those changes, or if you do and then they suddenly disappear, it does not necessarily mean that you are likely to miscarry. Conversely – and this is confusing – having all of those symptoms doesn’t guarantee that all is or will be well. It can be very difficult to make sense of symptoms or their absence.

‡ Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s, Unpublished dissertation