What is a threatened miscarriage?
About 20 per cent of pregnant women will experience bleeding in early pregnancy. Although women are often very worried about this, it is not always the sign of a serious problem. However, with bleeding there is a higher chance of miscarriage.
What are the signs of threatened miscarriage?
- Vaginal bleeding which may be fresh red blood, brown discharge or spotting
- Pain in the lower abdomen, often described as cramp-like pain or backache.
What should I do if I have bleeding in pregnancy?
If you have any bleeding and/or pain, you can get medical help and advice from:
- Your GP or midwife
- The Early Pregnancy Assessment Unit (EPAC) (see contact details at the end of the leaflet)
- NHS 111 is available 24 hours a day, and calls are free from landlines and from mobile phones
- The A&E department at your local hospital, particularly if you are bleeding heavily, have severe pain or feel very unwell.
If it is not an immediate emergency, the RVI team will take some information and arrange an assessment. This will likely involve a scan, and possibly an examination or some blood tests.
If your bleeding is not heavy, then they might suggest that you rest at home and wait for your appointment with us.
What investigations are needed for a threatened miscarriage?
A transvaginal ultrasound scan will often be performed to check the pregnancy. This involves inserting a small probe inside your vagina. Your privacy and dignity are maintained at all times. The scan is safe and will not cause additional risk to the pregnancy. You can bring someone with you for support.
Sometimes, especially in very early pregnancies, it is not possible to be sure if the pregnancy is healthy on the first scan and you will be asked to return for a repeat scan and possibly some blood tests. In this circumstance time is needed to see if a heartbeat develops normally. This can be an anxious time but there is nothing that the nurses or doctors can do to speed this up.
We will explain the scan findings to you (and your partner if present) and you will be given the opportunity to ask questions.
What causes a threatened miscarriage?
In most cases it is not possible to be sure about what caused the bleeding. It is possible that it is caused by:
- A vaginal infection
- Cervical bleeding – in pregnancy the cervix (neck of the womb) is more sensitive. Friction through exercise or sex can cause bleeding
- ‘Implantation bleed’ – as the pregnancy attaches to the womb lining, causing some bleeding
- A small blood clot around the amniotic sac (subchorionic haematoma).
Treatment for a threatened miscarriage
We advise for you to rest if you have bleeding in early pregnancy. You should avoid strenuous exercise and avoid sex until the bleeding has settled. We understand that this can be a stressful time, so if time off work is needed, please ask the hospital staff for a ‘sick note’ for your employer.
Progesterone treatment
Studies have shown that women, who are bleeding in early pregnancy and have had at least one miscarriage may benefit from taking progesterone after a viable pregnancy was seen on scan.
Progesterone (drug name Cyclogest or Utrogestan) is taken as vaginal pessaries, 400mg twice daily from when you have a scan showing a normally sited pregnancy until 16 weeks of pregnancy.
The initial prescription will be given to you in the early pregnancy unit. Future prescriptions should be obtained from your GP. If you have any concerns or difficulties, please contact the early pregnancy unit.
Are there any side effects or risks of using progesterone in pregnancy?
The large studies mentioned, found no increase in problems in babies of women taking progesterone compared to women who did not take progesterone.
Common side effects
- Abdominal bloating and pain
- Constipation
- Breast pain
- Tiredness.
Some women may prefer to take the drug rectally (inside your bottom) if it causes vaginal discomfort.
Feelings
A threatened miscarriage can be a very uncertain time, and it is perfectly normal to feel emotional and anxious about the outcome of your pregnancy.
Please remember that we are here to help you. If you have any questions, doubts or worries, please feel free to ask.
Contacts
Useful websites
PALS (Patient Advice and Liaison Service) for help, advice and information about NHS services. You can contact them on freephone 0800 032 02 02, email [email protected].
If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk
You can find accessibility information for our hospitals.
The Miscarriage Association offers support and information to anyone affected by the loss of a baby in pregnancy.
The Ectopic Pregnancy Trust focuses on early pregnancy loss through ectopic pregnancy and provides general information and peer support.
