Dr Suman Bijlani, Gynaecologist, Sonologist, Infertility Specialist, Obstetrician and Laparoscopic Surgeon, Mumbai.

Bleeding in early pregnancy- what to do

What exactly is a miscarriage?

Miscarriage means the spontaneous loss of embryo or foetus before 20 weeks of gestation or when the foetus is less than 500 g weight.



How do I know whether I am having a miscarriage?

You may start bleeding … which may be fresh red blood, brown or black. It may be mild, moderate or heavy bleeding or just a stain on your panty.

Often the bleeding is accompanied by abdominal cramps and pain.

Many times, you may not feel any symptom at all and a routine ultrasound examination may bring bad news.

The nausea, vomiting and food fads of early pregnancy you had earlier may suddenly wane or disappear.

Nonetheless, all bleeding is not miscarriage. Many cases of bleeding in pregnancy can be salvaged.

What is implantation bleeding?

Many women experience mild bleeding (brown, red or black) or spotting at around the time of  the expected period. This bleeding usually passes off within a day or two. It does not harm the baby, but it may alarm the mother or mislead her into believing that she has got her menses.

How do I know if I am at risk for miscarriage?

It is important to note that a majority of the miscarriages happen to women who are completely healthy with no ‘risk factors’. Women with the following conditions are at a higher risk:

  • Women above 40
  • Smokers
  • Drug abusers
  • Alcoholics
  • Previous miscarriages (more than one)
  • Uncontrolled diabetes
  • Thyroid condition
  • Certain infections
  • Defects of the uterus (septum, double or very small uterus)
  • PCOS
  • Endometriosis
  • Large/submucous fibroids
  • Certain auto-immune diseases
  • A condition called thrombophilia (characterised by excessive clotting in the blood vessels)

Women who have had a previous miscarriage, especially more than one miscarriage, are more at risk for a future loss. More the number of previous losses, greater the risk to a future pregnancy (see article on Repeated Miscarriages).

The chance of a woman having a miscarriage increases after the age of 35 and by the time she is 40, she has about 30% risk of losing her baby early in pregnancy.

What signs and tests can help me?

Your doctor is the best judge of that. An ultrasound is the best tool to know the status of your pregnancy. A transvaginal ultrasound (meaning an internal ultrasound) can detect fetal heart rate as early as 5.5 weeks (about 12 days after a missed period). It may be noted that a gentle internal sonography is not harmful to the pregnancy. On the contrary, it is a valuable source of information, especially to rule out a tubal (ectopic) pregnancy.

subchorionic bleed


Serial blood testing of the hormone Beta HCG can tell you whether your pregnancy is growing at a normal rate or not.

Your doctor may recommend many more tests to rule out infections, autoantibodies and certain hormonal deficiencies including diabetes and thyroid condition.

When it occurs, what is the treatment for it?

In most cases of bleeding, supporting the pregnancy with the hormone ‘progesterone’ helps to a certain degree.

In specific medical conditions where the woman is at risk (such as PCOS or previous miscarriages), the doctor would prescribe certain medications (such as hormones or blood thinners) and these decisions are best left to the obstetrician.

Most obstetricians and family members prescribe “bed rest”, but the benefit of bed rest in preventing miscarriage is as yet unproven and at best remains a ‘placebo’ therapy.

Since a majority of miscarriages are unexplained or due to a genetic cause, there are no guarantees of a successful pregnancy outcome. This is a perfect example of one of those medical conditions where “Man proposes, God disposes.”

Can complications occur? What are they?

A miscarriage can occasionally cause heavy bleeding which may threaten the life of the patient and may require immediate hospitalisation and D&C (surgical evacuation or ‘cleaning’ of the uterus). In neglected cases, the womb may get infected. These cases are fortunately relatively rare.

A miscarriage can leave you scarred for a long time, so please do not hesitate to ask for family and medical support and guidance.

How can I prevent a future miscarriage from occurring?

Unfortunately, there is no definite way to prevent an abortion before or during the pregnancy.

However, certain precautions may help:

  • Visit a gynaecologist for pre-pregnancy counselling to prepare you mentally and physically for pregnancy
  • Ingest folic acid daily, starting before pregnancy
  • Eat healthy, wholesome, home food
  • Avoid emotional and physical stress
  • Do not delay pregnancy till a very late age

If you have had a miscarriage before, please visit your doctor before planning the next pregnancy so that he/she may initiate treatment before the pregnancy.

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