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What are some of the causes of first trimester bleeding?
by Robert James Gallo, MD, FACOG

The first three months of your pregnancy are referred to as the first trimester. Each trimester lasts approximately three months, so there are three trimesters for each pregnancy.

Vaginal bleeding bleeding in pregnancy at any time is a significant event, and you should inform your OBGYN if you experience vaginal bleeding of any kind. As many as one out of every three women will experience vaginal bleeding, so if you do, don't panic. Notify your OBGYN and follow through with the recommendations that are suggested.

There are many reasons for vaginal bleeding during the first trimester, some are serious and significant, some are less serious and pose no threat to the pregnancy. The most benign type of bleeding is called "implantation bleeding". This is bleeding from the site in the uterus where the developing fetus has chosen to implant. It is painless bleeding and occurs often. Your OBGYN will more than likely ask that you restrict heavy activity, and avoid sex. You may also be placed on modified bedrest to increase the chances of a better implantation. Occasionally, an early ultrasound, or sonogram will be ordered to make sure that the pregnancy is proceeding normally. This type of bleeding is also referred to as "threatened miscarriage", since there is always a possibility that the bleeding will increase in severity and that the pregnancy will miscarry. There are no medications or treatments that will make you "hold" a pregnancy. Increased bleeding, passage of clots, and the presence of worsening lower abdominal cramps are signs of impending miscarriage, and must be reported to your OBGYN immediately.

In most cases, with ample restriction of activity, the bleeding episode will pass, and you will be allowed back to full activity again. Sometimes, though, the implantation site will continue to bleed and you may be restricted for longer periods of time.

The progression of bleeding usually associated with more severe cramping may be a warning of an impending miscarriage. The chances of miscarriage in the first trimester are approximately one in five. Some miscarriages are the result of a pregnancy stopping because there might have been an improper combination of genetic material in the fetus. There is also a possibility that the implantation site for the pregnancy in the uterus was not a good one, or that there might be some type of problem within the uterus. These answers are rarely apparent at the time of a miscarriage, but sometimes become obvious afterward when genetics reports and pathology reports are available to your doctor.

I am always saddened by patients who blame themselves for the vaginal bleeding that occurs during the course of a pregnancy. "If only I didn't exercise so much," "If my husband wasn't so insistent on having sex last night," are all unfortunate attempts to explain why vaginal bleeding occurs in pregnancy. It can probably be said with certainly that a pregnancy that is a good pregnancy will not miscarry even in the face of physical activity, and that a pregnancy that is a doomed pregnancy will not be rescued by even total immobilization and bedrest. So why do OBGYN's suggest bedrest when we are informed by our pregnant patients about bleeding ? Consider the fact that the placenta attaches to the uterus with an attachment process that is akin to two pieces of Velcro adhesive. Minimize the movement of the "velcro" and the placenta and uterus stay better attached.

There are, of course, other reasons for bleeding in early pregnancy which are not considered as a threat for the continuation of a pregnancy. Any irritation of the cervix and vagina may produce bleeding. When you are examined by your OBGYN, a thorough inspection of your vagina and cervix with an instrument called a speculum (the same one that is used for Pap Smears) may be done. Hormonal changes in early pregnancy make the vagina and cervix slightly more "delicate" and may produce some light bleeding which may be treated by vaginal creams, or not treated at all.

In summary, vaginal bleeding in the early stages of pregnancy is a fairly common event. You must inform your OBGYN about any bleeding, even light "staining" may indicate a problem and should be respected.

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