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Some Causes and Features of Vaginal Bleeding During Early Pregnancy

Some Causes and Features of Vaginal Bleeding During Early Pregnancy

Cause

Common Features*

Diagnostic Approach†,‡

Pregnancy-related (obstetric) disorders

Sometimes only slight vaginal bleeding

Abdominal or pelvic pain that

  • Is often sudden and constant

  • Begins in a specific spot

  • Is sometimes slight

Usually tenderness when the pelvic examination is done

If the ectopic pregnancy has ruptured, fainting, light-headedness, or a racing heart

A blood test to measure a hormone produced by the placenta (human chorionic gonadotropin, or hCG)

Ultrasonography of the pelvis

Sometimes laparoscopy (insertion of a viewing tube through an incision in the abdomen) or laparotomy (surgery involving an incision into the abdomen)

  • Has occurred or is occurring

  • May occur (threatened abortion)

Vaginal bleeding, sometimes with passage of tissue from the pregnancy

Crampy pain in the pelvis and throughout the abdomen

Sometimes a doctor’s examination alone

Usually tests as for ectopic pregnancy

Fever and chills

Constant, severe abdominal pain,

Often in women who have had an intentional abortion (often done by untrained practitioners or by the women themselves)

Ultrasonography of the pelvis

Cultures of samples taken from the cervix

A uterus that is larger than expected

No heartbeat or movement detected in the fetus (or no fetus)

Sometimes high blood pressure, swelling of the feet or hands, severe vomiting, or passage of tissue that resembles a bunch of grapes

Tests as for ectopic pregnancy

A biopsy if no pregnancy is seen in the uterus

Rupture of a corpus luteum cyst (which develops in the structure that releases the egg after the egg is released)

Abdominal or pelvic pain that

  • Begins in a specific spot

  • Sometimes causes nausea and vomiting

  • Usually begins suddenly

Most common during the first 12 weeks of pregnancy

Tests as for ectopic pregnancy

Disorders unrelated to the pregnancy

Only spotting or slight bleeding

Vaginal discharge

Sometimes pain during sexual intercourse, pelvic pain, or both

Testing for sexually transmitted diseases using samples taken from the cervix

Only spotting or slight bleeding

Sometimes tenderness when the pelvic examination is done, abdominal pain, or both

Testing for sexually transmitted diseases using samples taken from the cervix

Slight bleeding

No pain

Polyps sometimes seen protruding from cervix

A doctor’s examination alone

Follow-up visits to further evaluate the polyps

Injury

A tear in the cervix or vagina

A doctor's examination alone

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

‡ A urine pregnancy test is typically done if women have had only a home pregnancy test. Because an ectopic pregnancy can be very dangerous, tests are done to check for ectopic pregnancy in most pregnant women with vaginal bleeding unless symptoms clearly point to another disorder.