Early vaginal bleeding during pregnancy can be alarming. When this bleeding occurs before the 20th week of gestation, and the pregnancy is still viable, healthcare providers use the clinical term “threatened miscarriage.” This diagnosis serves as a marker for increased risk, prompting careful evaluation and monitoring.
Defining Threatened Miscarriage and Key Symptoms
A threatened miscarriage is defined by vaginal bleeding or spotting in the first half of pregnancy, most commonly during the first trimester, while the cervix remains closed. A medical evaluation must confirm that the developing fetus still shows signs of life, such as a detectable heartbeat. Bleeding severity varies widely, ranging from light pink or brown spotting to bright red blood that may contain small clots. The bleeding is often accompanied by mild to moderate abdominal or lower back cramping, which is typically dull.
Identifying Potential Causes and Risk Factors
Chromosomal abnormalities in the fetus are the most common cause for miscarriages occurring in the first trimester. Maternal risk factors that increase the likelihood of this complication include advanced maternal age and a history of previous miscarriages. Bleeding can also result from issues with the implantation site, such as a subchorionic hematoma. This condition involves a blood clot forming between the uterine wall and the chorionic membrane, which may indicate a higher risk depending on its size.
Diagnostic Procedures and Medical Monitoring
The diagnostic process begins with a physical examination to assess the status of the pregnancy and rule out other serious conditions. A pelvic examination confirms that the cervix is closed, a defining feature of a threatened miscarriage, and helps exclude other sources of bleeding. Ultrasound imaging, performed either transvaginally or abdominally, is the most important tool for assessing viability. The scan confirms the pregnancy is located inside the uterus and checks for a fetal heartbeat and appropriate growth. Serial quantitative human chorionic gonadotropin (hCG) blood tests monitor hormone levels over a period of days; in a healthy early pregnancy, hCG levels typically double every two to three days.
Management Strategies and Prognosis
Management for a confirmed threatened miscarriage typically involves “expectant management,” focusing on careful monitoring. Healthcare providers often advise patients to engage in pelvic rest, meaning abstaining from sexual intercourse. Reducing strenuous activity is also commonly recommended, though studies have not conclusively shown that strict bed rest alters the outcome. A positive prognosis is strongly associated with the confirmation of a fetal heartbeat during the initial evaluation. While a threatened miscarriage indicates a higher risk of loss compared to asymptomatic pregnancies, the majority of these cases resolve favorably, and the pregnancy continues to term. For patients with a history of recurrent miscarriage, some providers may prescribe progesterone supplementation, as studies suggest it can increase live birth rates in women who present with early pregnancy bleeding.