When Early Pregnancy Bleeding is a Medical Emergency

Spotting or bleeding during early pregnancy is understandably scary, but also very common. While spotting does not always mean that you are having a miscarriage, it can be a symptom of miscarriage. As a result, upon first sight of vaginal bleeding in pregnancy, or any other miscarriage symptoms, many women drop everything and head to the emergency room. But is this the best course of action?

Why Go to the ER

Some, but not all, doctors advise women to the emergency room if they notice any bleeding in early pregnancy. The reason for this is unfortunately not because immediate care can make a difference in whether the pregnancy miscarries. In fact, by the time vaginal bleeding occurs because of a miscarriage, the developing baby has usually already passed away—often because of unpreventable issues such as chromosomal abnormalities.

Why bother with an emergency room, then, if nothing can be done? A visit to the emergency room is warranted to rule out emergency complications that could threaten the mother. Bleeding can occur for other reasons besides miscarriage, but when it is a sign of miscarriage, emergency room physicians can make sure a woman is not hemorrhaging and does not have an ectopic pregnancy or life-threatening rupture.

When to Go to the ER

Most of the time, the best thing to do if you are experiencing miscarriage symptoms in the first trimester is call your regular medical practitioner's office for guidance. Your OB-GYN will probably ask you to come in for an office visit; they will have access to your medical history and will be best able to determine whether or not you are having a miscarriage through diagnostic tests.

Sometimes, however, going to the emergency room is the best course of action. These include the following situations:

• Unusually heavy bleeding (soaking through a menstrual pad in under an hour)
• Severe abdominal pain on either side of the lower abdomen, or dizziness
• Symptoms of shock, such as agitation, confusion, or bluish lips and fingernails
• Your regular physician has advised you to go to the emergency room

Note that bleeding (not spotting) later in pregnancy could be a sign of placental abruption, which is an emergency and requires immediate medical attention.

How Common Is Miscarriage?

Unfortunately, miscarriage is pretty common among women who have a positive pregnancy test, and rarely an emergency. Estimates of the actual number of miscarriages vary, and the number can be as high as 15% to 20% of known gestations. The percentages of miscarriages in people who don't realize that they're pregnant—are too early along—may be as high as 50%. Most miscarriages occur during the first trimester.

Causes

Many things can lead to miscarriage:

• Genetic (chromosomal) problems with the embryo or fetus
• Trauma
• Infection
• High maternal weight
• Illicit drug use
• Medications
• Diabetes or other medical conditions present in the mother

Often it's impossible to pinpoint the exact cause of miscarriage. Please keep in mind that most miscarriages result from genetic problems in the embryo and fetus and cannot be prevented in any way.

Unfortunately, people who have one or multiple miscarriages are more likely to experience an additional miscarriage.

Although most women who have miscarriage physically recover quickly, the psychological stress of miscarriage can be great, with enduring feelings of sadness, guilt, anger and so forth. If you are experiencing any physical or psychological problems related to miscarriage, please contact your physician immediately.