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Unfortunately, about one in four pregnancies ends in miscarriage. It is usually difficult to know the exact cause, but it is important to know that it is very unlikely to have happened because of anything you did or didn't do.

Once a pregnancy starts to miscarry, there is rarely anything that can be done to stop it. In some cases the womb empties itself completely, but not always. In these cases a doctor may suggest that you have a small operation called to empty your womb.

You may be offered the option of treatment with pills (medical management), or of having no treatment at all. You may choose to let the miscarriage happen naturally, although this process may take some time. However you decide to manage your miscarriage should you need one, our compassionate staff will be there to support you.

What is a threatened miscarriage?

An ongoing pregnancy associated with vaginal bleeding is called a threatened miscarriage.

The first symptoms are usually vaginal bleeding with or without mild period type pain. The bleeding can occur at any time after a missed period.  It is often noticed when going to the toilet as a smear of pink, brown or red loss on the toilet paper.

The amount of bleeding may vary from just spotting to a gush with clots.

The diagnosis of threatened miscarriage is made with the help of an ultrasound scan.  At 6 weeks of pregnancy the ultrasound scan will be able to visualise your tiny baby and the scan will also show a heartbeat, particularly if it is a vaginal scan.

Sometimes the scan may show up a small haematoma (blood clot) around the pregnancy sac, which identifies the source of the bleeding, but more often nothing abnormal is seen.

It is not possible to give an explanation as to why this bleeding occurs. In most cases the pregnancy continues safely. The baby will come to no harm even if the bleeding is heavy.

Some likely causes of bleeding may be:

• The implantation site - As the placenta of your baby tries to burrow itself into the lining of the womb, it may cause some blood vessels to bleed.
• The cervix - During pregnancy, tissues become rich in blood supply and softer as a result of this any slight trauma to the cervix can provoke bleeding.
• The vagina - Thrush or any other infection may cause bleeding from the inflamed vagina in the form of spotting.

A baby's heartbeat on ultrasound is reassuring. In the presence of a heartbeat there is an 85-97% chance of your pregnancy continuing.

Follow-up

If a collection of blood around the sac is seen on ultrasound you will be advised that you may experience further bleeding. It might be that we suggest a rescan in 1-2 weeks. Sometimes the area of bleed may well be absorbed into the lining of the womb with no further bleeding experienced.

Often there is no recognisable cause of bleeding found and the bleeding you are experiencing settles with no further problems. However you may contact the clinic if you have any further anxieties.

Bed rest

Although bed rest was routinely advised in the past for threatened miscarriage it has since been recognised that this will not affect your pregnancy outcome. There is no specific treatment to stop your bleeding. Although we do not recommend strict bed rest we suggest you take it easy and do what you feel is best for you.

Work

Again this will depend on what type of employment you have. You may wish to take time off while you are actively bleeding, especially if it is more than just spotting. If you have been off sick for more than a certain length of time (usually more than 7 days) you will need to get a doctor’s from your GP.

Further bleeding

If your bleeding increases and you are concerned, do not hesitate to call the early pregnancy unit (EPAU) for advice.

Sexual intercourse

Having sex during pregnancy does not cause any known adverse outcomes, however if you are bleeding then you may wish to avoid sex until the bleeding has stopped.

Blood grouping

It is not routinely recommended before 12 weeks gestation. However women over 12 week’s gestation experiencing a threatened miscarriage should be given anti-D immunoglobulin. Where bleeding continues after 12 weeks gestation, Anti-D should be repeated every six weeks.