A Referral is required for this type of Appointment! Please consult with your Physician.
EARLY PREGNANCY BLEEDING
Up to 50% women have bleeding in the first few months of pregnancy. This can make you worried that you are miscarrying, which can be really upsetting when you have been trying to get pregnant.Many times, early pregnancy bleeding is just a sign of the pregnancy attaching to the uterus. It stops by itself in a few days, and the pregnancy continues normally.
Sometimes, it does mean that the pregnancy is miscarrying. This can be either that the sac has formed to hold the embryo, but no embryo forms (anembryonic pregnancy). It can also mean that the pregnancy may have died (fetal demise).
How can I find out if the bleeding is okay?
Do I need blood work?
Yes. When you bleed in early pregnancy, it is really important that we know your blood type. Even if you have had a pregnancy in the past, we will take a blood test in this pregnancy to be sure of your blood type. If you are Rh negative, we recommend WinRho, an injection of an immune globulin, within 72 hours of the bleeding.
What about hormone testing?
Pregnancy hormones, called b-HCG or “beta HCG” are the ones that turn the urine pregnancy test positive. The amount of hormone can be measured in a blood test. Sometimes this might be useful to monitor the pregnancy, especially when the results of the ultrasound are ambiguous. In the first 9 weeks of pregnancy, the hormone level doubles every 24-48 hours. If the level does not increase, or drops, it may be another sign of miscarriage.
Do I need treatment?
Possibly. If the pregnancy is confirmed as not viable, and a miscarriage is inevitable, it may pass on its own without medical intervention. Sometimes women may opt for medication (misoprostol) or surgery (D&C) to pass the pregnancy tissue. We will advise you about this.
Miscarriages are common; about 1/6 pregnancies stop growing and miscarry. Usually it does not mean there is anything wrong with the woman or increase her risk of a second miscarriage.
We offer medical or surgical treatment of miscarriages. Most miscarriages can happen naturally without any treatment but sometimes it can take a long time. Miscarriages are usually more painful than a period, and you may need a prescription for pain medications. We strongly recommend using NSAIDs such as ibuprofen. In Canada, it is advised to check your blood type when you have a miscarriage. If you are Rh negative, you should have WinRho when the bleeding occurs, or within 72 hours. We can do the test and provide WinRho if needed.
Medication: We provide instructions and a prescription for misoprostol which causes the uterus to contract and expel the pregnancy tissue. Some women get side effects for a few hours such as fever, chills, diarrhea, headache or vomiting. We always check afterwards to make sure all the tissue is gone because with either a natural miscarriage (no treatment), or a medically managed miscarriage there is a 5-10% chance of having retained tissue that needs further treatment. You cannot resume ovulation and trying again for a pregnancy until all the pregnancy tissue is gone. We will always arrange a follow up ultrasound at the clinic to check.
Surgery: we do dilation and curettage (D&C) at the clinic or at the hospital. We use local anaesthetic (freezing) and IV sedation. You can request a general anaesthetic. The procedure is very safe. There is less than 1% chance of infection or complications requiring a second procedure. There is about 1/100,000 chance of a serious reaction to the medications used or any damage to the uterus.