Symptoms of Miscarriage

Bleeding and pain are the most common symptoms of a miscarriage; however, the symptoms differ from person to person and can occur at any time after a missed period. The amount of bleeding and pain varies and is more likely to increase when the pregnancy is further along (in number of weeks).

In some cases, for example, in missed miscarriage, there are no symptoms of miscarriage; it may only be discovered that a pregnancy has ended during a routine ultrasound examination.

Bleeding is often noticed when going to the toilet as a staining of brown, pink or red blood loss on the toilet paper. The bleeding can range from brown vaginal discharge or light pink spotting, to bright red and heavy bleeding with or without clots. Some people experience very heavy bleeding, a situation that may require hospitalisation.

Bleeding

At home, there may be times when you notice increased bleeding. This may occur when you stand up or go to the toilet. This is due to the pooling of blood in the vagina from lying down, which then becomes noticeable upon standing due to gravity.

If the bleeding is very heavy, i.e., you need to change a sanitary towel (pad) that has filled with blood clots every 15 minutes for over an hour (or 4 soaked pads in the course of 1 hour), you need to go to the Emergency Room in CUMH. 

Some will experience pain associated with their miscarriage. The level of pain can vary, ranging from a dull ache to strong abdominal cramping. Many women describe it as a strong period pain, but others experience much more severe pain. This pain may or may not be associated with vaginal bleeding. You might also experience dizziness due to this pain and/or the level of bleeding.

If the pain is very severe, and not responding to over-the-counter pain relief such as paracetamol or ibuprofen, you may need to go to the Emergency Room in CUMH.

Pain

Causes of Vaginal Bleeding in Early Pregnancy

Vaginal bleeding in early pregnancy is very common, affecting 20-40% of pregnancies. It is not always possible to give an explanation as to why bleeding occurs in early pregnancy. If an ultrasound scan of the pregnancy shows a heartbeat between 7 to 8 weeks, there is an 85-97% chance of the pregnancy continuing as normal.

The most likely causes of bleeding in early pregnancy are:

The implantation site: As the pregnancy itself attaches to the uterus (womb), it may cause some blood vessels of the uterus to bleed.
The cervix (neck of the uterus): During pregnancy, tissues become rich in blood supply and soften. Any slight trauma to the cervix can provoke bleeding. Sometimes an unusual area of tissue on the cervix can also cause bleeding.
The vagina: Thrush or infection can cause the vagina to become inflamed, and bleeding may occur in the form of spotting.
Miscarriage: This can be a threatened miscarriage, an incomplete miscarriage or a complete miscarriage. More information on each type of miscarriage can be found here.

CUMH Bleeding in Early Pregnancy Leaflet

What You Should Do If You Think You Are Having a Miscarriage

If you are concerned, you should go to your GP (General Practitioner). However, know that it is not always possible to get a conclusive diagnosis right away. The GP might first ask you some detailed questions about your menstrual cycle and timing of your first positive pregnancy test, and they might do a blood test. This may be followed by a physical examination.

Depending on your symptoms and on how far along (how many weeks) in the pregnancy you are, the GP may not be able to make a diagnosis and may refer you to the Early Pregnancy Unit (EPU) or the Emergency Room in CUMH. This referral may take days, or weeks.

It is possible that your GP might not be available to see you. If this situation, another option is to contact the Emergency Room in CUMH for advice.

You should go immediately to the Emergency Room if:

Your pain is severe
Your bleeding is especially heavy - i.e., you need to change a sanitary towel (pad) that has filled with blood clots every 15 minutes for over an hour (or 4 soaked pads in the course of 1 hour)
You are feeling weak or dizzy
You have severe abdominal pain that is not relieved by painkillers
You have a high temperature
You feel very unwell.

It is advisable to bring someone with you to the hospital.