Merck Manual

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Some Causes and Features of Vaginal Bleeding During Early Pregnancy

Some Causes and Features of Vaginal Bleeding During Early Pregnancy

Cause

Common Features*

Tests

Pregnancy-related (obstetric) disorders

An ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)

Sometimes only slight vaginal bleeding

Abdominal or pelvic pain that

  • Is often sudden and constant (not crampy)

  • Begins in a specific spot

  • Is sometimes slight

Usually tenderness when the pelvic examination is done

If the ectopic pregnancy has ruptured, fainting, light-headedness, or a racing heart

Usually blood tests to measure a hormone produced by the placenta (human chorionic gonadotropin, or hCG)

Ultrasonography of the pelvis

Sometimes laparoscopy (insertion of a viewing tube through an incision in the abdomen) or laparotomy (surgery involving an incision into the abdomen)

A miscarriage that

  • Has occurred or is occurring

  • May occur (threatened abortion)

Crampy pain in the pelvis and often throughout the abdomen

Often vaginal bleeding, sometimes with passage of tissue from the fetus

Tests as for ectopic pregnancy

Septic abortion (infection of the contents of the uterus)

Fever and chills, constant abdominal pain, vaginal discharge that contains pus

Usually in women who have had an intentional abortion (often done by untrained practitioners or by the women themselves)

Tests as for ectopic pregnancy

Cultures of samples taken from the cervix

A hydatidiform mole (overgrowth of tissue from the placenta) or another form of gestational trophoblastic disease

A uterus that is larger than expected

No heartbeat or movement detected in the fetus

Sometimes high blood pressure, swelling of the feet or hands, severe vomiting, or passage of tissue that resembles a bunch of grapes

Tests as for ectopic pregnancy

Rupture of a corpus luteum cyst (which develops in the structure that releases the egg after the egg is released)

Abdominal or pelvic pain that

  • Begins in a specific spot

  • Sometimes causes nausea and vomiting

  • Usually begins suddenly

Most common during the first 12 weeks of pregnancy

Tests as for ectopic pregnancy

Disorders unrelated to the pregnancy

Vaginitis (inflammation of the vagina, often due to infection)

Only spotting or slight bleeding

A vaginal discharge

Sometimes pain during sexual intercourse, pelvic pain, or both

A doctor’s examination to rule out other causes

Cultures of samples taken from the cervix

Cervicitis (infection of the cervix)

Only spotting or slight bleeding

Sometimes tenderness when the pelvic examination is done, abdominal pain, or both

A doctor’s examination to rule out other causes

Cultures of samples taken from the cervix

Polyps (fingerlike growths) in the cervix, which are usually benign

Slight bleeding

No pain

Polyps sometimes seen protruding from cervix

A doctor’s examination

Follow-up visits to further evaluate the polyps

Injury

A tear in the cervix or vagina

Possibly due to a procedure such a amniocentesis

A doctor's examination

*Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

A urine pregnancy test is typically done if women have had only a home pregnancy test. Because an ectopic pregnancy can be very dangerous, tests are done to look for ectopic pregnancy in most pregnant women with vaginal bleeding unless symptoms clearly point to another disorder.