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| |    Bleeding in the First Trimester by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. One of the more frightening yet common experiences in pregnancy is vaginal bleeding. This may vary from a small amount of spotting, to heavy bleeding with clots and cramps. Is it normal to have bleeding in the first trimester? It may not be normal to bleed early in pregnancy, but it certainly is common. First trimester bleeding occurs in about a quarter of pregnancies. Technically, any bleeding in the first half of pregnancy is defined as threatened miscarriage, or (in medical terms) threatened abortion. That said, more than half of the women who have some bleeding in early pregnancy go on to carry the pregnancy forward. If you are having first trimester bleeding, you should let your practitioner know, but waiting for working hours is often okay. It is more urgent to call your practitioner if you have bleeding heavier than a period, severe cramps, lower abdominal pain, or fever. These can be signs of miscarriage or other pregnancy complications such as tubal pregnancy. If these things occur, you need to call even if it is during the night or weekend. Physical examination, ultrasound, and/or your blood level of the pregnancy hormone hCG can be used to see if the pregnancy is okay. What can I do to prevent miscarriage? About one in eight pregnancies ends in miscarriage. The rate is even higher for older mothers or fathers. Unfortunately, most first trimester losses cannot be prevented. Most are caused by fetal chromosomal abnormalities or by abnormal fetal development. If you are having bleeding in the first trimester, discuss your activities with your practitioner. Although bed rest is recommended in some situations, it does not help to prevent first trimester miscarriage. Whether you are going to miscarry or not is already destined. Ultrasound may help identify if the pregnancy is viable (healthy) or destined for loss. Although bed rest is generally not needed, we usually recommend what is euphemistically called "pelvic rest." When there is bleeding, germs can get up into the uterus more easily. Therefore, it is best to put nothing into your vagina until the bleeding has stopped: no douching, no tampons, and no intercourse. You will be able to resume sexual relations when your bleeding has resolved. Discuss activity recommendations with your practitioner.
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